Introduction

GRAVE’S DISEASE is an autoimmune disorder that affects the thyroid gland. As an autoimmune disorder, the immune system mistakenly attacks healthy and normal body cells and tissues. Most of the time, it  causes the thyroid gland to make excessive quantities of thyroid hormones, a condition called hyperthyroidism.

With hyperthyroidism, most of the processes in the body are sped up.

The thyroid gland is a small organ, with the shape of a butterfly, found in the neck region anterior to the windpipe.The thyroid gland makes thyroid hormones such as triiodothyronine (T3) and tetraiodothyronine (T4) that are involved in processes of metabolism. They also affect other body organs- they affect how the heart beats.

 

 Key Facts & Statistics

What are the key facts and statistics about Grave’s disease?

• It affects 1% of the American population.
• It is the main cause of hypothyroidism. In the united States, Grave’s disease is responsible for 80% cases of hypothyroidism.
• Grave’s disease is named after an Irish physician called Robert Graves. He first  described the disorder in the 19^th century.
•   About 25%-30% of individuals with Grave’s disease present with eye symptoms. This is referred to as Grave’s ophthalmopathy.

 

 Risk Factors

What are the risk factors for Grave’s disease?

• Family history. Having a family history of Grave’s disease.
• Sex. It affects women and persons assigned female at birth (AFAB) more as compared to their counterpart males.
• Age. Grave’s disease typically happens in persons aged between 30 to 50 years. However, it can affect children and adults.
• Presence of other autoimmune disorders. This include;

1.  Vitiligo.
2.  Lupus.
3.  Rheumatoid arthritis.
4.  Type 1 diabetes.

• Smoking. This unhealthy practice affects the immune system, increasing the risk for development of Grave’s disease. Smokers with Grave’s disease have higher chance of developing thyroid eye disease.

 Causes & Triggers

What are the causes of Grave’s disease?

The exact cause(s) of autoimmune conditions such as Grave’s disease is unknown.

Usually, the immune system gets triggered to produce excessive amounts of an antibody. This antibody is referred to as thyroid-stimulating immunoglobulin (TSI).

Attachment of TSI antibodies onto normal thyroid cells makes these cells to produce thyroid hormones in more than normal levels.

 

What factors trigger Grave’s disease?

Triggers include 2 factors combining, usually:

•  Genetic predisposition.
• Environmental factors. These can be infections and stress.

 

 Signs & Symptoms

What are the signs and symptoms of Grave’s disease?

• Grave’s disease occurs gradually, and it takes weeks or even months to develop.
• This condition can cause hypothyroidism, and thus many patients may present with signs and symptoms of hyperthyroidism, which include:

1. Tachycardia.
2. Raised blood pressure.
3. Increased perspiration and heat sensitivity.
4. Nervousness and irritability.
5. Hand tremors.
6. Sleeping problems.
7. Goiter, which is neck swelling and enlargement.
8. Swollen eyes.
9. Irregular menses.
10. Menstrual changes.
11. Muscle weakness.
12. Insomnia.
13. Loss of weight.
14. Hair loss.
15. More frequent bowel movements.
16. Increased appetite.
17. Rapid heartbeat.
18. Warm and moist skin.

 

Eye disease signs and symptoms

• Grave’s disease can cause eye disease symptoms, and this condition is referred to as Grave’s ophtalmopathy.
• It happens when the immune system attacks the muscles and tissues surrounding the eyes. Signs and symptoms include:

1. Blurred vision.
2. Painful eyes.
3. Sensitivity to light.
4. Puffy (swollen) eyes.
5. Bulging eyes.

 

Skin problems

• Pretibial myxedema (Grave’s dermopathy). This is a reddish thickening of the skin on the shin that appears as a lump.
• It develops rarely.

 

 Diagnostic Procedures  & Tests

How is Grave’s disease diagnosed?

• Data regarding Grave’s disease can be obtained from the patient through:

1. Patient history-taking.
2. Physical examination.

• After assessment and evaluation of the information obtained, tests can be conducted in order to confirm a diagnosis.
• To confirm a diagnosis of Grave’s disease:

1. Blood tests. These are conducted to quantify the levels of thyroid hormones and also check for TSI.
2. Radioactive iodine uptake test. It quantifies the amount of iodine that the thyroid gland is taking up from the bloodstream.  Intake of excessive quantities may be suggestive of Grave’s disease.
3. Thyroid scan. It is performed together with the radioactive iodine uptake test, which shows how iodine is distributed in the thyroid and to which points of the gland.
4. Doppler blood flow measurement. It is also called Doppler ultrasound. It utilizes sound waves for detecting raised flow of blood in the thyroid as a result of thyroid disease.

 

 Treatment and Management

How is Grave’s disease treated?

Grave’s disease is a chronic disorder. Treatment strategies such as medications can keep the thyroid hormones in check.

With good medical attention, remission may occur (the disease can temporarily go away).

 

Treating hyperthyroidism

Curing hyperthyroidism involves permanent destruction of the thyroid by using oral radioactive iodine which is targeted at destroying the thyroid cells.

 

How is Grave’s  disease (and hyperthyroidism) treated?

• Treatment strategies include:

1. Anti-thyroid medications such as methimazole.
2. Radioactive iodine therapy permanently destroys the thyroid gland and  cures hyperthyroidism. To maintain levels of  thyroid hormones within the normal ranges, levothyroxine (synthetic T4 hormone) must be everyday taken for life.
3. Surgical procedures  to get rid of all or part of the thyroid gland.
4. Beta-blockers that  manage symptoms such as tachycardia that are associated with hyperthyroidism.

 

 Complications

What are the complications of Grave’s disease?

1. Hyperthyroidism. It is known that Grave’s disease is the most common cause of hyperthyroidism.
2. Pregnancy health issues. In pregnant women, Grave’s disease can lead to miscarriage and poor growth of the fetus in-utero. Apart from this, it is associated with preeclampsia in the expectant woman.
3. Weak, brittle bones. Untreated hyperthyroidism can lead to development of osteoporosis because excessive quantities of thyroid hormones cam  make it difficult for calcium to enter the bones.
4. Thyroid storm. It is also known as thyrotoxic crisis or accelerated hyperthyroidism.
5. Heart abnormalities. Untreated Grave’s disease can cause arrhythmia (irregular heart rhythms).

 

Prevention

How do we prevent Grave’s disease?

It is still unclear what are the causes of autoimmune conditions such as Grave’s disease.

Currently, it is unfortunate that there are no known ways for preventing Grave’s disease.