Graves' disease is an autoimmune disease that affects the thyroid. The condition occurs when the body's immune system mistakes the healthy cells for foreign particles and attacks them. The condition makes the hyperactive and is the leading cause of a thyroid condition known as hyperthyroidism. In this condition, the thyroid provides too many hormones. The thyroid gland is a butterfly-shaped gland that produces two hormones, thyroxine (also called T4) and triiodothyronine (also known as T3). These hormones are of great importance in maintaining bodily functions.
In Graves' disease, the immune system creates antibodies, known as thyroid-stimulating immunoglobulins, that attach to the thyroid cells. This causes the thyroid gland to produce higher than normal hormones, which results in hyperthyroidism. The condition may also lead to an enlarged thyroid, also known as goiter. The disease gets its name from Sir Robert Graves, an Irish doctor who first discovered the condition around 150 years ago.
Graves' Disease Symptoms
The signs and symptoms of Graves' disease can sometimes be similar to hyperthyroidism. These may include:
The leading cause behind Graves' disease is currently unknown. However, experts believe it occurs due to a combination of factors, including genes and external triggers. The thyroid gland produces hormones that control the body's speed to convert food into energy.
In usual conditions, the thyroid gland produces the hormones triggered by a chemical known as a thyroid-stimulating hormone. The pituitary gland releases this hormone in the brain. In Graves' disease, the immune system releases abnormal antibodies that act like TSH. This leads the thyroid gland to produce too much T3 and T4 hormones that, in the end, causes hyperthyroidism.
Experts cannot find out what causes the production of these antibodies. However, genes and environmental factors seem to play a role in this condition. Moreover, Graves' disease is more likely to develop in women than men.
Diagnosis of Graves' Disease
The doctor may perform a physical exam to check for signs and symptoms of Graves' disease. The doctor may also check if the thyroid gland is enlarged or not during the checkup. The doctor will order specific tests to confirm Graves' disease based on the assessment. These may include:
Blood test: The doctor may order a blood test to check the levels of thyroid-stimulating hormone (TSH) along with the levels of thyroid hormones. People with Graves' disease usually have lower levels of TSH and higher levels of thyroid hormones.
Antibody test: The test is used to measure the levels of antibodies that may cause Graves' disease. This test is also helpful to diagnose if there are other causes for hyperthyroidism.
Ultrasonography: The test uses sound waves to create images of the thyroid gland. The test helps to reveal the size of the gland and detect whether there are nodules present on it.
Radioactive Iodine Uptake Test: The test is performed by giving a small amount of radioactive iodine. The doctor then uses a special machine to measure how well the thyroid gland absorbs iodine. The high level of iodine absorption indicates the presence of Graves' disease.
Thyroid scan: The test is done by injecting a material known as technetium. The doctor then scans the picture of the gland to see how much is absorbed by the thyroid gland.
Graves' Disease Treatment
Graves' disease is a lifelong condition, and there are a variety of treatments to keep it in check. These may include:
The doctor may prescribe anti-thyroid drugs to control the production of thyroid hormones. The doctor may prescribe medicines like methimazole and propylthiouracil. The propylthiouracil is preferred medication for women during the first trimester of pregnancy, while methimazole is considered a good option as it won't risk developing liver disease. Apart from this, the doctor may also prescribe beta-blockers. These medicines block the effect of hormones on the body. Some of the common beta-blockers used for treating Graves' disease include:
Propranolol (Inderal, InnoPran XL)
Metoprolol (Lopressor, Toprol-XL)
Radioactive Iodine Therapy
The patient takes one dose of radioactive iodine in pill or liquid form during this procedure. The thyroid gland absorbs the radioactive iodine. The radiation slowly destroys the overactive thyroid cells, causing the thyroid gland to shrink and help reduce the symptoms of Graves' disease. Some of the side effects of radioactive iodine therapy include the risk of eye problems like Graves' ophthalmopathy, tenderness in the neck, and more. Due to the radiation, the treatment is not suitable for pregnant women.
Also known as thyroidectomy, the surgical procedure involves removing all or part of the thyroid gland. During the procedure, the surgeon makes a small incision at the crease in the base of the neck. The surgeon then removes part of the thyroid, most of it or all of the gland.
Risk Factor of Graves' Disease
There are certain factors that may increase the risk of Graves' disease, including:
If the Graves' disease is not treated with time, it may result in various complications, including:
Graves' ophthalmopathy: Untreated Graves' disease can cause Graves' ophthalmopathy. The condition occurs when the immune system attacks the muscles and tissues around the eyes, which causes them to bulge. Severe swelling can also lead to vision loss.
Graves' dermopathy: People may also develop Graves' dermopathy, which is a condition that causes the thickening and reddening of the skin.
Osteoporosis: Untreated Graves' disease may cause brittle bones complications, also known as osteoporosis.
Heart problems: Lack of thyroid hormone can also lead to a higher risk of heart failure and heart disease. This may be caused due to high levels of LDL cholesterol that occur due to underactive thyroid.
Thyroid storm: This is a rare yet life-threatening condition that can occur due to Graves' disease. A drastic increase in thyroid hormones leads to high fever, sweating, diarrhoea, severe weakness, arrhythmia, shock, and coma. A thyroid storm requires immediate medical attention.
Graves' disease is a lifelong condition that requires long-term medications to manage the symptoms. However, the disease may go away with successful surgery, though it will likely cause another condition known as hypothyroidism. One should call the doctor if the following symptoms appear: