Graves’ Disease: Symptoms, Diagnosis and Treatment

Grave’s disease is an autoimmune disorder that results in increased production of thyroid hormones. Autoimmune disorders are those in which the immune system of the body attacks the cells of their own body. Though hyperthyroidism can be caused by many diseases but Graves’ disease is one of the most common causes. This disease affects every one out of 200 people. Thyroid hormones control the metabolism of the body so the signs and symptoms are wide-ranging. It can affect any’s group but it is the more common disease in women.

Symptoms of Graves’ disease

The common symptoms of the disease are due to excess of thyroxine hormone and due to underline autoimmune disease

• Restlessness
• Weight loss
• Weak tremors
• Irritability
• Enlargement of the thyroid gland (goiter) seen as swelling in the anterior neck.
• Altered menstrual cycles in the women
• Reduced libido in men
• Increased heart rate and irregular heartbeat/ palpitation
• Graves’ ophthalmology: The immune system and inflammation affect muscles and other tissue around the eyes. Every one out of three people suffering from Graves’ disease suffers from this. Symptoms are Bulging eyes, Gritty sensation in the eyes, eye Pressure, Redness
• Graves’ dermopathy:  very Uncommon symptom, rudeness, and thickening of skin occurs generally in the shin area.

Causes of Graves’ disease

As told earlier it is an autoimmune disorder, your normal immune system produces antibodies to fight against foreign pathogens such as bacteria, fungi, viruses but sometimes the immune system becomes malfunctioned and starts forming antibodies against your own cell of the body. The mechanism behind this autoimmunity is not known properly. The antibody produced in Graves’ disease is called a thyrotropin receptor antibody (TrAB). This antibody behaves similarly to that pituitary hormone which tells the thyroid gland how much thyroxine is to be produced.

Risk factors for Graves’ disease

Physicians are not sure why only some people develop Graves’ disease but they have found that the following factors increase the risk of having Graves’ disease

• Age: It can affect at any age but it occurs usually in people of age group 30 to 40
• Gender: Females have seven to eight times higher chance than males
• Family history and genetics: It has been observed that people having affected family members are at increased risk of having Graves’ disease
• Other autoimmune disorders: people easily get an autoimmune disorder when they have pre-existing autoimmune disorders like type 1 diabetes, rheumatoid arthritis, pernicious anemia, lupus etc.
• Smoking: cigarette smoking can give a blow to many diseases and Graves’ disease is one of them.

Diagnosis of Graves’ disease

Most of the times, diagnosis can be made by medical history or physical examination only but to confirm the diagnosis your doctor can order some test

• Medical history: Your doctor will ask you many questions related to your signs and symptoms, physical activity, your family history
• Physical examination: Basically, your doctor will check your Vitals such as blood pressure, temperature, heart rate and check for anterior neck swelling, eye bulge or signs of tumor

         Tests

Blood tests: Blood tests may help to differentiate between several causes of hyperthyroidism. Your doctor can directly check the levels of TrAB but in some cases of Graves’ disease, its level is minute to be determined. so, it is better to check for the level of thyroxine and thyroid-stimulating hormone (TSH). In Graves’ disease, thyroxine levels are high but TSH is low

Radioactive iodine uptake test: The thyroid gland needs iodine for the production of thyroxine hormones. Since normal iodine cannot be detected so, a small amount of radioactive iodine is given. This test helps to determine the amount and rate of iodine uptake which is high in Graves’ disease.

Ultrasound: It is used to see the enlargement of the thyroid gland by using high-frequency sound waves. It is helpful in a condition where radioactive iodine uptake test can not be done like pregnancy

CT scan/MRI: It can be used to make out the diagnosis of Graves’ ophthalmopathy because it requires separate treatment.

Treatment of Graves’ disease

 The two goals of the treatment of Graves’ disease is to reduce the production of thyroxine hormone and block its effect. There are three treatment options available and on the basis of your age and other medical conditions your doctor will advise you on the most suitable treatments option as

• Radioiodine therapy: most common treatment for Graves’ disease in the US but nowadays physicians are shifting to medications. Upon your doctor’s advice you will capsule or liquid containing radioactive iodine (I-131). The dose of radioactive iodine is more than that used in the radioiodine uptake test but still adequate that it only destroys thyroxine producing thyroid gland. Symptoms can be controlled by beta-blockers. This treatment option can not be used for pregnant or breastfeeding women due to the risk of damaging the baby’s thyroid gland

Medications

• Beta-blockers – these reduce some of the symptoms of excess thyroid hormones like increased heart rate, tremors or nervousness.
• Antithyroid medications – don’t provide a permanent cure but effects last longer even after stopping the medications. Doctors prescribe methimazole generally. Medications are used for pregnant and breast-feeding women in which radioiodine therapy cannot be used. The average treatment is around 12 to 18 months but treatment can continue for years. Up to 3 months of pregnancy, methimazole cannot be given due to its side effects so in this time period doctor uses propylthiouracil.
• Surgery:  the thyroid gland is removed surgically and patiently suffers from hypothyroidism for the rest of life for which he or she takes thyroid hormones medication.

Reference:

• A 2011 survey of clinical practice patterns in the management of Graves’ disease. Journal of Clinical Endocrinology and Metabolism;97(12):4549-4558.
• Graves’ disease. The New England Journal of Medicine.2016;375(16):1552-1565.
• Genetics Home Reference. National Library of Medicine. National Institutes of Health.
• 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343–1421.