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Grave's Disease

Grave's Disease

Grave's disease is an autoimmune disease that affects the thyroid. The thyroid is a small gland in the front of the neck. It makes hormones called T3 and T4 that regulate how the body uses energy. Thyroid hormone levels are controlled by the pituitary, which is a pea-sized gland in the brain. It makes thyroid stimulating hormone (TSH), which triggers the thyroid to make thyroid hormone.

 

With Grave's disease, the immune system makes antibodies that act like TSH, causing the thyroid to make more thyroid hormone than your body needs. This is called an overactive thyroid or hyperthyroidism. An overactive thyroid causes every function of the body to speed up, such as heart rate and the rate your body turns food into energy. Grave's disease is one cause of overactive thyroid. It is closely related to Hashimoto's disease, another autoimmune disease affecting the thyroid.

 

Grave's disease facts

 

  • Grave's disease is a thyroid condition that results from abnormal stimulation of the thyroid gland by a material in the blood referred to as thyroid stimulating immunoglobins (TSIs) that bind to and activate thyrotropin receptors.
  • Grave's disease is the most common cause ofhyperthyroidism in the US.
  • The cause of Grave's disease is thought to be related to many factors including genes, gender,stress, pregnancy, and possibly infections.
  • Symptoms of Grave's disease include goiter, problems conceiving a child, lighter menstrual flow and less frequent periods, weight loss, frequent bowel movements, heart palpitations, thinning of hair, brittle hair, hand tremors, problems sleeping, heat insensitivity, increased sweating, eye changes (exophthalmos), reddening and thickening of the skin on the shins and top of the feet (pretibial myxedema).
  • Grave's disease affects both men and women; however, women are affected about 8 - 10 times more often than men. 
  • Risk factors for Grave's disease are associated with other autoimmune diseases such as vitiligo, rheumatoid arthritis, Addison's disease, type 1 diabetes, pernicious anemia and lupus.
  • Tests to diagnose Grave's disease include thyroid function tests, radioactive iodine uptake tests and tests to detect TSI's.
  • Treatments for Grave's disease include radioactive iodine, antithyroid medications such as methimazole (Tapazole) and propylthiouracil (PTU), and beta blockers; in some patients, surgery is done.
  • Untreated Grave's disease can lead to thyrotoxicosis and its severe form, thyroid storm (death rate is about 20%), heart problems, weak and brittle bones, and death.
  • Poorly treated Grave's disease during pregnancy can cause problems for the woman such as preterm birth, miscarriage, heart failure, preeclampsia and placental abruption.
  • Poorly treated Grave's disease can cause health problems for a fetus or baby such as preterm birth, low birth weight, thyroid problems, and still birth.

Symptoms

Most people with Graves' disease have symptoms of an overactive thyroid, such as:

  • Goiter (enlarged thyroid).
  • Trouble sleeping.
  • Irritability or nervousness.
  • Heat sensitivity, increased sweating.
  • Hand tremors.
  • Rapid heartbeat.
  • Thinning of skin or fine, brittle hair.
  • Frequent bowel movements.
  • Weight loss without dieting.
  • Fatigue or muscle weakness.
  • Lighter menstrual flow and less frequent periods.
  • Problems getting pregnant.

 

Unlike other causes of an overactive thyroid, Graves' disease also can cause:

 

  • Eye changes. For some people with Grave's disease, the tissue behind the eyes becomes inflamed and swells. This can cause bulging or discomfort in one or both eyes. Sometimes it affects vision. Eye symptoms can occur before, at the same time, or after other symptoms of Grave's disease begin. It may rarely occur in people with normal thyroid function. We do not know why these eye problems occur. They are more common in people who smoke, and smoking makes eye symptoms worse. Eye problems often get better without treatment. 
  • Reddening and thickening of the skin, often on the shins and tops of the feet. This rare skin problem is not serious and is usually painless. Most people with this skin problem also have eye problems from Grave's disease.

 

Symptoms of Grave's disease can occur slowly or very suddenly and are sometimes confused with other health problems. Some people with Grave's disease do not have any symptoms.

Causes

Many factors are thought to play a role in getting Grave's disease.

 

These might include:

 

  • Genes. Some people are prone to Grave's disease because of the irgenes. Researchers are working to find the gene or genes involved.
  • Gender. Sex hormones might play a role, and might explain why Grave's disease affects more women than men.
  • Stress. Severe emotional stress or trauma might trigger the onset of Grave's disease in people who are prone to getting it.
  • Pregnancy. Pregnancy affects the thyroid. As many as 30 percent of young women who get Grave's disease have been pregnant in the 12 months prior to the onset of symptoms. This suggests that pregnancy might trigger Graves' disease in some women.
  • Infection. Infection might play a role in the onset of Grave's disease, but no studies have shown infection to directly cause Grave's disease.

Treatment

There are 3 main treatments for Grave's disease:

 

Antithyroid medicine. Two drugs are used in the United States:

  • Methimazole (meh-THEYE-muh-zohl), or MMI (brand name, Tapazole).
  • Propylthiouracil (PROH-puhl-theye-oh-YUR-uh-sil), or PTU.

 

These drugs keep the thyroid from making too much thyroid hormone. MMI is the preferred drug for most non-pregnant people. These drugs are generally not used for more than 1 or 2 years. For some people, thyroid function returns to normal when the drugs are stopped. But for most people, the overactive thyroid comes back.

 

  • Radioactive iodine (RAI). The thyroid gland uses iodine to make thyroid hormone. With this treatment, you swallow a pill that contains RAI, which is a form of iodine that damages the thyroid by giving it radiation. The RAI destroys thyroid cells so that less thyroid hormone is made. This cures the overactive thyroid. But you will likely need to take thyroid hormone for the rest of your life to replace the needed thyroid hormone your body can no longer make. RAI has been used for a long time and does not harm other parts of the body or cause infertility orbirth defects.
  • Surgery. Most or all the thyroid is removed. As with RAI, surgery cures overactive thyroid. But you will need to take thyroid hormone to replace the needed thyroid hormone your body can no longer make.

 

Besides one of these 3 treatments, your doctor might also suggest you take a type of drug called a beta-blocker. Beta-blockers do not affect how much thyroid hormone is made. Rather, they block the action of thyroid hormone on your body. This slows down your heart rate and reduces symptoms such as shaking and nervousness. Beta-blockers work quickly and can help you feel better while waiting for the main treatment to take effect.

 

The treatment that is best for you will depend on many factors. Antithyroid drugs and RAI – or a mix of both – often are preferred. During and after treatment, your doctor will want to monitor your thyroid hormone levels. Ask how often you need to be seen for follow-up visits.

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