Graves' disease
Basics
Graves' disease is a condition in which the thyroid gland makes too much thyroid hormone (hyperthyroidism). It is usually easy to treat and the prognosis is good, although life-long observation by a physician will be required Figure 01.
Graves' disease, named after the Irish doctor who first described the illness, is the most common type of hyperthyroidism. It is also referred to as “diffuse toxic goiter”.
The thyroid is the butterfly-shaped organ situated at the base of the throat. It secretes two hormones (thyroxine and triiodothyronine, also called T4 and T3) that regulate the speed at which the body converts food and oxygen into energy (metabolism). In Graves' disease, the gland goes into overdrive and makes too much hormone, increasing the body's metabolic rate by as much as 60% to 80%. The consequences of a racing metabolism range from weight loss and lighter periods (in women) to serious health concerns such as heartbeat irregularities and osteoporosis.
Figure 01. Glands of the endocrine system
The thyroid is the butterfly-shaped organ situated at the base of the throat. In Graves' disease, the thyroid gland goes into overdrive and makes too much hormone, increasing the body's metabolic rate by as much as 60% to 80%.
Causes
Graves' disease results when the body's immune system attacks the thyroid gland.
The immune system normally guards the body against infections and cancer by making special proteins called antibodies. In Graves' disease, the blood cells that perform this task (lymphocytes) produce antibodies against proteins on the surface of thyroid cells. This stimulates the thyroid gland to secrete too much thyroid hormone, and the gland becomes enlarged.
Symptoms
An overactive thyroid gland can produce a host of symptoms that can be mistaken for other things.
In fact, it is easy for people to blame weight loss, fatigue, and insomnia on stress when Graves' disease is the true culprit. Nervousness, irritability, trembling, sweating, and muscle weakness are other common symptoms of an overactive thyroid gland. In some patients, skin becomes delicate and hair falls out. In premenopausal women, menstrual flow may lighten or stop altogether. More dangerous manifestations include heart palpitations and osteoporosis, which can lead to brittle bones that break easily.
A painless bulge in the throat (goiter) is a telltale sign of a thyroid problem.
People with Graves' disease often have bulging, watery eyes, and may experience vision problems such as double vision or blurry vision Figure 02.
Figure 02. Bulging, watery eyes characteristic of Graves' disease
Though rare, Graves' disease can produce a thick, red rash on the front of the shins Table 01.
Table 1. Symptoms of Graves' Disease
| Nervousness, irritability, anxiety |
| Muscle weakness, fatigue |
| Increased appetite, weight loss despite normal eating |
| Sweating, shaking, heart pounding |
| Hair loss or thinning |
| Light or no menstrual flow |
| Goiter, bulging eyes |
| Vision disturbances (blurred or double vision) |
| Skin rash |
Risk Factors
Having a family member with Graves' disease or another similar disease in which the body attacks itself (autoimmune disease) increases the risk for developing Graves' disease.
Increased iodine intake in a person predisposed to Graves' disease seems to play a role in triggering the disease.
Stress is thought to trigger Graves' disease in some people.
Some patients report that symptoms began during or just after emotionally difficult times in their lives, such as caring for a sick family member, a divorce, losing a loved one, or severe financial problems. Research also reveals a link between elevations in stress hormones like cortisone and adrenaline and increased antibody production by the immune system.
Women are more prone to developing all types of thyroid problems, including Graves' disease.
About 2% of women in the U.S. have hyperthyroidism at some time, compared to 0.4% of men. The condition usually strikes during the middle age, but may occur earlier in life.
Diagnosis
Graves' disease is a condition in which the thyroid gland makes too much thyroid hormone (hyperthyroidism). It is usually easy to treat and the prognosis is good, although life-long observation by a physician will be required Figure 01.
Graves' disease, named after the Irish doctor who first described the illness, is the most common type of hyperthyroidism. It is also referred to as “diffuse toxic goiter”.
The thyroid is the butterfly-shaped organ situated at the base of the throat. It secretes two hormones (thyroxine and triiodothyronine, also called T4 and T3) that regulate the speed at which the body converts food and oxygen into energy (metabolism). In Graves' disease, the gland goes into overdrive and makes too much hormone, increasing the body's metabolic rate by as much as 60% to 80%. The consequences of a racing metabolism range from weight loss and lighter periods (in women) to serious health concerns such as heartbeat irregularities and osteoporosis.Figure 01. Glands of the endocrine system
The thyroid is the butterfly-shaped organ situated at the base of the throat. In Graves' disease, the thyroid gland goes into overdrive and makes too much hormone, increasing the body's metabolic rate by as much as 60% to 80%.
Graves' disease results when the body's immune system attacks the thyroid gland.
The immune system normally guards the body against infections and cancer by making special proteins called antibodies. In Graves' disease, the blood cells that perform this task (lymphocytes) produce antibodies against proteins on the surface of thyroid cells. This stimulates the thyroid gland to secrete too much thyroid hormone, and the gland becomes enlarged.
An overactive thyroid gland can produce a host of symptoms that can be mistaken for other things.
In fact, it is easy for people to blame weight loss, fatigue, and insomnia on stress when Graves' disease is the true culprit. Nervousness, irritability, trembling, sweating, and muscle weakness are other common symptoms of an overactive thyroid gland. In some patients, skin becomes delicate and hair falls out. In premenopausal women, menstrual flow may lighten or stop altogether. More dangerous manifestations include heart palpitations and osteoporosis, which can lead to brittle bones that break easily.
A painless bulge in the throat (goiter) is a telltale sign of a thyroid problem.
People with Graves' disease often have bulging, watery eyes, and may experience vision problems such as double vision or blurry vision Figure 02.
Figure 02. Bulging, watery eyes characteristic of Graves' disease
Though rare, Graves' disease can produce a thick, red rash on the front of the shins Table 01.
Table 1. Symptoms of Graves' Disease
| Nervousness, irritability, anxiety |
| Muscle weakness, fatigue |
| Increased appetite, weight loss despite normal eating |
| Sweating, shaking, heart pounding |
| Hair loss or thinning |
| Light or no menstrual flow |
| Goiter, bulging eyes |
| Vision disturbances (blurred or double vision) |
| Skin rash |
Having a family member with Graves' disease or another similar disease in which the body attacks itself (autoimmune disease) increases the risk for developing Graves' disease.
Increased iodine intake in a person predisposed to Graves' disease seems to play a role in triggering the disease.
Stress is thought to trigger Graves' disease in some people.
Some patients report that symptoms began during or just after emotionally difficult times in their lives, such as caring for a sick family member, a divorce, losing a loved one, or severe financial problems. Research also reveals a link between elevations in stress hormones like cortisone and adrenaline and increased antibody production by the immune system.
Women are more prone to developing all types of thyroid problems, including Graves' disease.
About 2% of women in the U.S. have hyperthyroidism at some time, compared to 0.4% of men. The condition usually strikes during the middle age, but may occur earlier in life.
If your doctor suspects that you have an overactive thyroid gland, he or she will take your medical history and perform a physical examination.
Goiter and a fast pulse are signs of hyperthyroidism. If you have warm, velvety skin, bulging eyes, and trembling fingertips, this too will alert your doctor to the possibility of an overactive thyroid. He or she will ask you if anyone in your family has had a thyroid problem or another autoimmune disease such as diabetes to get a better idea if your hyperthyroidism is genetic.
Blood tests can reveal a thyroid gland that is working too quickly.
A simple blood test can confirm hyperthyroidism. If your thyroid gland is overactive, your blood test will show high levels thyroid hormones and low levels of another hormone, called thyroid-stimulating hormone (TSH). In an attempt to determine the nature of your hyperthyroidism, your doctor may wish to measure the level of thyroid-stimulating antibodies in your blood. High levels reveal immune system involvement, which is indicative of Graves' disease.
A scan of your thyroid gland can show if your entire thyroid gland is involved, which is characteristic of Graves' disease.
Because a thyroid problem is not always obvious, regular screening is advised.
The American Thyroid Association recommends that all adults get their thyroids checked once every five years, starting at age 35. If you have a known thyroid problem, thyroid disease in your family, or other risk factors such as an autoimmune illness like diabetes, you should be screened more frequently. A simple blood test is all that is required.
Prevention and Screening
Because a thyroid problem is not always obvious, regular screening is advised.
The American Thyroid Association recommends that all adults get their thyroids checked once every five years, starting at age 35. If you have a known thyroid problem, thyroid disease in your family, or other risk factors such as an autoimmune illness like diabetes, you should be screened more frequently. A simple blood test is all that is required.
Treatment
Contact your doctor if you are experiencing any of the symptoms of hyperthyroidism.
Untreated hyperthyroidism can lead to serious health problems, such as heartbeat abnormalities and osteoporosis.
Your doctor is the best source of information on the drug treatment choices available to you.
The majority of people with hyperthyroidism are treated with radioactive iodine.
This treatment is administered orally. Once in the bloodstream, radioactive iodine travels to the thyroid gland, which takes up iodine readily. The radiation damages some of the thyroid tissue, shrinking the swollen gland and, in some cases, rendering it underactive. Radioactive iodine is not dangerous, is eliminated from the body via urine, and is transformed into a nonradioactive form. The treatment cures hyperthyroidism, but frequently results in permanent hypothyroidism—a disorder in which the thyroid gland that does not produce enough hormones. In such cases, thyroid hormones need to be every day for life.
Surgically removing the thyroid gland is another way to cure hyperthyroidism.
Surgery is reserved for patients with a disfiguring goiter that is not likely to be helped by other treatments. The surgical option is sometimes used by pregnant women or women who are trying to conceive. The operation is safe, although there is a small risk of injury to the glands near the thyroid (parathyroid glands) and vocal cords.
As with the radioactive iodine treatment, the remaining thyroid tissue is not sufficient, so thyroid replacement hormones are necessary.
Exercise, meditation, and mind-body techniques might ease some hyperthyroid symptoms, but these should not be used in place of standard medical treatment. Be sure to consult your doctor when using any additional therapies.
If you are diagnosed with Graves' disease during a pregnancy, be sure to get your thyroid problem under control and have your baby's thyroid function evaluated.
Thyroid-stimulating antibodies can cross the placenta, stimulate the baby's thyroid gland, and cause thyroid gland enlargement (goiter).
While Graves' disease is easy to treat and responds well to therapy, people with Graves' can experience hypothyroidism (an underactive thyroid gland) as a complication of treatment.
Sometimes patients experience a crisis, or "storm," which is a severe worsening of symptoms.
Regardless of which method is used to cure your hyperthyroidism, it is possible that you will develop an underactive thyroid gland and need to take replacement thyroid hormone.
Because radioactive iodine and surgical treatment damage the thyroid gland, the chances that your gland will become underactive or inactive are high. Therefore, you should be monitored with yearly blood tests. If you produce too little thyroid hormone, your doctor will prescribe a thyroid replacement hormone preparation, which you will have to take this medication every day for the rest of your life.