Robert James Graves Foundation SCIO

What Is Graves Disease?

First described by Sir Robert Graves in the early 19th century, Graves' disease is one of the most common of all thyroid problems.

It is also the leading cause of hyperthyroidism, a condition in which the thyroid gland produces excessive hormones.

Although the symptoms can cause discomfort, Graves' disease generally has no long-term adverse health consequences if the patient receives prompt and proper medical care.

 

What Causes Graves Disease?

Hormones secreted by the thyroid gland control metabolism, or the speed at which the body converts food into energy. Metabolism is directly linked to the amount of hormones that circulate in the bloodstream. If, for some reason, the thyroid gland secretes an overabundance of these hormones, the body's metabolism goes into high gear, producing the pounding heart, sweating, trembling, and weight loss typically experienced by hyperthyroid people. Normally, the thyroid gets its production orders through another chemical called thyroid-stimulating hormone (TSH), released by the pituitary gland in the brain. But in Graves' disease, a malfunction in the body's immune system releases abnormal antibodies that mimic TSH. Spurred by these false signals to produce, the thyroid's hormone factories work overtime and exceed their normal quota.

Exactly why the immune system begins to produce these aberrant antibodies is unclear. Also, women are more likely than men to develop the disease. And smokers who develop Graves' disease are more prone to eye problems than nonsmokers with the disease. No single gene causes Graves’ disease. It is thought to be triggered by both genetics and environmental factors, such as stress.

Eye trouble -- usually in the form of inflamed and swollen eye muscles and tissues that can cause the eyeballs to protrude from their sockets -- is a distinguishing complication of Graves' disease. However, only a small percentage of all Graves' patients will experience this condition, known as exophthalmos. Even among those who do, the severity of their bout with Graves' has no bearing on the seriousness of the eye problem or how far the eyeballs protrude. In fact, it isn't clear whether such eye complications stem from Graves' disease itself or from a totally separate, yet closely linked, disorder. If you have developed exophthalmos, your eyes may ache and feel dry and irritated. Protruding eyeballs are prone to excessive tearing and redness, partly because the eyelids can no longer shelter them effectively from injury.

 

In severe cases of exophthalmos, which are rare, swollen eye muscles can put tremendous pressure on the optic nerve, possibly leading to partial blindness. Eye muscles weakened by long periods of inflammation can lose their ability to control movement, resulting in double vision.

Rarely, people develop a skin condition known as pretibial myxedema. It is a lumpy reddish thickening of the skin on the shins. It is usually painless and is not serious. Like exophthalmos this condition does not necessarily begin with the onset of Graves' nor does it correlate with the severity of the disease.

 

What Are the Symptoms of Graves' Disease?

The symptoms of Graves' disease include:

• Weight loss despite increased appetite

• Faster heart rate, higher blood pressure, and increased nervousness

• Excessive perspiration

• Increased sensitivity to heat

• More frequent bowel movements

• Muscle weakness, trembling hands

• Development of a goiter (enlargement of the thyroid gland, causing a swelling at the base of the neck).

• Bulging eyes

• Reddish, thickened, and lumpy skin in front of the shins

• In women, change in frequency or total cessation of menstrual periods

 

Call Your Doctor About Graves' Disease If:

You are feverish, agitated, or delirious, and have a rapid pulse. You could be having a thyrotoxic crisis, in which the effects of too much thyroid hormone suddenly becomes life-threatening!

 

How Do I Find Out If I Have Graves' Disease?

Although Graves' disease can be diagnosed from the results of one or two tests, your doctor may use several methods to double-check the findings and rule out other disorders. An analysis of your blood will show if the levels of two hormones -- tetraiodothyrinine (free T-4) and triiodothyronine (free T-3), which are produced or regulated by the thyroid -- are higher than normal. If they are, and if levels of thyroid-stimulating hormone (TSH) in your blood are abnormally low, you are hyperthyroid, and Graves' disease is the likely culprit. Blood analysis can also detect the presence of the abnormal antibody associated with Graves' disease, but this test is somewhat expensive and generally not necessary.

To confirm a diagnosis of Graves' disease, your doctor may conduct a radioactive iodine uptake test, which shows whether large quantities of iodine are collecting in the thyroid. The gland needs iodine to make thyroid hormones, so if it is absorbing unusually large amounts of iodine, it obviously is producing too much hormone.

 

If bulging eyeballs (called exophthalmos) is the only symptom, your doctor will probably run blood tests to check for hyperthyroidism, since this eye disorder is not always related to Graves' disease. The doctor may also evaluate eye muscles using ultrasound, a CT scan, or magnetic resonance imaging (MRI). Signs of swelling in any one of these tests will go along with the diagnosis of Graves' disease.

 

What Are the Treatments for Graves' Disease?

If you have Graves' disease, or even suspect that you have it, you should have a professional diagnosis and, if necessary, a treatment plan that suits your particular condition. Although the disorder is rooted in a malfunctioning immune system, the goal of treatment is to restore thyroid hormone levels to their correct balance and to relieve discomfort.

 

Conventional Medicine for Graves' Disease

The two most frequently used treatments involve disabling the thyroid's ability to produce hormones.

One common approach uses a strong dose of radioactive iodine to destroy cells in the thyroid gland. Despite its destructive effect on thyroid cells, the iodine used in this procedure will not harm surrounding tissues and organs. To be on the safe side, during this treatment, you should also limit contact with infants, children, and pregnant women for at least seven days after you ingest the iodine. Over the next several months, the thyroid's hormone secretion should gradually begin to drop. During this time you need to see the doctor for periodic checkups to determine how well the treatment is progressing. If the condition hasn't improved three months or so after your initial treatment, your practitioner may give you a second dose of iodine. Once the doctor has decided that your Graves' disease is effectively under control, you will still need to have routine checkups to make sure that your thyroid levels remain within the normal range.

It should be noted that most people become hypothyroid after taking radioactive iodine for Graves' disease. If this occurs, you will have to take thyroid replacement medication for the rest of your life.

Antithyroid drugs such as propylthiouracil and methimazole (Tapazole), which interfere with thyroid hormone production, can be used to treat Graves' disease. 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. Once the stores are drained, hormone production should drop to its normal level. Although your disease may seem to go away entirely, you might still need drug therapy to keep your thyroid operating properly. Even if your case of Graves' disease does go into remission and your doctor says it's safe to stop taking medication, you will need to be evaluated every year or so to make sure hyperthyroidism has not returned since relapse is common.

Beta-blockers such as atenolol (Tenormin), propranolol (Inderal), and metoprolol (Lopressor), frequently prescribed to treat heart disease and high blood pressure, are also used by some patients to alleviate the heart palpitations and muscle tremors that characterize Graves' disease. Before prescribing beta blockers for this condition, however, your doctor needs to know if you are asthmatic or have any kind of heart trouble. These drugs aren't a cure; instead they are given to block some of the effects of thyroid hormones. They are used in conjunction with other treatments.

Radioactive iodine treatments and antithyroid drugs are usually effective in slowing down thyroid hormone output, but in some cases surgery is the best approach for Graves' disease. If you develop the disorder before or during pregnancy, for example, or if you are reluctant or unable to undergo radioactive treatment or are allergic to antithyroid medication, your doctor may recommend subtotal thyroidectomy, a relatively safe and simple procedure in which most of the thyroid gland is removed.

Because many conventional remedies severely limit the thyroid's ability to manufacture thyroid hormone, they increase the chances that you will develop hypothyroidism, a potentially serious condition marked by insufficient thyroid hormone production.

Some degree of eye complaints occur in 25%-50% of those that develop Graves' disease but most can be managed with the home remedies. Surgery is rare and reserved for those with severe symptoms.

Graves' disease patients with eye problems can find temporary relief from the redness, swelling, and pain through a number of drugs, including prednisone, methylprednisolone, and dexamethasone. However, these medications should not be used for long periods of time, as they can lead to bone loss, muscle weakness, and weight gain. Vision problems and severe cases of eye protrusion can often be corrected through radiation therapy and surgery. A person who has Graves' disease should also see an eye doctor. Make sure to ask your doctor about any possible complications before undergoing surgery.