Graves Disease – An Autoimmune Disorder

Overview of Graves Disease

Enlarged Thyroid Gland
Normal Thyroid Gland

Graves ’ Disease, also recognized as Toxic Diffuse Goiter, is the most widespread source of hyperthyroidism. Hyperthyroidism is a disorder that occurs when the thyroid gland makes more thyroid hormone than the body requires. Hyperthyroidism causes many of the body’s functions to speed up. Graves’ Disease is an Autoimmune Disorder, in autoimmune diseases, the immune system attacks the body’s own cells and organs.

Causes of Graves Disease

It is caused by an abnormal immune system response that causes the thyroid gland to produce too much thyroid hormone. Immune system generates antibodies called Thyroid-Stimulating Immunoglobulins(TSIs). These antibodies cause your thyroid gland to produce more thyroid hormone than your body needs. The Thyroid is a 2-inch-long, butterfly-shaped gland in the front of the neck below the larynx, or voice box. The thyroid makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). T3 is made from T4 and is the more active hormone, directly affecting the tissues. Thyroid hormones circulate all through the body in the bloodstream and operate on virtually every tissue and cell in the body. Thyroid Hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.

Symptoms of Graves Disease

Graves Disease

Signs and symptoms of Graves Disease include one or more of the following:-

  • An enlarged thyroid
  • Rapid heart rate
  • Widened pulse pressure
  •  A hyperthyroid stare (infrequent blinking) or frank exophthalmos
  • Tremor
  • Sweating
  •  Palpitations
  • Smooth moist skin
  • Frequent bowel movements or diarrhea
  • Sleeplessness
  • Attention problems
  • Irritability
  • Weight loss despite increased appetite
  • Heat intolerance, sweating
  • Shortness of breath, difficulty breathing
  • Irregular menstrual periods
  • Muscle weakness
  • Difficulty controlling diabetes
  • Prominent, bulging eyes
  • Vision problems (such as double vision)

Diagnosis and Tests for Graves Disease

  • Physical Examination
  • Blood tests to measure levels of TSH, T3, and free T4. Graves’ Patients usually have lower than normal levels of TSH and higher levels of thyroid hormones. Another laboratory test measures the levels of the antibody known to cause Graves’ disease.
  • Radioactive iodine uptake. By giving, a small amount of radioactive iodine and later measuring the amount of it in thyroid gland with a specialized scanning camera, doctor can determine the rate at which thyroid gland takes up iodine. A high uptake of radioactive iodine indicates thyroid gland is overproducing hormones.
  • Imaging Tests

Treatment of Graves Disease

Following treatments of Graves’ disease are common:-

Antithyroid Drugs. These drugs reduce the production of thyroid hormone. Treatment with antithyroid medications must be given for six months to two years, in order to be effective. The main antithyroid drugs are carbimazole, methimazole, and propylthiouracil. These drugs block the binding of iodine and coupling of iodotyrosines. Antithyroid medications can cause side effects in some people, including

  • Allergic reactions such as rashes and itching
  • A decrease in the number of white blood cells in the body, which can lower a person’s resistance to infection
  • Liver failure, in rare cases

Radioiodine (Radioactive Iodine).  It is suitable for most patients, although some prefer to use it mainly for older patients. In radioiodine therapy, patients take radioactive iodine-131 by mouth. Disadvantages of this treatment are a high incidence of hypothyroidism (up to 80%) requiring hormone supplementation

Thyroidectomy (Surgical Excision of the Gland). Operating on a hyperthyroid patient is dangerous.  Preceding to Thyroidectomy,  preoperative treatment with antithyroid drugs is given. This modality is suitable for young patients and pregnant patients.

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One thought on “Graves Disease – An Autoimmune Disorder

  1. Thank you for your great informational post! I have looked into methiamozole (ie Tapazole), and in most areas of the world it is often used as a permanent solution to Graves’ disease, with use for 10+ years if there are no side effects or remission. Follow up research suggests that at low doses there is no reason to suspect harm to children in utero or at the breastfeeding stage, especially as opposed to the harm done by untreated hyperthyroidism. This is a relief to a woman of my age, as I really have no desire to have my thyroid destroyed unless absolutely necessary, for the simple reason that hyperthyroidism can go away, while the hypothyroidism of physically having no thyroid cannot. 🙂 Also – side effects much more common with propy-whatsit.

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