What is that?
Graves' disease is a disorder of the immune system that causes the thyroid gland to become overactive. This is an autoimmune disorder, which means the immune system mistakenly attacks the body's own cells instead of protecting them from outside attackers. In Graves' disease, the immune system makes abnormal chemicals called immunoglobulins that stimulate the thyroid gland to make too much thyroid hormone. This overactive thyroid status is called hyperthyroidism.
Doctors do not know what causes Graves' disease, but the fact that he tends to run in families suggests that the disease may have a genetic component (inheritance). It is possible that the production of abnormal immunoglobulin is triggered by several unknown factors in the environment, and the immune system fails to stop this overproduction due to the inherited defect.
Graves' disease affects women more than men. It most often strikes between the ages of 20 and 40 but can occur at any age.
- Graves' disease can cause the following symptoms:
- Emotional swing
- Shake hands
- Unexplained weight loss (often an increase in appetite)
- Sensitivity to warm temperatures (feels hot all the time)
- Muscle weakness
- Hard to breathe
In women, menstrual periods may become less frequent or stop completely. In the elderly, especially people with heart disease, this disease can cause heart failure or chest-related heart pain called angina.
Graves' disease can also cause:
Mumps - Goiter is a swelling in the lower front of the neck caused by an enlarged thyroid gland.
Eye Symptoms - Graves' disease can cause swelling of tissue around the eyes, which creates a typical "gazing" or "fear" look. The eyes protrude and the eyelids appear to be pulled back. Some are not blinking. The person may have double vision, itching and crying.
Skin symptoms - Rarely, there may be swelling of the legs and lower legs. The skin in this swollen area may appear thicker and darker than normal skin, and may be itchy.
Your doctor will look for physical evidence of Graves' disease, including mumps, eye marks and skin marks. She will also ask you about weight loss, nervousness, recent vibration, increased sweating, palpitations, unusual bowel movements, menstrual irregularities and whether you feel hot all the time.
During your physical exam, your doctor will feel your thyroid for abnormal nodules (bumps) and to see if it is enlarged. She may also use a stethoscope to listen for signs of abnormal blood flow near your thyroid gland. In other parts of your body, your doctor will check for additional signs of hyperthyroidism, including rapid heartbeat, irregular heart rhythm, hand tremors, rapid reflexes when tendons are tapped with soft hammers, and prominent eyes.
Your doctor will order a blood test to determine if your thyroid is producing and releasing too much of the hormone. If your doctor looks at potential eye problems, he or she may scan your magnetic resonance imaging (MRI) scan. If your doctor considers your heart involved, electrocardiogram (EKG) and / or other heart tests may be needed.
Almost all patients with Graves care need, at least initially. Symptoms associated with high levels of circulating thyroid hormone will rapidly improve with drugs such as beta blockers and sedatives. It takes several weeks for the action of anti thyroid drugs to lower normal blood thyroid levels. Anti-thyroid drugs are continued for at least one year unless other treatments are used.
There is no way to prevent Graves' disease.
Treatment focuses on two purposes: to quickly improve the symptoms of hyperthyroidism, and slow the production of thyroid hormone thyroid.
Symptoms of palpitations, increased heart rate, tremors and nervousness are treated with beta-blocker drugs such as propanolol (Inderal). For anxiety and insomnia, your doctor may prescribe diazepam (Valium), lorazepam (Ativan) or similar drugs.
To stop the thyroid from producing too many hormones, there are three possible treatments: antithyroid drugs, radioactive iodine, and surgery.
Graves' disease is most often treated with methimazole anti thyroid medication (Tapazole, generic version). Metimimazol inhibits thyroid hormone formation. Other anti-thyroid drugs called propylthiouracil are also available. However, it should only be used in patients who can not tolerate methimazole and in women before and during their first trimester of pregnancy. Once your thyroid hormone levels are normal, you and your doctor can decide whether to continue daily anti-thyroid treatment or to opt for radioactive iodine treatment.
Radioactive iodine is given by mouth. Most specialists recommend a dose large enough to stop the thyroid completely producing thyroid hormone. You then have to take thyroid medication every day for the rest of your life. Because people who receive radioactive iodine therapy temporarily store a small amount of radiation in their thyroid, they need to avoid prolonged contact with pregnant women and children for several days after treatment. Radioactive iodine is concentrated in breast milk and women should stop breastfeeding if they choose this therapy.
Surgery for Graves' disease is rarely done today. However, people with very large goitre tend not to respond well to anti-thyroid drugs or radioactive iodine, and may have better results if most of the thyroid gland is removed surgically (called a subtotal thyroidectomy).
Graves' eye disease sufferers may be given eye drops to keep the eyes moist and glasses in order to protect the eyes from sun, wind and dust. In people with severe eye symptoms, glucocorticoid drugs may be necessary, either alone or in conjunction with radiation treatments to the muscles that control eye movements. Graves' skin disease symptoms can be treated with glucocorticoid creams and ointments.
While Calling Professional
Call your doctor if you have symptoms of hyperthyroidism, including:
- Continuous anxiety
- Difficulty sleeping
- Discomfort sweating or unusual at warm temperatures
- Palpitations, shortness of breath, or chest pains
- Losing weight, despite normal appetite or increased
- Muscle weakness or waste
Many patients persist after one anti-thyroid drug, but recurrence can occur at any time. Radioactive iodide is very effective, but it often results in abnormally low levels of thyroid hormone (hypothyroidism). Surgery can also cause low levels of thyroid hormone.
The signs of Graves' eye disease tend to improve with anti-thyroid medication. However, some elements of the look that stare at it often remain.