Graves’ Disease
Graves’ disease is an autoimmune disorder characterised by the excessive production of thyroid hormones (hyperthyroidism). Several vital body systems are affected by this condition.
Anatomy
The thyroid gland is located in the front of the neck. It secretes several hormones that are essential for the development of the brain, metabolic activity, body temperature maintenance and growth in general. The secretion of hormones is controlled and regulated by the thyroid-stimulating hormone (TSH) that is released by the pituitary gland present in the brain. An over-production of the gland can disrupt many important processes in the body.
Causes
For unclear reasons, the immune system produces antibodies that act in a manner like the thyroid stimulating hormone, resulting in the increased stimulation of the thyroid gland and overproduction of thyroid hormones. A family history of the disease, being below the age of 40 and a woman, having other autoimmune diseases and smoking are all considered risk factors. Emotional stress, pregnancy and recent childbirth can also increase your risk if you are genetically predisposed to the condition.
Impact
Graves’ disease can greatly impact mental health, physical and social functioning, and the overall quality of life.
Symptoms
Individuals with Graves’ disease will usually have the following signs and symptoms:
- Heart pounding
- Increased sweating
- Trembling sensation
- Loss of weight
- Sensitivity to heat
- Enlargement of the thyroid gland
- Irregular menstrual cycles
- Graves' ophthalmopathy: bulging eyes, light sensitivity or vision problems
- Graves' dermopathy: thickened red skin seen on the shin or top of feet
Diagnosis
The diagnosis of Graves’ disease is based on the following:
- Physical examination: check for swelling of the thyroid gland and bulging of the eyes, blood pressure and pulse abnormalities as well as signs of tremor.
- Blood sample:check for lowered levels of the thyroid-stimulating hormone and high levels of thyroid hormones as well as the presence of antibodies that cause Graves’ disease
- Radioactive iodine uptake: check for increased iodine uptake by the thyroid gland
- Ultrasound scan: detect enlargement of the thyroid gland
- CT or MRIs scans: create 3D images of the thyroid gland
Untreated
When left untreated, Graves’ disease can lead to progressively severe complications of hyperthyroidism such as:
- Pregnancy-related complications: poor foetal growth, foetal thyroid dysfunction, premature birth, miscarriage, preeclampsia (high blood pressure in the mother during pregnancy)
- Heart disorders: structural and functional abnormalities of the heart, congestive heart failure, and rhythm disorders
- Thyroid storm: a rare but potentially life-threatening complication characterised by heart palpitations, profuse sweating, high fever, jaundice, vomiting, diarrhoea, extremely low blood pressure, delirium and coma
- Osteoporosis: brittle bones as excess thyroid hormone levels hinders absorption of calcium by the bones
- Thyroid eye disease: inflammation of the eyes, inability to close the eyelids and other changes that may affect your vision
Treatment
The various treatment options include:
- Radioactive iodine therapy: Radioactive iodine is orally ingested to destroy the hyperactive thyroid cells, causing the gland to shrink.
- Anti-thyroid medication: These medications hinder the production of thyroid hormones by interfering with the uptake of iodine.
- Beta blockers: They prevent the action of thyroid hormones on the body and provide rapid relief of symptoms such as heart pounding, jitteriness, sweating, diarrhoea and muscle weakness.
- Surgery: This involves complete or partial removal of the thyroid gland.
- Treatment of Graves' ophthalmopathy: Mild eye problems can be managed using artificial tears during the daytime and lubricating gels at night-time. More severe eye problems can be treated with corticosteroids to decrease swelling of the eyes, prisms in your eye glasses to correct double vision, decompression surgery or orbital radiotherapy.