What is Graves’ disease?

Graves’ disease is an immune system disorder that causes overproduction of thyroid hormones ( hyperthyroidism ), meaning it’s an autoimmune disease . Some disorders can also cause hyperthyroidism, but Graves’ disease is a common cause.

Because thyroid hormones affect a number of different body systems, the symptoms associated with Graves’ disease can be far-reaching and can significantly affect your overall well-being. Although Graves’ disease can affect anyone, it is more common among women and before the age of 40.

The primary treatment goals are to prevent overproduction of thyroid hormones and to reduce the severity of symptoms.

What causes Graves’ disease?

Graves’ disease is caused by a malfunction in the body’s disease-fighting immune system, but the exact reason why this condition occurs is still unknown.

A normal immune system response is the production of antibodies designed to target a particular virus, bacteria, or other foreign substance. In Graves’ disease – for reasons that are not well understood – the body produces antibodies to some of the cells in the thyroid gland, a hormone-producing gland in the neck.

Normally, thyroid function is regulated by a hormone secreted by a small gland ( pituitary gland ) at the base of the brain . The antibody associated with Graves’ disease – thyrotropin receptor antibody (TRAb) – acts like a regulatory pituitary hormone. This means that TRAb overrides the normal regulation of the thyroid and causes overproduction of thyroid hormones (hyperthyroidism).

Cause of Graves’ ophthalmopathy

This condition is caused by the accumulation of certain carbohydrates in the muscles and tissues behind the eyes, the cause of which is unknown. The same antibody that can cause thyroid dysfunction appears to also have an effect on the tissues surrounding the eyes.

Graves’ ophthalmopathy usually occurs at the same time as hyperthyroidism or several months later. However, symptoms of ophthalmopathy may appear years before or after the onset of hyperthyroidism. Graves’ ophthalmopathy can occur even in the absence of hyperthyroidism.

Who is at risk?

Although anyone can develop Graves’ disease, a number of factors can increase the risk of the disease. These risk factors include:

  • Family history: Having someone in their family with this disease is an inherited risk factor that can make a person more susceptible to the disease.
  • Gender: Women are more likely to develop Graves’ disease than men.
  • Age: Graves’ disease usually develops in people younger than 40.
  • Other autoimmune disorders: People with other immune system disorders, such as type 1 diabetes or rheumatoid arthritis , are at greater risk.
  • Emotional or physical stress: Stressful life events or illnesses can act as a trigger for the onset of Graves’ disease among genetically susceptible people.
  • Pregnancy: Pregnancy or recent birth can increase the risk of the disorder, especially among genetically susceptible women.
  • Smoking: Smoking , which can affect the immune system, increases the risk of disease. Smokers with this disease are also at risk of developing Graves’ ophthalmopathy.
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What are the symptoms of Graves’ disease?

Common symptoms of Graves’ disease include:

  • anxiety and irritability
  • Tremor of your hands or fingers
  • Heat sensitivity and sweating
  • Weight loss despite normal eating habits
  • Enlargement of your thyroid gland ( goiter )
  • Change in menstrual cycles
  • Erectile dysfunction or decreased libido
  • frequent bowel movements
  • Bulging eyes (Graves’ ophthalmopathy)
  • Tiredness
  • changes in the skin
  • Fast or irregular heartbeat (palpitations)

Symptoms of Graves’ ophthalmopathy

About 30 percent of people with Graves’ disease develop some symptoms of a condition known as Graves’ ophthalmopathy. In Graves’ ophthalmopathy, inflammation and other immune system events affect the muscles and other tissues around the eyes. The resulting symptoms may include:

  • puffy eyes ( exophthalmos )
  • Change in sensation in the eyes
  • Pressure or pain in the eyes
  • Puffy or retracted eyelids
  • red or inflamed eyes
  • light sensitivity
  • double vision
  • vision loss

Symptoms of Graves’ dermopathy

Symptoms of Graves’ dermopathy, a rare manifestation of Graves’ disease; reddening and thickening of the skin. It most often appears on your fingers or the top of your feet.

When should you see a doctor?

Certain medical conditions can cause symptoms associated with Graves’ disease. You should consult your doctor if you have any potential problems with the disease to get a quick and accurate diagnosis.

If you experience heart-related symptoms, such as a fast or irregular heartbeat, or develop vision loss, you should seek emergency care.

How is Graves’ disease diagnosed?

Diagnosis of Graves’ disease may include:

  • Physical exam: Your doctor will examine your eyes for irritation and see if your thyroid gland is enlarged. Because Graves’ disease increases your metabolism, your doctor will check your heart rate and blood pressure and look for signs of tremors.
  • Blood sample: Your doctor will order blood tests to determine your levels of thyroid stimulating hormone (TSH), the pituitary hormone that normally stimulates the thyroid gland, and thyroid hormone levels. People with Graves’ disease often have lower-than-normal TSH levels and higher thyroid hormone levels.
  • Radioactive iodine uptake: Your body needs iodine to make thyroid hormones. By giving you a small amount of radioactive iodine and then measuring the amount in your thyroid gland with a special scanning camera, your doctor can determine the rate at which your thyroid gland takes up iodine. The amount of radioactive iodine taken up by the thyroid gland helps determine whether Graves’ disease or another condition is the cause of hyperthyroidism.
  • Ultrasound: Ultrasound uses high-frequency sound waves to produce images of structures in the body. Ultrasound can show whether the thyroid gland is enlarged and is most useful in people who cannot take up radioactive iodine, such as pregnant women.
  • Imaging tests: If the diagnosis of Graves’ ophthalmopathy is unclear in a clinical evaluation, your doctor may order an imaging test such as a computed tomography scan, a special X-ray technology that produces thin-sectional images. Magnetic resonance imaging , which uses magnetic fields and radio waves, can also be used to create cross-sectional or 3D images .
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How is Graves’ disease treated?

Treatment goals for Graves’ disease are to inhibit the production of thyroid hormones and to block the effects of hormones on the body. Some treatments include:

radioactive iodine therapy

With this treatment, you take radioactive iodine or radioiodine by mouth. Because the thyroid requires iodine to produce hormone, radioiodine enters the thyroid cells and the radioactivity destroys the overactive thyroid cells over time. This causes your thyroid gland to shrink, and the symptoms gradually subside, usually over a few weeks to a few months.

Radioiodine therapy may increase your risk of new or worsened symptoms of Graves’ ophthalmopathy. This side effect is usually mild and temporary, but treatment may not be recommended if you have moderate to severe eye problems.

Other side effects may include neck tenderness and a temporary increase in thyroid hormones. Radioiodine therapy is not used in the treatment of pregnant or breastfeeding women.

Because this treatment causes decreased thyroid activity, you will need treatment later on to provide your body with a normal amount of thyroid hormone.

Anti-thyroid drugs

Anti-thyroid medications for Graves’ disease block the thyroid’s use of iodine to produce hormones. These prescription medications include propylthiouracil and methimazole.

Because the risk of liver disease is more common with propylthiouracil, methimazole is considered the first choice when doctors prescribe medication.

When these two drugs are used alone, hyperthyroidism recurrence may occur later. However, taking the drug for more than a year may result in better long-term results. Anti-thyroid drugs may also be used as an adjunct therapy before or after radioactive therapy.

Side effects of both drugs include rash, joint pain, liver failure, or a decrease in disease-fighting white blood cells. Methimazole is not used to treat pregnant women in the first trimester because of the slight risk of birth defects. For this reason, propylthiouracil is the anti-thyroid drug of choice for pregnant women in the first trimester. After the first trimester, the use of methimazole is usually continued and propylthiouracil is no longer prescribed.

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Remember, your doctor will decide which medicine to take and how.

Beta blockers

These drugs do not inhibit the production of thyroid hormones, but block the effect of hormones on the body. They can provide fairly quick relief of irregular heartbeat, tremors, anxiety or irritability, heat intolerance, sweating, diarrhea, and muscle weakness.

Beta blockers include:

  • Propranolol
  • Atenolol
  • Metoprolol
  • Nadolol

Beta blockers are not often prescribed for people with asthma because the drugs can trigger an asthma attack. These medications can also complicate diabetes management.

Your doctor should decide which medicine to take and how.

Surgical treatment

Surgery to remove all or part of your thyroid ( thyroidectomy or subtotal thyroidectomy ) is also an option for treating Graves’ disease. After surgery, you will need treatment to provide your body with a normal amount of thyroid hormone.

The risks of this surgery include potential damage to the nerve that controls your vocal cords and the small glands located adjacent to your thyroid gland (parathyroid glands). Your parathyroid glands produce a hormone that controls the level of calcium in your blood. Complications are rare with a physician experienced in thyroid surgery.

Graves’ disease and nutrition

There is no specific diet for people affected by Graves’ disease but there are healthier options they can follow to improve their overall health, such as the following.

  • Increase your antioxidant intake: Since this disease is an autoimmune disease, antioxidants help keep your immune system strong. Some examples; blackberries, blueberries, cranberries, raspberries, tomatoes and bell peppers.
  • Increase the amount of calcium in your diet: Graves’ disease can cause bone loss, which can lead to other complications such as osteoporosis . Get calcium from dairy products such as low-fat milk, low-fat cheese, low-fat and no added sugar yogurt, orange juice, soy milk, whole grain cereals and bread. Another source of calcium is green leafy vegetables such as spinach, okra and turnip greens.
  • Get protein: When you have Graves’ disease, protein sources will be crucial for strength and muscle mass restoration. You can choose proteins with low fat content. These include fish, salmon, skinless chicken, eggs, turkey, mushrooms and beans.
  • Avoid refined foods: Avoid refined foods, fats, and foods that contain added sugar, as they have lower nutritional value, such as white bread, pastas, sugar, butter, and fried foods. Choose whole grains, baked or grilled foods, margarine and olive oil.
  • Don’t take caffeine: The University of Maryland Medical Center recommends avoiding things that contain caffeine, such as tea, coffee, chocolate, and soft drinks. Caffeine can exacerbate symptoms such as anxiety and rapid heart rate. ( Source )

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