Graves disease is an autoimmune thyroid disorder characterized by hyperthyroidism, ophthalmopathy and goitre. The autoimmune process in Graves disease is influenced by a combination of environmental and genetic factors. The signs and symptoms of Graves' disease include insomnia, tremor, hyperactivity, hyperhidrosis, heat intolerance, weight loss despite increased appetite, diarrhea, frequent defecation, palpitations and muscle weakness. It is named after Robert James Graves, a British physician.
The younger patients suffering from Graves’ disease usually present with the typical symptoms of thyrotoxicosis. Most of the symptoms are due to increased activation of the sympathetic system . In the elderly age group, there may be no symptoms or only subtle ones.
Patients suffering from Graves' disease may have the following complaints on history:
Physical exam may demonstrate the following findings:
Graves’ disease, if left untreated, results in a state of life threatening thyrotoxicosis which is known as thyroid storm . Even with early recognition and aggressive therapy, the mortality of this condition is 20% . It results in various complications including weight loss with catabolism of bone and muscle, cardiac complications and psycho-cognitive complications. Graves’ disease is also associated with dermopathy, ophthalmopathy and acropathy.
Various tests are helpful in establishing any diagnosis related to the thyroid gland.
The treatment of Graves’ disease depends upon symptoms and thyrotoxic states. Treatment options include drugs, surgery and radiation.
Either total or subtotal thyroidectomy is performed to reduce the mass of the active thyroid gland.
In the United States, radioactive iodine is given as first line therapy. Its dose usually ranges from 5-15 mCi. Thyroid function tests usually show improvement after 6 to 8 weeks of therapy. Radioactive iodine is absolutely contraindicated in pregnancy.
Many patients remain well after a single course of anti-thyroid drugs, but recurrence can happen at any time. Radioactive iodide is very effective, but often results in abnormally low levels of thyroid hormones (hypothyroidism). Surgery can also cause low levels of thyroid hormones.
The eye signs of Graves' disease tend to improve with anti-thyroid drug treatment. However, some element of the staring appearance often remains.
Normally thyroid gland releases its hormones (T3 and T4) under actions of thyroid stimulating hormone (TSH) that is produced by the pituitary gland in brain. In Graves' disease, abnormal antibodies are produced that are capable of mimicking the action of thyroid stimulating hormone. As a result, the levels of thyroid hormones T3 and T4 are increased. All these conditions collectively result into condition like Graves’ disease.
The prevalence of Graves’ disease varies in different areas around the world. Graves’ disease is most common cause of hyperthyroidism in the United States. These patients often have a family history of autoimmune diseases involving the thyroid gland which include Hashimoto thyroiditis, postpartum thyroiditis, Riedel thyroiditis and others . Graves' disease is also commonly associated with non-thyroid conditions including diabetes mellitus type 1, myasthenia gravis, pernicious anemia, systemic lupus erythematosus, vitiligo and Sjogren syndrome .
The prevalence of maternal thyrotoxicosis is 1 case per 500 persons approximately in United States. In the United Kingdom, the incidence was reported to be 80 cases 100,000 per year in women .
Worldwide, Graves’ disease represents 60 to 90% of all causes of thyrotoxicosis. In one study, the incidence was reported to be around 100 to 200 cases per 100,000 population annually.
The hormones released by thyroid gland regulate the body metabolism and control the rate at which food is converted into energy form. The rate of metabolism is directly dependent on the amount of thyroid hormones released. If for some reason, there is an excessive production of hormones, the body metabolism is enhanced to very higher levels producing symptoms like sweating, trembling, weight loss in hyperthyroid individuals.
Graves’ disease is an autoimmune disorder mediated by autoantibodies that are capable of binding and stimulating the receptor for thyroid stimulating hormone on the thyroid gland . Continued stimulation of the thyroid gland results in hypertrophy of the gland and overproduction of its hormones.
Binding of these antibodies to similar antigen retro-orbital connective tissue causes the ocular symptoms of Graves' disease.
There is no way to prevent Graves' disease as it is genetically mediated.
Graves’ disease is an autoimmune disorder characterized by hyperthyroidism due to circulating autoantibodies that are capable of stimulating the thyroid gland. It most commonly results in increased thyroid gland (twice or more of its size) due to increased synthesis of thyroid hormones by hyperfunctioning thyroid follicles.
Graves’ disease is a disorder in which the thyroid gland becomes overactive because bof stimulation by the body’s own antibodies. The symptoms seen in Graves’ disease include protuberance of eyes, heat intolerance, muscular weakness, increased sweating and anxiety.
It most commonly occurs in young individuals. There is no definitive prevention to this disease. Treatment can be done through drugs, surgery or radiation with favorable results.