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Graves’ Disease

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Graves' disease also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid, resulting in the overproduction of thyroid hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves' disease is a common cause. It is the most common cause of hyperthyroidism in the United States. It is named after Robert Graves, an Irish physician, who described this form of hyperthyroidism about 150 years ago.

Because thyroid hormones affect a number of different body systems, signs and symptoms associated with Graves' disease can be wide ranging and significantly influence your overall well-being. Although Graves' disease may affect anyone, it's more common among women and before the age of 40.

The primary treatment goals are to inhibit the overproduction of thyroid hormones and lessen the severity of symptoms.

Symptoms of Graves' disease include:

  • Anxiety and irritability
  • Muscle weakness
  • Sleeping problems
  • A fine tremor of your hands or fingers
  • Heat sensitivity and an increase in perspiration or warm, moist skin
  • Weight loss, despite normal eating habits
  • Enlargement of your thyroid gland (goiter)
  • Change in menstrual cycles
  • Erectile dysfunction or reduced libido
  • Frequent bowel movements
  • Bulging eyes (Graves' ophthalmopathy)
  • Fatigue
  • Thick, red skin usually on the shins or tops of the feet (Graves' dermopathy)
  • Rapid or irregular heartbeat (palpitations)

When to see a doctor

A number of medical conditions can cause the signs and symptoms associated with Graves' disease. See your doctor if you experience any potential problems related to Graves' disease to get a prompt and accurate diagnosis.

Seek emergency care if you're experiencing heart-related signs and symptoms, such as a rapid or irregular heartbeat, or if you develop vision loss.

Causes:

The exact cause is unclear. It is believed to involve a combination of genetic and environmental factors. While a theoretical mechanism occurs by which stress could cause an aggravation of the autoimmune response that leads to Graves' disease, more robust clinical data are needed for a firm conclusion.

A genetic predisposition for Graves' disease is seen, with some people more prone to develop TSH receptor activating antibodies due to a genetic cause. Human leukocyte antigen DR (especially DR3) appears to play a role. To date, no clear genetic defect has been found to point to a single-gene cause.

Graves' disease is caused by a malfunction in the body's disease-fighting immune system, although the exact reason why this happens is still unknown. One normal immune system response is the production of antibodies designed to target a specific virus, bacterium or other foreign substance. In Graves' disease — for reasons that aren't well understood — the body produces an antibody to one part of the cells in the thyroid gland, a hormone-producing gland in the neck.

Normally, thyroid function is regulated by a hormone released by a tiny gland at the base of the brain (pituitary gland). The antibody associated with Graves' disease — thyrotropin receptor antibody (TRAb) — acts like the regulatory pituitary hormone. That means that TRAb overrides the normal regulation of the thyroid, causing an overproduction of thyroid hormones (hyperthyroidism).

Cause of Graves' ophthalmopathy:

This condition results from a buildup of certain carbohydrates in the muscles and tissues behind the eyes — the cause of which also isn't known. It appears that the same antibody that can cause thyroid dysfunction may also have an "attraction" to tissues surrounding the eyes.

Graves' ophthalmopathy often appears at the same time as hyperthyroidism or several months later. But signs and symptoms of ophthalmopathy may appear years before or after the onset of hyperthyroidism. Graves' ophthalmopathy can also occur even if there's no hyperthyroidism.

Risk factors:

Although anyone can develop Graves' disease, a number of factors can increase the risk of disease. These risk factors include the following:

  • Family history. Because a family history of Graves' disease is a known risk factor, there is likely a gene or genes that can make a person more susceptible to the disorder.
  • Gender. Women are much more likely to develop Graves' disease than are men.
  • Age. Graves' disease usually develops in people younger than 40.
  • Other autoimmune disorders. People with other disorders of the immune system, such as type 1 diabetes or rheumatoid arthritis, have an increased risk.
  • Emotional or physical stress. Stressful life events or illness may act as a trigger for the onset of Graves' disease among people who are genetically susceptible.
  • Pregnancy. Pregnancy or recent childbirth may increase the risk of the disorder, particularly among women who are genetically susceptible.
  • Smoking. Cigarette smoking, which can affect the immune system, increases the risk of Graves' disease. Smokers who have Graves' disease are also at increased risk of developing Graves' ophthalmopathy.

Complications can include:

  • Pregnancy issues. Possible complications of Graves' disease during pregnancy include miscarriage, preterm birth, fetal thyroid dysfunction, poor fetal growth, maternal heart failure and preeclampsia. Preeclampsia is a maternal condition that results in high blood pressure and other serious signs and symptoms.
  • Heart disorders. If left untreated, Graves' disease can lead to heart rhythm disorders, changes in the structure and function of the heart muscles, and the inability of the heart to pump enough blood to the body (congestive heart failure).
  • Thyroid storm. A rare, but life-threatening complication of Graves' disease is thyroid storm, also known as accelerated hyperthyroidism or thyrotoxic crisis. It's more likely when severe hyperthyroidism is untreated or treated inadequately.
    • The sudden and drastic increase in thyroid hormones can produce a number of effects, including fever, profuse sweating, vomiting, diarrhea, delirium, severe weakness, seizures, markedly irregular heartbeat, yellow skin and eyes (jaundice), severe low blood pressure, and coma. Thyroid storm requires immediate emergency care.
  • Brittle bones. Untreated hyperthyroidism also can lead to weak, brittle bones (osteoporosis). The strength of your bones depends, in part, on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with your body's ability to incorporate calcium into your bones.

Diagnosis:

The diagnosis may be suspected based on symptoms and confirmed with blood tests and radioiodine uptake. Typically, blood tests show a raised T-3 and T-4, low TSH, increased radioiodine uptake in all areas of the thyroid, and TSI antibodies.

Treatments:

The three treatment options are radioiodine therapy, medications, and thyroid surgery.

  • * Radioiodine therapy involves taking iodine-13 by mouth, which is then concentrated in the thyroid and destroys it over weeks to months. The resulting hypothyroidism is treated with synthetic thyroid hormone.
    • Medications such as beta blockers may control some of the symptoms, and antithyroid medications such as methimazole may temporarily help people while other treatments are having effect.
    • Surgery to remove the thyroid is another option. Eye problems may require additional treatments.
  • Foods (diet) to avoid if you have Graves' disease:
    • People with Graves' disease may be sensitive to harmful side effects from iodine. Eating foods that have large amounts of iodine - such as kelp, dulse, or other kinds of seaweed - may cause or worsen hyperthyroidism. Taking iodine supplements can have the same effect.
    • Talk with your health care professional about what foods you should limit or avoid, and let him or her know if you take iodine supplements. Also, share information about any cough syrups or multivitamins that you take because they may contain iodine.

Statistical info:

  • Graves’ Disease affects approximately 2-3% of the population or almost 10 million people. The figure may be higher because some may have eye involvement but not diagnosed with thyroid problems.
  • Graves disease affects about 1 in 200 people.
  • Graves' disease will develop in about 0.5% of males and 3% of females.
  • It occurs about 10 times more often in women than in men.
  • Often, it starts between the ages of 40 and 60, but can begin at any age.
  • It is the most common cause of hyperthyroidism in the United States (about 50 to 80% of cases).
  • Between 25 and 50 percent of people with Graves disease have eye abnormalities, which are known as Graves ophthalmopathy.
  • A person’s chance of developing Graves’ disease increases if other family members have the disease.
  • People with other autoimmune disorders, such as rheumatoid arthritis, pernicious anemia, lupus, addison’s disease, celiac disease, vitiligo, & type 1 diabetes, are more likely to develop Graves’ disease than people without these disorders.
  • Graves’ disease is the most common cause of hyperthyroidism.
  • It is rarely fatal, but can be if untreated.

Notables with Graves’ Disease:

  1. HRF - Famous People with Graves Disease (15 Dec 2013)
  2. College Candy - 10 Celebrities with Graves Disease & Other Thyroid Disorders (21 Feb 2018)
  3. Wikipedia - Graves’ Disease - Notable cases

References & Further Reading:
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