Graves' disease is a thyroid-specific autoimmune disorder in which the body makes antibodies to the thyroid-stimulating hormone receptor (TSHR), leading to hyperthyroidism, or an abnormally strong release of hormones from the thyroid gland. Normally, the release of thyroid hormones is mediated by thyroid-stimulating hormone (TSH), a hormone secreted by the pituitary gland that binds to TSHR to stimulate the thyroid to release thyroid hormones. This normal cycle is self-regulating: the hormones secreted by the thyroid keep more TSH from being produced Causes of Graves Disease
Normally, your immune system uses naturally occurring proteins (antibodies) and white blood cells (lymphocytes) to help eliminate viruses, bacteria and foreign substances (antigens) that invade your body.
If the body makes too much thyroid hormone, the condition is called hyperthyroidism. (An underactive thyroid leads to hypothyroidism.)
Graves disease is the most common cause of hyperthyroidism. The production of thyroid hormone is increased, causing a wide range of symptoms from anxiety and restlessness to insomnia and weight loss. In addition, the eyeballs may begin to stick out (exophthalmos), causing eye irritation and tearing. Exactly why the immune system begins to produce these aberrant antibodies is unclear. Heredity and other characteristics seem to play a role in determining susceptibility. Studies show, for example, that if one identical twin contracts Graves' disease, there is a 20% likelihood that the other twin will get it, too. Also, women are more likely than men to develop the disease. And smokers who develop Graves' disease are more prone to eye problems than nonsmokers with the disease. No single gene causes Graves’ disease.
What are the symptoms?
The thyroid gland grows larger (goiter) as it produces more and more hormone. Common symptoms of hyperthyroidism include weight loss, nervousness, irritability, sweating, dislike of hot weather, shakiness, and rapid pulse. About 50% of patients have red, watery, bulging eyes (the actor Marty Feldman had a severe case).
Excessive sweating
Heat intolerance
Increased bowel movements
Tremor (usually fine shaking)
Nervousness; agitation
Rapid heart rate
Treatment of Graves Disease
Antithyroid drugs
The main antithyroid drugs are carbimazole (UK), methimazole (US), and propylthiouracil (PTU). These drugs block the binding of iodine and coupling of iodotyrosines. The most dangerous side-effect is agranulocytosis (1/250, more in PTU); this is an idiosyncratic reaction which does not stop on cessation of drug. Others include granulocytopenia (dose dependent, which improves on cessation of the drug) and aplastic anemia. Patients on these medications should see a doctor if they develop sore throat or fever.
The first treatment is about 20-30% effective, and the latter two treatments result in about a 90-95% resolution rate of the disease. In a few cases, the treatments must be repeated. In all cases, lifetime follow-up laboratory studies must be done, and in almost all cases, lifetime replacement thyroid hormone must be taken.
Surgery -- In severe cases, surgery to remove the thyroid, called thyroidectomy, may be performed. If the thyroid is removed, replacement thyroid hormones must be taken for the rest of a person's life. Candidates for surgery may include pregnant hyperthyroid patients intolerant of antithyroid drugs, patients desiring definitive therapy without the use of radioactive iodine, children and patients with very large or nodular goiters.
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