Graves’ Disease: Not Grave but still Serious
01/26/2012 | 10:17 AM
Graves’ Disease: Summary and Overview
Graves’ disease takes its name from Sir Robert Graves’ a renowned Irish surgeon who first described the disease in the early part of the 19th century. Graves’ disease is an immune system disorder that causes an overactive thyroid gland. Your thyroid gland located at the base of the neck. It regulates your metabolism, which influences dietary habits, energy levels, mood swings, thinness of skin and thickness of bones, and others aspects of your physiology and psychology. Graves’ disease is not fatal, and treatment is a matter of lifestyle changes to manage the symptoms, drugs, surgery and other treatments.
Graves’ Disease: Cause
Graves' disease is an autoimmune disorder, i.e. it is caused by a dysfunction in the body's immune system. With Graves’ disease, for reasons that aren’t yet understood, the body produces too much of the thyrotropin receptor antibody (TRAb). The antibody TRAb overrides normal regulation of the thyroid. This result in the overproduction of thyroid hormones.
If the body makes too much thyroid hormone, the condition is called hyperthyroidism. (An underactive thyroid leads to hypothyroidism.) Graves’ Disease is the most common cause of hyperthyroidism in the United States.
Graves’ Disease: Symptoms
The thyroid gland controls how quickly the body uses energy, makes proteins, and controls how sensitive the body is to other hormones. This influences many physiological factors, including:
- Mood Swings: irritability, mood swings and anxiety are symptoms of the condition.
- Big Appetite: people with Graves’ Disease often eat more than people with a normal metabolism.
- Increased bowel movements: frequent bowel movements are a common symptom of the condition. Diarrhea can occur but it is rare.
- Weight loss: people with Graves’ Disease may find themselves losing weight despite great appetites and a higher than average caloric intake.
- Body temperature: the body tends to run hotter than average with the condition.
- Muscle strength: a weakened muscle mass is one of the symptoms of Graves' Disease.
- Menstrual cycle: irregular periods are a symptom.
- Thin hair and others: Graves’ Disease can cause thin hair, thin skin thickness, and lower bone density leading to more frequent fractures and breaks.
- Higher heart rate: a rapid heart rate and accompanying nausea are symptoms.
About 25-30% of people with Graves' disease will also suffer from Graves' ophthalmopathy. This is a protrusion of one or both eyes.
The exact cause of Graves' ophthalmopathy is not well understood. However, it appears that the same antibody that can cause thyroid dysfunction may also have an "attraction" to tissues surrounding the eyes. The antibody activity triggers inflammation that results in the protruding ophthalmopathy and lid retraction of Graves' ophthalmopathy.
Graves’ Disease: Diagnostic Tests
In general doctors diagnose Graves’ disease by asking you a serious of questions and doing a physical exam. Because Graves’ disease increases your metabolism, your doctor will check your pulse and blood pressure. He or she will also look at your eyes to see if they are irritated or bulging and check if your thyroid is enlarged. Because Graves’ disease can develop slowly, over a period of number of years, and because its symptoms are common to a number of other diseases, it can take years for a person with Graves’ disease to be correctly diagnosed.
In addition, your doctor may do a number of the following tests:
- Blood sample. Your doctor may order blood tests to determine your levels of thyroid hormones. People with Graves' disease usually have lower than normal levels of thyroid-stimulating hormone (TSH) and higher levels of thyroid hormones.
- Radioactive iodine uptake. Your body needs iodine to make thyroid hormones. Your doctor may give you a small amount of radioactive iodine and measure how quickly your thyroid takes it up with a special camera. A high uptake of radioactive iodine indicates your thyroid gland is overproducing hormones.
- Thyroid scan. A thyroid scan shows how and where iodine is distributed in the thyroid. In Graves' disease, the entire thyroid gland is involved so the iodine shows up throughout the gland. Other causes of hyperthyroidism such as small lumps in the gland will show a different iodine pattern.
Graves’ Disease: Treatments
Graves' disease is treated by slowing the production of thyroid hormones and blocking its effect of the hormones on the body.
Some treatments include:
- Radioactive iodine therapy: With this therapy, you take radioactive iodine, or radioiodine, orally. The thyroid uses iodine to produce hormones so it takes up the radioiodine. The radioactive chemical destroys the overactive thyroid cells over time. This causes your thyroid gland to shrink, and your condition heals over several months. Most people become hypothyroid (slow metabolism) after taking radioactive Iodine for Graves' disease. If this occurs, you will have to take thyroid replacement medication for the rest of your life.
- Anti-thyroid medications, such as methimazole (Tapazole) or propylthiouracil interfere with the thyroid's use of iodine to produce hormones. After you begin treatment, it may take several months for hyperthyroid symptoms to subside. This is because the thyroid has already generated and stored enough hormone to keep it circulating at elevated levels.
- Beta-blockers: Drugs such as atenolol (Tenormin), propranolol (Inderal), and metoprolol (Lopressor), are frequently prescribed to treat heart disease and high blood pressure. And they are used to lessen the heart palpitations and muscle tremors that characterize Graves' disease.
- Surgery: In cases where Graves’ Disease has caused your eyes to bulge or the lids to retract, your doctor may recommend eye surgery.
Graves’ Disease: Prevention
Since the causes of Graves’ Disease aren’t completely known, preventing the condition is hard. Genetic factors are important, but not determinative for predisposition to Graves' disease. Severe emotional stress is also thought to play a role in triggering the disease. Leading a well balanced life with regular exercise, time for friends and family, and a good diet will help remove this trigger, as well as improve your overall well-being.
Graves’ Disease: Conclusion
Graves’ Disease is an autoimmune disorder that leads to the overproduction of thyroid hormones. It is not fatal but can impact many aspects of your mental and physical health. Treatment is generally done through radioactive iodine.