Graves Disease: Symptoms, Diagnosis and Treatment
Author: Disabled World : Contact: disabled-world.com
Published: 2009-05-16 : (Rev. 2018-03-16)
Synopsis and Key Points:
Graves disease is a common form of hyperthyroidism and causes hyperthyroidism which causes the thyroid glands to produce excessive amounts of hormones.
A person's immune system uses antibodies and white blood cells to kill bacteria, viruses and foreign substances that enter their body. Persons with Grave's disease have an immune system that mistakes their thyroid gland as an enemy, although their immune system does not destroy their thyroid gland. Instead an antibody called, 'Thyrotropin Receptor Antibody (TRAb) is produced, stimulating their thyroid and making it produce increased amounts of thyroid hormone. A combination of factors such as the person's age, stress, environmental factors, and heredity may all contribute to development of Grave's disease - although doctors are not sure of the exact causes of the disease. There is no one particular gene that causes the disease.
Graves' disease, also known as toxic diffuse goiter and Flajani-Basedow-Graves disease, is an autoimmune disease that affects the thyroid. Grave's disease is the most common of all forms of hyperthyroidism and is named after Sir Robert Graves who first described it in the early nineteenth century. The disease is the leading cause of hyperthyroidism, which causes a person's thyroid glands to produce excessive amounts of hormones.
Grave's disease is also known as, 'Diffuse Thyrotoxic Goiter.' A person's thyroid gland is located in the front of their neck, right below their voice box, and is an important organ of their endocrine system. The thyroid gland produces hormones that include Thyroxine (T4), as well as Triiodothyonine (T3), that control their body's metabolism. Metabolic control is important in regulating things such as physical and mental energy, mood, and weight. Symptoms of hyperthyroidism may include irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea, and weight loss.
Symptoms of Grave's Disease
Grave's disease is common in women over the age of twenty, although it may affect people of any age as well as men. Grave's disease affects eight times as many women as it does men, often between the ages of twenty and forty. The disease can affect a number of parts of the human body, to include the eyes, skin, lungs, hair, nails, nervous system, muscles, bones, digestive system, and reproductive system. If Grave's disease is left untreated it may even result in the death of the person who has it. While the symptoms of the disease can be uncomfortable, the disease itself usually does not have any long-term negative health consequences if a person with it gets both prompt and appropriate medical attention. Sometimes, Grave's disease even goes into remission, or disappears completely after a number of months or years.
When a person's body produces too much thyroid hormone it may lead to various complications, some of the most serious of which involve the person's heart. Rapid heart rate, atrial fibrillation, and congestive heart failure are among complications of untreated Grave's disease and hypothyroidism. Untreated hypothyroidism may also lead to osteoporosis, or a condition known as, 'Thyrotoxic Crisis,' which is a sudden intensification of signs and symptoms that lead to a fever, rapid pulse or delirium. For these reasons it is highly important to seek appropriate treatment for Grave's disease. Symptoms of Grave's disease can include:
- Brittle hair
- Weight loss
- Double vision
- Sensitivity to heat
- Muscle weakness
- Increased appetite
- Increased sweating
- Eyeballs that stick out
- Difficulty concentrating
- Menstrual irregularities
- Eye irritation and tearing
- Breast enlargement in men
- Rapid or irregular heartbeat
- Frequent bowel movements
- Shortness of breath with exertion
- Restlessness and difficulty sleeping
- Enlargement of thyroid gland (goiter)
Person's with Grave's disease may experience something referred to as, 'Grave's Opthalmopathy,' a condition that causes their eyeball to bulge outward past its orbit. The condition is also known as, 'Exophthalmos,' and happens as the muscles and tissues behind the person's eye swell, causing the eye to move forward. Persons with Grave's disease who smoke are more likely to experience eye problems. Grave's opthalmopathy can present symptoms that include:
- Double vision
- Excess tearing
- Light sensitivity
- Ulcers on the cornea
- Limited eye movements
- Blurred or reduced vision
- Reddened or inflamed eyes
- Sensation of grit in either or both eyes
- Widening of the space between the eyelids
- Swelling of the lids and tissues around the eyes
Very few persons with Grave's disease experience Grave's opthalmopathy. Of those who do experience Grave's opthalmopathy, the severity of Grave's disease they have itself has no bearing on the eye problem the person has, or the extent to which their eye will protrude. Doctors are unsure at this point if the complication is truly connected to Grave's disease, or if it is a closely-linked, yet separate disorder. In severe cases of Grave's opthalmopathy, a person's eye muscles may put enough pressure on their optic nerve to lead to partial blindness; this is very rare. A person's eye muscles may also become weakened by extensive periods of inflammation, leading to loss of eye movement control or double vision.
Another rare symptom that persons with Grave's disease may develop is a skin condition referred to as, 'Pretibial Myxedema.' The condition presents lumpy, reddish thickening of the person's skin in front of the tibia. The condition is not serious and is usually not painful. The skin condition is also something that doesn't start at the same time as Grave's disease; neither does it correlate with the severity of Grave's disease.
Diagnosing Grave's Disease
In order to make a diagnosis of Grave's disease, a doctor looks for several things. A doctor examines a person's personal and family medical history, and performs a physical examination. During the physical examination, the doctor looks for any enlargement of the person's thyroid gland, the presence of tremor, or a rapid pulse, any bulging of the person's eyes, or other symptoms of Grave's disease. The doctor may order some blood testing to assess the person's thyroid function.
The blood tests a doctor may order can help them to determine levels of thyroid-stimulating hormone (TSH) and thyroxine the person is producing. TSH is produced by the pituitary gland, and is the hormone that stimulates the person's thyroid. Person's with Grave's disease produce an antibody called, 'TRAb,' that mimics TSH and causes elevated thyroxine levels. If the person being tested has low levels of TSH and high levels of thyroxine, their doctor may diagnose them with Grave's disease. A doctor may also order a, 'Radioactive Iodine Uptake,' test.
The Radioactive Iodine Uptake test involves administration of a small amount of radioactive iodine to the person's thyroid gland. The iodine is measured at a later time by the doctor in order to determine the rate at which their thyroid takes up iodine. This is important because a person's body requires iodine to make thyroxine. Persons who have a high uptake of radioactive iodine are producing too much thyroxine; this indicates Grave's disease.
Treating Grave's Disease
There are a number of treatment options related to Grave's disease, it is a disease that responds well to treatment. Unfortunately, treating Grave's disease with either radioactive iodine or surgery commonly results in hypothyroidism. Incorrect dosages of thyroid hormone replacement and hypothyroidism may lead to weight gain, depression, as well as physical and mental sluggishness. At this time there is no treatment that will stop a person's immune system from producing antibodies which cause Grave's disease. Instead, medical treatment focuses on controlling the signs and symptoms of the disease; they are designed to decrease the amount of thyroxine produced, or block its action. Treatment for Grave's disease can include:
Anti-Thyroid medications may include Methimazole or Propylthiouracil. Anti-thyroid medications may work faster than radioactive iodine therapy, although they do not work immediately. The medication can also be used along with radioactive iodine treatment. Anti-thyroid medication can present side-effects such as joint aches, liver issues, itching, rashes, and a low white blood cell count.
Beta blockers are medications that are used to relieve signs and symptoms of hyperthyroid such as nervousness, tremors, and rapid heart rate. Beta blockers are many times used along with other forms of treatment for Grave's disease.
Radioactive Iodine Treatment:
Radioactive Iodine treatment collects in a person's thyroid gland, and over time destroys over-active thyroid cells, causing the person's thyroid gland to shrink. Problems the person experiences gradually lessen over a period of several weeks to several months. The side-effects are often both temporary and mild, but radioactive iodine therapy is not recommended for persons with severe eye problems. Persons who receive radioactive iodine treatment many times require thyroxine treatment later to give their body needed amounts of thyroid hormones.
Surgery is an option for persons who are unable to tolerate anti-thyroid medications and choose not to receive radioactive iodine treatment. Surgery removes the person's thyroid gland, requiring them to receive thyroxine treatment in order to supply their body with amounts of thyroid hormones. Risks associated with this surgery include potential damage to the person's parathyroid glands, or their vocal chords. A person's parathyroid glands produce a hormone which controls the level of calcium in their blood.
Treatment of Grave's Opthalmopathy that is mild can involve the use of artificial tears applied during the day, with application of lubricating gels at night. For persons who experience symptoms that are severe, treatment options include medications, eye muscle surgery, orbital decompression surgery, or the use of prisms in the person's glasses.
Medications used in treatment of Grave's opthalmopathy may include corticosteroids that can diminish the swelling behind their eyes.
Eye Muscle Surgery:
Eye muscle surgery involves cutting the muscle where it attaches to the person's eyeball, then re-attaching it at a place farther back. Occasionally, more than one surgery is needed in order to meet this objective.
Orbital Decompression Surgery:
Orbital Decompression Surgery involves removal of the bone between the person's eye socket and their sinuses, giving their eyes room to return to their original position. One of the potential complications of this surgery is double-vision; another involves lip numbness.
Prisms may be used in a person's glasses if they experience double-vision due either to Grave's disease itself, or because of a side-effect of surgery for the disease. Prisms work for some, although not for everyone.
- The thyroid gland is a bow-tie shaped gland, located in the neck, that is involved with many bodily functions.
- The thyroid gland regulates things like weight, mental energy, mood, and physical energy.
- In Graves disease the thyroid gland becomes over-active and produces much more T4 and T3 than the body needs.
- Graves disease is has a genetic constituent and is found one-fourth of the time in identical twins.
- Graves' disease occurs in about 0.5% of people.
- It occurs about 7.5 times more often in women than men.
- Graves' disease often starts between the ages of forty and sixty.
- Graves' disease is the most common cause of hyperthyroidism in the United States (about 50% to 80% of cases).
- The condition is named after Robert Graves who described it in 1835.
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