Graves’ disease

Graves’ Disease Definition

Graves’ disease also called toxic diffuse goiter or Flajani-Basedow-Graves disease is an autoimmune disease that causes overproduction of the thyroid hormone resulting in hyperthyroidism. Since thyroid hormones affect a number of organs and body functions, this disease by and large concerns and influences the overall well-being of a person. It can affect anyone though it is more common among women below the age of 40.

Graves’ Disease Symptoms

The common symptoms of this disease are the following

• Irritability and anxiety
• Fine tremor in the hands or the fingers
• Sensitivity to heat, increased perspiration and warm, moist skin
• Unusual weight loss despite regular normal eating habits
• Enlargement of the goitre or thyroid gland
• Erratic change in menstrual cycle
• Reduced libido or erectile dysfunction
• Frequent unexplained bowel movement
• Irregular or rapid palpitations
• About 30 percent people have Graves’ opthalmopathy where muscles and tissues around the eyes are affected and it comes with symptoms like bulging eyes (exophthalmos),gritty sensation in the eyes, pain and pressure in the eyes, retracted or puffy eyelids, red and sore eyes, sensitivity to light, double vision and loss of vision
• Another rare manifestation is Graves’ dermopathy where the skin reddens and thickens mostly on the shins and the top of feet.

Graves’ Disease Risks

The risk factors that contribute to Graves’ disease are the following –

• A history of Graves’ disease in the family makes one more susceptible to this condition
• Women are more prone to developing this condition than men
• This disease typically develops in people less than the age of 40
• Those with other autoimmune disorders like Type 1 diabetes or rheumatoid arthritis have a higher susceptibility
• Those with emotional or physical stress are genetically more susceptible
• Pregnancy or recent childbirth increases the risks for those women who are genetically susceptible
• Compulsive smoking

Graves’ Disease Diagnosis

The diagnosis of Graves’ disease includes the following

• A physical examination by the doctor to check for irritated and protruded eyes, an enlarged thyroid gland, and pulse and blood pressure to look for tremor signs because of an increased metabolism
• Blood tests to check levels of thyroid-stimulating hormone(TSH), pituitary hormone and thyroid hormones, and the antibody that causes the disease
• Radioactive iodine scan to check the uptake and patterns of how much iodine the thyroid gland takes up
• An Ultrasound is particularly useful for those who cannot undergo a radioactive iodine uptake like pregnant women. This checks if the thyroid gland is enlarged.
• If clinical assessments do not give a clear picture, the doctor will run an imaging test such as CT scan or MRI

Graves’ Disease Treatment

The primary aim of treatment is to bring down the overproduction of thyroid hormones and the severity of symptoms. The following are some of the treatments –

• Radioactive iodine therapy where a small amount of radioiodine is given orally to destroy the hyperactive thyroid cells by shrinking them and suffocating symptoms gradually. This therapy comes with the side effect of temporary rise in thyroid hormones, tenderness in the neck and risk of new or acute symptoms of Graves’ opthalmopathy which is mild and temporary. This therapy may not be recommended if the eye problems are moderate to severe or for pregnant or nursing women. Post treatment, the patient may have to restore the body to normal thyroid hormone balance.
• Anti-thyroid medications to interfere the thyroid’s use of iodine or as a supplemental treatment before or after radioiodine therapy. Possible side effects include rash, joint pain, liver failure or a drop in the disease fighting white blood cells.
• Beta blocker medications to block the hormonal effect on the body. They may provide instant relief from irregular heartbeats, tremors, anxiety or irritability, low tolerance of heat, perspiration and muscle weakness. These medications are not recommended for those with asthma as it may trigger an attack or complicate matters for those with diabetes.
• Thyroidectomy or subtotal thyroidectomy surgery is an option for those with this disease where all or a part of the thyroid is removed. Potential risks include potential damage to the vocal cords and the tiny parathyroid glands which control calcium levels in the blood. Post-surgery, the body will require treatment for normal amounts of thyroid to be restored.
• Graves’ opthalmopathy can be treated with OTC artificial tears during the day and lubricating gels at night and medical supervision if conditions worsen. Corticosteroids will be prescribed to treat swollen eyes behind the eyeballs.
• The problem of double vision may be due to the disease or as a result of the surgery. Prisms in glasses correct this problem.
• Orbital decompressions surgery in case of a possible loss of vision due to pressure on the optic nerves. In this surgery, the bone between the eye socket and sinuses is removed to give more room to the eyes to move back to their original position and the only complication seems to be double vision.
• If eye problems worsen, the doctor may recommend Orbital radiotherapy targeted at the eye muscles.