What is Graves’ Disease?

Graves’ disease is an autoimmune disorder that affects the thyroid gland. The thyroid is a bowtie-shaped gland located at the front of your neck (approximately where a bowtie might be worn). Graves’ disease prompts the thyroid into overdrive, producing an excessive amount of thyroid hormone, a condition known as hyperthyroidism. Thyroid hormones regulate the energy in your body, and play a role in influencing your metabolism, nervous system, body temperature, brain development, heart, bones, eyes and skin.

Graves’ disease most frequently impacts females under the age of 40. Although the disease is seven to eight times more common in women, anyone can develop the disease at any age. It is the most common cause of hyperthyroidism in the United States, affecting approximately 1 in 200 people annually.

Symptoms

Graves’ disease shares many of the same signs and symptoms in common with other medical conditions. Typically, Graves’ disease symptoms look the same in men and women, though there are some exceptions

Common signs of Graves’ disease:

• Nervousness or irritability
• Fatigue
• Trouble sleeping
• Rapid or irregular heart rate
• Weight loss
• Sensitivity or intolerance to heat
• Increased perspiration or dampness of skin
• Slight hand tremors
• Change in menstrual cycle (females)
• Erectile dysfunction (males)
• Enlarged thyroid gland
• Increased regularity of bowel movements or diarrhea
• Muscle weakness
• Reduced interest in sexual activities

In addition to the more common manifestations listed above, a smaller percentage of those with Graves’ disease may experience Graves' ophthalmopathy or Grave’s dermopathy. These two rarer side effects occur in only about 30% or fewer diagnosed cases.

• Graves’ ophthalmopathy occurs when inflammation causes the eyelids to retract and the eyes to enlarge or appear to bulge from their sockets. Additional indicators of ophthalmopathy can include puffy eyelids, pressure or pain in the eyes, light sensitivity, reddening of the eyes, double vision or vision loss. Most of the time, this symptom is mild.
• Even more uncommon, Graves’ dermopathy is the presence of thick, reddened skin on the shins and tops of the feet. This symptom is usually painless and mild.

If you or a loved one experience any of the Graves’ disease symptoms, please do not delay in seeking proper medical support. Begin with making an appointment with your primary care physician.

Causes

The ultimate cause of Graves’ disease is unknown and may differ per person. As with all autoimmune diseases, the immune system malfunctions. Typically, your immune system produces special proteins called antibodies to defend against invading bacteria and viruses. However, with Graves’ disease, your immune system mistakenly produces antibodies that target and attack healthy tissue and cells in your body.

While research is ongoing for exact and conclusive causes of Graves’ disease, there are several known risk factors for developing the condition:

• Age
• Gender
• Family history
• Stress
• Smoking
• Preexisting autoimmune disorders

The most vulnerable population for developing Graves’ disease are women under the age of 40 who smoke, who experience prolonged periods of high stress, who have a preexisting immune disease and/or who have a strong family history of autoimmune disorders. Examples of preexisting or genetically inherited autoimmune disorders are Type 1 diabetes, lupus, rheumatoid arthritis and Crohn’s disease.

Diagnosis

Your physician will take one or more of the following steps to diagnose Graves’ disease:

• Medical history review: Your doctor will ask routine questions about your health, symptoms and medical history to uncover risk factors for Graves’ disease.
• Physical examination: Your doctor will conduct a physical examination to discover and/or more thoroughly inspect any presenting signs and symptoms related to Graves’ disease.
• Blood tests: A blood test can detect thyroid-stimulating immunoglobulin (TSI), the protein antibody produced by the thyroid that is attacking the healthy cells instead of protecting them.
• Imaging scans: There are two forms of imaging scans used for Graves’ disease diagnosis.
  • A Radioactive Iodine Uptake Test uses safe doses of iodine to measure how much iodine the thyroid collects. The more iodine your thyroid collects, the greater likelihood of Graves’ disease.
  • A Thyroid Scan shows the pattern of iodine distribution in the thyroid. The pattern for Graves’ disease is characteristically widespread dispersion throughout the thyroid (as opposed to gathered into clusters).

The prognosis for Grave’s disease is optimistic, generally with no long-term adverse health consequences. Once accurately diagnosed, most medical professionals consider the treatment for the condition relatively simple and straightforward. The condition sometimes goes into remission or disappears entirely within a few months or years of treatment.

Treatment

There are three standard treatment options for Graves’ disease. Your doctor will recommend a specific Graves’ disease treatment based on your current health, medical history and response to other treatment options.

The three main treatments for Graves’ disease are:

• Radioactive iodine (RAI) therapy: In this treatment, you ingest pills filled with safe doses of radioactive iodine to shrink your thyroid. This treatment typically takes 3-6 months.
• Anti-thyroid drugs: In this treatment, your doctor prescribes anti-thyroid medication. These medications prevent the thyroid from producing the TSI protein antibodies. You may also be prescribed beta-blockers to diminish the symptoms of Graves’ disease until the anti-thyroid medication fully activates in your system. Doctors usually prefer this treatment for pregnant and breastfeeding women, since it may be the safest treatment option for the baby. Anti-thyroid drug treatment generally takes 3 months to relieve your symptoms. This is typically followed by a medication regimen that lasts up to 18 months to prevent relapse of the condition.
• Thyroid surgery: Typically, your doctor will fully explore RAI therapy and anti-thyroid drug treatments before recommending surgery. Thyroid surgery will remove your thyroid. This operation risks damaging your vocal cords and parathyroid glands, which control the amount of calcium levels in your blood. After surgery, you may require medication to manage your calcium levels.

In addition to these standard treatments, if you suffer from Graves’ ophthalmopathy (inflammation behind your eyes) or Graves’ dermopathy (red, scaly skin on your shins and feet), your doctor may prescribe special treatments. For Grave’s ophthalmopathy, your doctor may recommend eye drops and steroids to reduce the swelling. In some severe cases, eye surgery is necessary. For Graves’ dermopathy, treatment usually involves a combination of cortisone creams, cortisone injections and cortisone stockings.

Complications

Left untreated, Graves’ disease can lead to severe health conditions. Complications can be especially serious for individuals whose wellbeing is already impacted by additional health or life circumstances, such as pregnancy, other autoimmune disorders, age, smoking or high levels of emotional or physical stress.

Graves’ disease complications can include:

• Heart problems: Untreated Graves’ disease can affect heart rhythm, heart muscle structure and heart function. It can reduce the capacity of the heart to pump enough blood to the body to support and sustain life.
• Brittle bones: Untreated hyperthyroidism can reduce the body’s ability to assimilate calcium into your bones. This can lead to weak, easily damaged bones, a condition known as osteoporosis.
• Pregnancy difficulties: Consequences during pregnancy can include miscarriage, early birth, poor fetal growth, heart failure of the mother and preeclampsia (high blood pressure and other issues).
• Thyroid storm: A rapid and extreme surge in thyroid hormones can trigger fever, sweating, vomiting, confusion, severe weakness, seizures, sporadic heartbeat, plunging blood pressure and unconsciousness (coma). A thyroid storm is also referred to as accelerated hyperthyroidism or thyrotoxic crisis. This rare and life-threatening complication requires immediate emergency care.

Early assessment, diagnosis and treatment can often prevent or significantly minimize any complications of Graves’ disease. Baptist Health can help.