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Graves’ disease is an autoimmune disorder characterized by the immune system attacking the thyroid gland, a small gland located in the neck. The cause of this immune response is still unknown. The thyroid gland plays a vital role in regulating metabolism by releasing hormones. When affected by Graves’ disease, the thyroid gland becomes overactive, leading to a condition called hyperthyroidism. Although the condition can affect anyone, it is more commonly observed in women and individuals under 40 years old.
The symptoms of Graves’ disease can vary widely and affect different body systems. Common signs include rapid heartbeat, weight loss, anxiety, irritability, and trembling hands. Other possible symptoms include bulging eyes, sensitivity to heat, fatigue, and muscle weakness. The severity of symptoms can differ from person to person.
The primary goal of treating Graves’ disease is to reduce the excessive production of thyroid hormones and alleviate symptoms. Treatment options may include medication to regulate hormone levels or inhibit hormone synthesis. In some cases, radioactive iodine therapy or surgery to remove part or all of the thyroid gland may be necessary. The treatment plan may vary depending on factors such as the individual’s overall health, age, and the severity of the condition. Regular monitoring and follow-up are essential to manage the disease effectively.
Symptoms
The signs and symptoms of Graves’ illness typically appear gradually over a period of weeks or months. The following are common Graves’ disease signs and symptoms:
- Anxiety and nervousness
- Palpitation or irritability
- Tremor of the hands or fingers
- Sensitivity to heat
- Unexplained weight loss or increase appetite
- Goiter, an enlarged thyroid gland
- Menstrual cycles changes
- Erectile dysfunction or reduced libido
- Diarrhea or frequent bowel movements
- Fatigue or muscle weakness
- Sleep disturbance or insomnia
- Hair loss or texture change
Graves’ ophthalmopathy: Also known as orbitopathy or thyroid eye illness. About 30% of Graves’ disease patients exhibit some Graves ophthalmopathy symptoms. Muscles and other tissues around the eyes are affected by inflammation and other immune system activities in Graves’ ophthalmopathy. Some warning signs and symptoms include:
- Puffy or swelling of the tissue around the eyes
- Bulging eyes
- Gritty sensation or irritation in the eyes
- Pressure or pain in the eyes
- Inflamed eyes or redness
- Sensitivity to light
- Double vision or blurred vision
- Vision loss
Graves’ dermopathy: Graves’ disease can sometimes lead to a less common condition known as Graves’ dermopathy, characterized by the thickening and reddening of the skin. This typically occurs on the lower legs, specifically the shins or the tops of the feet.
If you notice any signs or symptoms related to Graves’ disease, it is important to consult your doctor promptly for an accurate diagnosis, as various medical conditions can produce similar effects. In case you experience heart-related indications like a fast or irregular heartbeat, or if you encounter vision loss, it is crucial to seek emergency medical care.
Causes
Autoimmune diseases like Graves’ disease have an unknown cause. Thyroid-stimulating immunoglobulin (TSI), an antibody, is produced excessively by the immune system as a result of some triggering factors. Thyroid hormone production is increased when TSI binds to healthy thyroid cells.
Normally, the immune system makes antibodies that are intended to attack a particular virus, bacteria, or other foreign object. For unknown reasons, the immune system creates an antibody against a portion of the cells of the thyroid gland, a gland in the neck that produces hormones, in Graves’ disease.
A hormone produced by the pituitary gland, a small organ near the base of the brain, normally controls thyroid function. Thyrotropin receptor antibody (TRAb), an antibody that is associated with Graves’ disease, functions similarly to the regulating pituitary hormone. In other words, TRAb interferes with the thyroid’s normal regulatory system, resulting in hyperthyroidism, or the overproduction of thyroid hormones.
Graves’ ophthalmopathy is caused by an accumulation of certain carbohydrates in the muscles and tissues behind the eyes; the exact reason for this accumulation is unknown. The tissues surrounding the eyes may be attracted by the same antibodies that can lead to thyroid disease.
When hyperthyroidism first manifests, or a few months later, Graves’ ophthalmopathy frequently follows. However, ophthalmopathy signs and symptoms might manifest years before or after the onset of hyperthyroidism. Even without hyperthyroidism, Graves’ ophthalmopathy might still manifest.
Risk factors
Graves’ illness can affect anyone, however a number of factors can make it more likely to occur, such as:
- Family history: The presence of a family history of Graves’ disease increases the risk of developing the disorder, indicating the involvement of one or more genes that may make individuals more susceptible to this condition.
- Age: People under the age of 40 typically get Graves’ disease. However, it can also affect children and older individuals.
- Sex: Graves’ disease predominantly affects women, making them more prone to developing the condition than men.
- Smoking: The risk of Graves’ disease is heightened by cigarette smoking, which can impact the immune system. Smokers with Graves’ disease also face an elevated risk of developing Graves’ ophthalmopathy.
- Pregnancy: Pregnancy or recent childbirth can elevate the risk of developing Graves’ disease, especially in women with genetic predisposition for the disorder.
- Other autoimmune disorders: There is a higher risk for people with various problems such type 1 diabetes, lupus, celiac disease, or rheumatoid arthritis.
- Emotional or physical stress: In individuals with genetic predisposition, stressful life events or illness can potentially serve as triggers for the development of Graves’ disease.
Diagnosis
The following procedures may be conducted by a healthcare provider to diagnose Graves’ disease:
- Physical examination: The healthcare provider will perform a physical examination and look for any Graves’ signs and symptoms. They will also talk about thyroid disease’s medical and family history.
- Imaging tests: The healthcare provider may request specialized imaging tests, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), if the diagnosis of Graves’ disease cannot be determined by a clinical evaluation.
- Ultrasound: Ultrasound is a medical imaging technique that utilizes high-frequency sound waves to create visual representations of internal body structures. This non-invasive procedure is particularly effective in detecting enlargement of the thyroid gland. It serves as a valuable alternative for individuals who cannot undergo radioactive iodine uptake, such as pregnant women.
- Blood tests: Blood tests are useful in assessing thyroid function by measuring levels of thyroid-stimulating hormone (TSH) and thyroid hormones. In the case of Graves’ disease, a condition characterized by an overactive thyroid, TSH levels are typically lower than normal while thyroid hormone levels are higher. Although diagnosing Graves’ disease does not usually require measuring the specific antibody associated with the condition, such tests may be conducted to rule out other causes of hyperthyroidism if the antibody is not detected.
- Radioactive iodine uptake: To evaluate the functioning of your thyroid gland and identify the underlying cause of hyperthyroidism, your doctor can administer a small dose of radioactive iodine and use a specialized scanning camera to measure the iodine uptake in your thyroid. Iodine is crucial for thyroid hormone production, and by assessing the amount of radioactive iodine absorbed by the gland, the test helps distinguish whether the hyperthyroidism is caused by Graves’ disease or another condition. In some cases, a radioactive iodine scan may also be performed to generate a visual image displaying the uptake pattern.
Treatment
While Graves’ disease is a chronic condition that lasts a lifetime, effective treatments are available to regulate thyroid hormone levels and manage the disease. With appropriate medical care, it is possible for the disease to enter a state of temporary remission. Following are some treatments:
- Beta blockers: Beta-blockers, such as propranolol, metoprolol, atenolol, and nadolol, are commonly used as the initial treatment for Graves’ disease. While they do not suppress the production of thyroid hormones, these medications work by blocking the effects of the hormones on the body, providing relief for symptoms such as irregular heartbeats, tremors, anxiety, heat intolerance, sweating, diarrhea, and muscle weakness. They are primarily prescribed to regulate heart rate and protect the heart while other treatments for hyperthyroidism take effect. It is important to note that beta-blockers are generally not recommended for individuals with asthma due to the potential risk of triggering asthma attacks. Additionally, these medications may complicate the management of diabetes.
- Radioiodine therapy: Radioactive iodine therapy is a form of treatment that involves consuming a single dose of radioactive iodine in the form of a pill or liquid. The thyroid, which relies on iodine to produce hormones, absorbs the radioiodine into its cells. Over time, the radiation emitted by the iodine destroys the overactive thyroid cells, leading to a gradual reduction in symptoms and a shrinkage of the thyroid gland. As the thyroid gland decreases in size, hormone levels normalize, bringing relief to the individual. However, it’s important to note that radioiodine therapy may potentially exacerbate or cause new symptoms of Graves’ ophthalmopathy, although this side effect is typically mild and temporary. If a person already has moderate to severe eye problems, this therapy may not be recommended for them. Additionally, individuals who are pregnant, breastfeeding, or women who are breastfeeding should not undergo this treatment.
While undergoing radioiodine therapy, individuals may experience some side effects such as neck tenderness and a temporary increase in thyroid hormones. It’s crucial to be aware that this treatment often leads to the development of hypothyroidism, which is an underactive thyroid. However, hypothyroidism is easier to manage compared to hyperthyroidism and causes fewer long-term health issues. Treatment for hypothyroidism usually involves medication to regulate thyroid hormone levels.
- Anti-thyroid medications: Anti-thyroid medications such as propylthiouracil and methimazole (Tapazole) are commonly prescribed to interfere with the thyroid’s use of iodine in hormone production. Methimazole is typically the preferred choice due to a lower risk of liver disease compared to propylthiouracil. However, during the first trimester of pregnancy, propylthiouracil is generally favored as methimazole carries a slight risk of birth defects. Pregnant women typically switch back to methimazole after the first trimester. It is worth noting that using these medications alone may lead to a relapse of hyperthyroidism at a later stage. Prolonged use of either drug, exceeding one year, tends to yield better long-term outcomes. Additionally, anti-thyroid drugs can be used as supplemental treatment before or after radioiodine therapy.
In a small percentage of individuals, these medications can cause skin rashes and a decrease in white blood cell count, which may increase the risk of infections. Although rare, liver disease can also develop as a side effect. Therefore, it is important for patients to be aware of these potential risks and to consult with their healthcare provider regularly to monitor their condition and manage any adverse effects effectively.
- Surgery: Thyroidectomy or subtotal thyroidectomy, which involves the removal of all or part of the thyroid gland, is a viable treatment option for Graves’ disease. However, one potential consequence of this surgery is the development of hypothyroidism, wherein the body produces insufficient thyroid hormone. To manage this condition, lifelong treatment with thyroid replacement hormone medications like levothyroxine may be necessary.
While thyroid surgery carries some risks, such as potential damage to the nerve controlling the vocal cords and the adjacent parathyroid glands (which regulate blood calcium levels), complications are rare when performed by an experienced surgeon.
Treatment for Graves’ ophthalmopathy.
Graves’ ophthalmopathy, a condition characterized by eye symptoms, can be managed with various treatment options. For mild symptoms, over-the-counter artificial tears during the day and lubricating gels at night can provide relief. However, if the symptoms are more severe, your doctor may suggest the following treatments:
- Corticosteroids: These medications, such as prednisone, can help reduce swelling behind the eyeballs. It’s important to note that corticosteroids may have side effects like fluid retention, weight gain, elevated blood sugar levels, increased blood pressure, and mood swings.
- Teprotumumab (Tepezza): This newer medication can be administered through an IV every three weeks for a total of eight treatments. While its role in managing Graves’ ophthalmopathy is still being defined, it has shown effectiveness. However, there may be side effects like nausea, diarrhea, muscle spasms, and elevated blood sugar levels.
- Prisms: If you experience double vision due to Graves’ disease or its treatment, prisms in your glasses may help correct the issue. Keep in mind that not everyone responds positively to this treatment.
- Orbital decompression surgery: In cases where there is a risk of vision loss due to pressure on the optic nerve, this surgical procedure involves removing the bone between the eye socket and sinuses. By creating more space, the eyes can return to their original position. However, there is a possibility of complications, including double vision.
- Orbital radiotherapy: This treatment, once commonly used, involves targeted X-rays over several days to destroy some of the tissue behind the eyes. However, the benefits of this approach are not well-established. Your doctor may recommend it if your eye problems worsen and corticosteroids alone are not effective or well-tolerated.
It’s important to consult with your doctor to determine the most suitable treatment for your specific condition and to weigh the potential benefits and risks of each option.
