Last reviewed by Editorial Team on August 13th, 2018.
- What is Graves’ Disease?
- Graves Disease Symptoms
- Graves Disease Causes
- Heart difficulties
- Bones that are brittle
- Thyrotoxic crisis
- Graves Disease Diagnosis
- Physical exam
- Blood sample
- Uptake of radioactive iodine
- Graves Disease Treatment
- Beta blockers
- Anti-thyroid drugs
- Treatment with radioactive iodine
- Surgery to decompress the orbital
- Surgery of eye muscle
- Radiotherapy of orbit
What is Graves’ Disease?
This is the most common form of hyperthyroidism which develops when the immune system incorrectly attacks the thyroid gland causing the thyroid gland to produce too much of the hormone thyroxine. Any higher level of thyroxine will increase the body’s metabolic rate and this can affect the human body in many ways – from mood swings to physical looks.
Graves’ disease is not in most cases fatal. It can develop at any age and in both male and female. It is most common in females and normally starts after the age of twenty years.
At this time, there is no way to halt the immune system from this attack on the thyroid gland, but the symptoms can be managed with the reduction of thyroxine.
Graves Disease Symptoms
Symptoms of Graves’ disease can include:
- Sleeping problems
- Irregular or rapid heartbeat
- Tremor of the fingers or hands that is very fine
- Perspiration increase
- Weight loss
- Heat sensitivity
- Hair that is brittle
- Enlargement of thyroid gland referred to as goiter
- Bowel movements that are frequent
- Menstrual cycle changes
With Graves’ disease it is common for the eyes to show signs of Graves’ ophthalmopathy. With this condition, there is the bulging out of eyeballs from the protective orbit. This happens because the muscles as well as the tissues behind the eyes swell causing the eyeballs to move forward. Since the eyes can be pushed forward so very far, the surface of the eyes can come to be dried out.
Graves’ ophthalmopathy can cause the following mild symptoms and signs:
- Inflamed or reddened of the eyes
- Excess tearing of the eyes
- Sensation of sand or grit in either one or both eyes
- Space between eyelids widens
- Tissues swelling as well as the lids around the eyes
- Sensitivity to light
The following are less often symptoms and signs from Graves’
- Corneal ulcers
- Limited eye movement
- Double vision
- Reduced or blurred vision
One very infrequent sign of Graves’ disease is the skin swelling and reddening, often on the shins as well as the top of the feet – known as Graves’ dermopathy.
An individual should see their physician if they have any of the symptoms which are suggestive of Graves’ disease:
- Enlarged thyroid
- Eyes that protrude
- Loss of weight
- Heat intolerance
It is advised to seek emergency medical care if they experience heart-related symptoms or signs, such as an irregular or rapid heartbeat.
Graves Disease Causes
It is not known what causes Graves’ disease. When functioning normally the immune system uses natural proteins referred to as antibodies and white blood cells or lymphocytes to help eradicate bacteria, viruses as well as foreign substances or antigens that attack the body.
But with Graves’ disease, the immune system erroneously attacks the thyroid gland with an antibody referred to as thyrotropin receptor antibody or TRAb which motivates the thyroid gland to produce extreme amounts of thyroid hormone.
The hormones produced by the thyroid gland manage the activities of the body – from metabolism to digestion and everything in between. Thyroxine is the hormone produced and excessive amounts of this hormone causes problems with all the different functions of the body.
Even though the cause of Graves’ disease is not known, medical researchers theorize that a combination of factors can determine the likelihood of any individual developing this condition. The factors include:
- Family history of Graves’ disease
- Age – normally develops after age 20
- Sex – females are more prone to develop Graves’ disease than males
Excess amount of thyroid hormone due to Graves’ disease can lead to a number of complications or problems such as:
Bones that are brittle
Hyperthyroidism left untreated may lead to brittle and weak bones or osteoporosis. Too much thyroid hormone hinders the body’s capacity to combine calcium into the bones and the bones depend on calcium and other minerals to maintain their strength.
Graves’ disease can place an individual at risk for what is referred to as thyrotoxic crisis – which is an abrupt increase in the symptoms and signs leading to rapid pulse, fever and in some cases delirium. This is a rare complication but if it does happen, immediate medical care is needed.
Graves Disease Diagnosis
In order to make a diagnosis of Graves’ disease, the physician will normally use the following procedures:
The physician will check the eyes to look for protrusion or irritability as well as check to see if the thyroid gland is enlarged. The physician will also check for increases in pulse or blood pressure and look for signs of any tremor.
The physician will also order blood tests to define the level of “thyroid stimulating hormone” or TSH as well as thyroxine. With Graves’ disease, there is an atypical antibody referred to as TRAb which imitates TSH, creating an elevated thyroxine level while the TSH levels remains low. It is this low level of TSH combined with high levels of thyroxine that leads to the diagnosis of Graves’ disease.
Uptake of radioactive iodine
The body uses iodine in order to produce thyroxine. By introducing a small amount of radioactive iodine and measuring later the amount of it in the thyroid gland, a physician is able to define the rate of iodine usage. High uptake indicates Graves’ disease while low uptake indicates some other reason for the hyperthyroidism.
Graves Disease Treatment
There is not any treatment to stop the body’s immune system from creating the antibodies that cause Graves’ disease. In order to manage the signs of symptoms of Grave’ disease, therapy is intended to lessen the creation of thyroxine or to block its production all together. Treatments for Graves’ disease include:
These types of medications include propranolol or Inderal, metoprolol or Lopressor, atenolol or Tenormin as well as nadolol or Corgard. They offer relieve of hyperthyroid symptoms such as nervousness, tremors as well as rapid heart rate. The body will still produce an abundance of thyroxine but the beta blockers will block the effect of the excessive thyroid hormone.
These medications which include propylthiouracil and methimazole stop the thyroid from creating excessive amounts of hormones. Normally management with this type drugs lasts for over a year.
Treatment with radioactive iodine
In order to make thyroid hormone, the body requires iodine. By taking iodine that is radioactive, the radioactivity collects in the thyroid gland and therefore destroys the overactive thyroid cells.
For those that don’t endure anti-thyroid drug, surgical removal of the thyroid gland – thyroidectomy – is another option. After surgery, the individual will need thyroxine therapy in order to maintain the body’s normal amount of thyroid hormones. With this surgery, there is a risk of injury to the vocal cords as well as the parathyroid gland.
If the individual’s eyes are affected, mild symptoms are usually managed with artificial tears during the day and lubricating gels at night. If eye symptoms are severe, the physician might recommend:
Therapy with prescribed corticosteroids, for example prednisone, can reduce any swelling behind the eyeballs.
Surgery to decompress the orbital
With this surgery, the physician removes any bone between the eye socket and the sinuses. This can provide more room for the eye to move back to the normal position.
Surgery of eye muscle
With this surgery, the physician will cut the muscle at the point where it is attached to the eyeball and then reattach it futher back in the orbit.
These correct any double vision from the Graves’ disease or that occurs as a side effect of any surgery.
Radiotherapy of orbit
This is used to extinguish tissue behind the eyes especially if the eye problems worsen and any medication alone is not well tolerated or effective.