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.