Graves Disease

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overview

Graves Disease

Graves disease is a rare, sometimes life-threatening, autoimmune (immune system) disorder that affects the thyroid resulting in the overproduction of thyroid hormones. Although several conditions can cause hyperthyroidism, Graves disease is considered the most common cause. Graves disease, also sometimes called Basedow’s disease, or toxic diffuse goiter, affects fewer than 200,000 people per year in the United States. Graves disease is also sometimes spelled differently, such as Grave’s disease or Graves’ disease. 

It appears that those who are affected may have a genetic predisposition to Graves disease, but the exact gene inheritance pattern is not clear. Even if someone has inherited the genes that cause it, they may not have any symptoms unless it is “triggered,” meaning something happens to activate it.   

Females under the age of 40 seem to be most at risk of developing Graves disease. Besides age, sex, and genetic factors, additional risks for developing Graves disease include: 

  • Being pregnant or having recently given birth 
  • Being under high emotional or physical stress 
  • Smokers because smoking cigarettes can affect the immune system 
  • Having other autoimmune disorders such as type 1 diabetes or rheumatoid arthritis 

Graves disease during pregnancy 

Graves disease during pregnancy can be life-threating events for both the mother and the unborn child because it can cause:  

  • Miscarriage 
  • Premature birth 
  • Poor fetal growth 
  • Fetal thyroid dysfunction 
  • Preeclampsia 
  • Maternal heart failure 
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Females under the age of 40 seem to be most at risk of developing Graves disease

Symptoms

Graves Disease Symptoms

  • Fatigue
  • Weakness
  • Mood swings
  • Sensitivity to heat 
  • Sudden unexpected/unintended
  • weight loss  
  • Anxiety or irritability 
  • Erectile dysfunction
  • Reduced sex drive (libido) 
  • Change in menstrual cycles
  • An increase in perspiration or warm, moist skin  
  • Small tremors of the hands or fingers 
  • Enlargement of the thyroid gland (goiter)
  • Rapid or irregular heartbeat (palpitations)
  • Sleep disturbances 
  • Frequent bowel movements

Palpitations can be life-threatening and require immediate medical attention.  

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Thyroid Storm

A “thyroid storm” is a life-threatening event. Signs of a thyroid storm may include a sudden onset of: 

  • Sweating 
  • Extreme weakness  
  • Irregular heartbeat 
  • Seizures or delirium 
  • Diarrhea or vomiting  
  • Severely low blood pressure 
  • Yellow skin and eyes (jaundice) 

Urgent medical attention is needed because a thyroid storm can lead to coma and death if left untreated.  

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Graves Dermopathy

Graves Dermopathy, although not typical, is another feature of Graves disease that affects the skin, and some signs include:  

  • Thick, red skin usually on the shins or tops of the feet  
  • Change in skin texture and color, especially on top of the feet 
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Graves Ophthalmopathy

Graves Ophthalmopathy, also known as thyroid eye disease, affects the eyes of about 30% of people with Graves disease, and those who smoke are at a greater risk of developing Graves ophthalmopathy. Symptoms most often start within six months of being diagnosed with Graves disease. But in some patients with eye symptoms, hyperthyroidism never develops and, in rare cases, patients may be affected by hypothyroid instead of hyperthyroid. The severity of the eye symptoms is not related to the severity of the hyperthyroidism.  

Graves Ophthalmopathy symptoms may include:  

  • Dry or gritty eyes  
  • Painful or red eyes 
  • Puffy or bulging eyes which can cause inability to completely close the eyelid 
  • Double vision or light sensitivity 
  • Irritated eyes or excessive tearing 
  • Decreased eye or eyelid movement 
  • Inflammation in the white of the eye (conjunctiva) 
  • A change or loss of vision which may indicate compression of the optic nerve 
  • Corneal ulceration 

A loss of vision requires immediate medical attention.  

Diagnosis

Graves Disease Diagnosis

Your doctor will order blood tests to check your thyroid hormone levels. Depending on the results, your doctor may order a radioactive iodine uptake (RAIU) and scan test. RAIU tests measure the amount of iodine absorbed by the thyroid gland and take place in a hospital. Your doctor may order an ultrasound to see if you have an enlarged thyroid gland. Other possible tests include a CT scan or MRI.   

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Treatments

Graves Disease Treatments

Treatment for Graves disease varies depending upon the individual and the type of symptoms they are experiencing. But almost everyone will benefit from lifestyle changes no matter their situation. 

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Lifestyle Changes

Treatment for Graves disease may begin with lifestyle changes. Eating well and exercising can help you feel better by controlling your metabolism and thyroid. Weight-bearing exercises can strengthen your bones which can weaken and become brittle with Graves disease. Doing activities to ease your stress levels, such as listening to music, taking a walk, going jogging, swimming, or taking a bath, can improve your mental and emotional health and make you less susceptible to Graves disease. If you smoke, your symptoms may improve if you quit smoking.   

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Medications

Lifestyle changes alone are not sufficient in treating your Graves disease. Medications may help regulate thyroid hormone levels. Antithyroid medications such as Propylthiouracil and Methimazole can control the overproduction of thyroid hormones. Beta-blockers such as Atenolol, Propranolol, and Metoprolol can block hormone activity and relieve symptoms. If medication alone doesn’t alleviate your symptoms, then radioactive iodine therapy may be the next step.

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Radioactive Iodine Therapy

Taking radioiodine by mouth can treat Graves disease. With this therapy, the radiation destroys the overactive cells over time, causing your thyroid gland to shrink over weeks or months. This therapy is not appropriate for pregnant women or women who are breastfeeding.  

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Surgery

Thyroidectomy is a medical procedure to remove part or all of your thyroid. Complications are rare under the care of an experienced thyroid surgeon, and you will need to take thyroid medication for life after this surgery. 

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For Graves Dermopathy

If the disease affects your skin, using over-the-counter ointments and creams with hydrocortisone may relieve swelling and reddening. Also, using compression wraps on your legs may help. 

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For Graves Ophthalmopathy

Graves ophthalmopathy does not always improve with the treatment of Graves disease alone. Symptoms of Graves ophthalmopathy might even get worse for three to six months. After that, symptoms of Graves ophthalmopathy usually become stable for a year or so and then begin to get better, often on their own. But there are some things you can do in the meantime to reduce the symptoms. 

Applying cool compresses to your eyes may soothe them. Wearing sunglasses will protect them from ultraviolet rays, bright light, and wind. Over-the-counter artificial tears during the day and lubricating gels at night will help reduce scratchiness. Elevating the head of your bed will minimize fluid accumulation in your head and may help relieve the pressure on your eyes. If you smoke, now is a good time to quit because smoking worsens your symptoms. 

If your symptoms are not relieved by the above recommendations, your doctor may refer you to an Ophthalmologist for recommendations on medications or surgery.  

Specialists

Graves Disease Specialists