What Is Graves' Disease?
Graves' disease is an autoimmune disease that causes high levels of thyroid hormone in the body (hyperthyroidism). The thyroid gland, located in the neck, makes thyroid hormone, which controls how the body uses and stores energy. In Graves' disease, the body's immune system mistakenly attacks the thyroid gland, causing it to grow and produce more thyroid hormone.
Graves' disease can occur at any age but most commonly affects adults between the 30-50 years of age. It is seven to eight times more common in women than men.
What Are Signs and Symptoms of Graves' Disease?
Symptoms and signs of Graves' disease include the following:
- Increased metabolism and weight loss, despite an increase in appetite
- Warm, most, fine skin
- Increased sweating
- Fine hair
- Loss of skin pigmentation (vitiligo)
- Hair loss
- Abnormally thick and waxy skin over the shins (pretibial myxedema)
- Thyroid eye disease, characterized by
- eye inflammation and irritation,
- bulging eyes,
- eyelid abnormalities (widening of edges of eyelids [palpebral fissures], upper eyelid higher than normal [lid lag], lid retraction),
- impairment of eye muscle motion,
- visual loss in severe optic nerve involvement, and
- swelling around the eyes.
- Enlarged thyroid gland in the neck
- Breast development in males
- Rapid breathing
- Fast heart rate
- Heart murmur
- Irregular heart rate and rhythm
- Hyperdynamic precordium; S3, S4 heart sounds; ectopic beats
- Hyperactive bowel sounds
- Swelling of extremities
- Clubbed digits
- Separation of fingernails or toenails from nailbed
- Hand tremor
- Hyperactive deep tendon reflexes
- Rounding of the back (kyphosis), inner curvature of the spine (lordosis)
- Loss of height
- Muscle weakness
- Muscle weakness or paralysis due to low blood potassium
- Restlessness
- Anxiety
- Irritability
- Insomnia
- Depression
What Causes Graves' Disease?
The cause of Graves' disease is unknown. Researchers think that a combination of genetics (a person has a greater chance of developing Graves' disease if other family members have it) and an outside trigger, such as a virus, cause Graves' disease.
People with other autoimmune disorders are more likely to develop Graves' disease than the general population. Conditions linked with Graves' disease include the following:
How Do Doctors Diagnose Graves' Disease?
A doctor will first take a medical history and perform a physical examination. Following that, a doctor may order these tests:
- Ultrasensitive (third-generation) thyrotropin assays
- Thyroid function tests
- Liver function tests
- Complete blood count (CBC) with differential
- Radioactive iodine scanning and measurements of iodine uptake
- Ultrasound of the thyroid gland
What Is the Treatment for Graves' Disease?
The most common treatment for Graves' disease is radioactive iodine taken orally. The radioactive iodine enters the thyroid cells, and the radioactivity destroys the overactive cells, which results in the thyroid shrinking and symptom reduction. This treatment may cause thyroid activity to decline to a point where thyroid hormone supplementation therapy is needed later on.
Other treatments for Graves' disease include:
- beta-blockers, which help block the effects of thyroid hormones on the body;
- antithyroid medications such as propylthiouracil and methimazole (Tapazole); and
- full or partial thyroid removal surgery (thyroidectomy or subtotal thyroidectomy) is usually not a recommended first-line therapy for Graves' disease, though it may be indicated if a thyroid nodule is suspected to be cancerous.
Radioactive iodine therapy also treats Graves' ophthalmopathy (thyroid eye disease).
Doctors recommend that people with Graves' disease quit smoking because smoking worsens symptoms.
Patients may also take the following conservative measures to alleviate symptoms and signs of thyroid eye disease:
- Wearing sunglasses
- Use of artificial tears (saline eyedrops)
- Raising the head of the bed at night
- Eye patching or prisms
- Prisms in eyeglasses to correct double vision
Additional treatments for Graves' ophthalmopathy include
- cholesterol-lowering drugs of the hydroxymethylglutarate-coenzyme A reductase inhibitor class;
- corticosteroids to reduce swelling;
- orbital decompression surgery; and
- orbital radiotherapy.
What Are Complications of Graves' Disease?
If Graves' disease is left untreated, it can cause excessively high levels of thyroid hormone in the blood (severe thyrotoxicosis) resulting in a life-threatening thyrotoxic crisis (called a thyroid storm).
Chronic severe thyrotoxicosis leads to serious weight loss with breakdown of bone and muscle.
Cardiac complications and psychological and cognitive complications can cause significant illness. Graves' disease is also associated with eye disease and skin disease.
What Is the Life Expectancy for Graves' Disease?
Graves' disease itself is rarely life-threatening, but it can lead to serious heart problems, weak bones, breakdown of muscle, eye disease, and skin disease. These complications may decrease normal life expectancy.
Thyroid storm (thyrotoxic crisis), where thyroid hormone levels are chronically and seriously high, has a mortality rate of approximately 20%.
