Graves Disease
What is Graves' Disease?
Graves' disease is an autoimmune condition in which proteins (autoantibodies) produced by our body activate thyroid gland receptors. As a result, an excessive amount of thyroid hormones is produced, leading to a condition called hyperthyroidism.
Symptoms
The symptoms of Graves' disease include:
Rapid or irregular heartbeat
Heat intolerance and excessive sweating
Weight loss despite increased appetite
Vision problems (exophthalmos)
Tremors in hands and fingers
Enlarged thyroid gland (goiter)
Menstrual cycle changes
Erectile dysfunction or decreased libido
Frequent bowel movements
Fatigue
Insomnia
Irritability
Eye Conditions Caused by Graves' Disease (Graves' Orbitopathy)
Eye problems occur in about 25% of people with Graves' disease, affecting the muscles and other tissues around the eyes. Symptoms include:
Bulging of the eyeballs
Sensation of a foreign body in the eye
Pressure or pain in the eyes
Swollen eyelids or eyelids that do not fully cover the eyeball (a condition known as eyelid retraction)
Redness of the eyes
Increased sensitivity to light
Blurred or double vision
Vision loss
Graves' Dermopathy
Rarely, patients with Graves' disease may develop skin thickening and darkening, primarily on the shins. The affected skin resembles an orange peel due to protein deposits. This condition is usually mild and painless.
Causes
Normally, the immune system produces antibodies that fight viruses, bacteria, and other foreign substances. In Graves' disease, the immune system mistakenly produces antibodies against the thyroid gland (TRAb), leading to hyperthyroidism.
Causes of Graves' Orbitopathy
Graves' orbitopathy may appear before, during, or after the onset of hyperthyroidism.
Risk Factors
Family history – A genetic predisposition may increase the risk.
Gender – Graves' disease is more common in women than in men.
Age – It is most frequently diagnosed between the ages of 30 and 60.
Other autoimmune conditions – Patients with other autoimmune diseases, such as type 1 diabetes or rheumatoid arthritis, have a higher risk of developing Graves' disease.
Smoking – Tobacco use affects the immune system and increases the risk of developing Graves' disease. Smokers with Graves' disease are also at a higher risk of developing orbitopathy.
Complications
Thyroid storm – A rare but life-threatening complication.
Cardiovascular risks – Without treatment, Graves' disease can lead to arrhythmias and heart failure.
Osteoporosis – Decreased bone density.
Pregnancy complications – Increased risk of miscarriage, premature birth, heart failure, and high blood pressure during pregnancy.
Diagnosis
Laboratory Tests:
TSH, Free T4 (FT4), Free T3 (FT3) – To assess thyroid function.
Antibody tests – To detect thyroid autoantibodies.
Imaging Studies:
Thyroid ultrasound – To assess the size and structure of the thyroid gland.
Scintigraphy – A diagnostic test in which a small amount of radioactive iodine is used to determine the cause of hyperthyroidism.
Treatment
The goal of treatment is to block the excessive production of thyroid hormones.
Anti-thyroid Medications
Methimazole and Propylthiouracil – These medications block the production of thyroid hormones.
Duration – Treatment is determined by the physician and often lasts for more than a year.
Side effects – Rash, joint pain, and, rarely, liver failure or reduced white blood cell count.
Warning signs – If a patient experiences fever, sore throat, or allergic reactions, they should seek medical attention immediately.
Beta-Blockers
These medications help manage symptoms such as rapid heartbeat, palpitations, anxiety, irritability, heat intolerance, sweating, diarrhea, and muscle weakness.
Radioactive Iodine Therapy
This radical treatment involves taking radioactive iodine in pill form, which destroys the hormone-producing thyroid cells. The maximum effect is usually achieved within six months.
Contraindications – This treatment is not recommended for moderate or severe Graves' orbitopathy, pregnancy, or breastfeeding.
Side effect – Most patients develop hypothyroidism after treatment and require lifelong levothyroxine therapy.
Surgery
Surgical treatment involves partial or complete removal of the thyroid gland (thyroidectomy). After surgery, patients require lifelong levothyroxine replacement therapy.