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Grave’s Disease

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Grave’s Disease

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Grave’s disease is an autoimmune disease, that causes overactivity of the thyroid gland and is a common cause of hyperthyroidism. Read the article to know more.

Medically reviewed by

Dr. Rahul Ramji Kackar

Published At July 12, 2021
Reviewed AtOctober 27, 2023

What Is Graves Disease?

Graves’ disease is an autoimmune disorder that results in a hyperactive thyroid gland. Graves’ disease is named after an Irish Physician Robert Graves who described this disease 150 years ago. Graves’ disease is more commonly noticed in women than in men.

How Is Graves Disease Resulting in Hyperthyroidism?

The thyroid gland, a small gland resembling a butterfly in shape, is situated at the front of the neck. These thyroid glands secrete thyroid hormones that control how the body uses energy. They nearly affect each and every organ in the body. They even control the way the heart beats.

In Graves' disease, thyroid-stimulating immunoglobulins, which are antibodies, are produced by the immune system. These antibodies attach to the healthy thyroid cells. This can cause the thyroid to secrete more thyroid hormone than the body needs.

If this disorder is left untreated, then hyperthyroidism can lead to serious problems in the menstrual cycle, bones, muscles, heart, and fertility. Graves’ disease can also affect eyes and skin.

Who Is More Likely to Develop Graves Disease?

People who are more likely to develop Graves’ disease based on certain factors such as:

1. Age: People between the ages of 30 and 50 are more likely to develop Graves’ disease, but it can occur at any age.

2. Gender: Graves' disease is more common in women than in men. It is about seven to eight times more common in women than men.

3. Autoimmune diseases: People with other autoimmune diseases are also at a higher risk of developing Graves’ disease. Autoimmune diseases like:

  • Rheumatoid arthritis (inflammatory disorder affecting joints of hand wrist and knees).

  • Type 1 diabetes mellitus (also called juvenile diabetes or insulin-dependent diabetes occurs due to the destruction of insulin-producing pancreatic cells).

  • Crohn’s disease (An inflammatory condition that results in swelling of the digestive tract tissues, causing symptoms like abdominal pain, diarrhea, and weight loss).

4. Hereditary: People with family members who have a history of Graves’ disease are more likely to develop Graves’ disease.

5. Stress: Stressful events may trigger the onset of Graves’ disease.

6. Pregnancy: Pregnancy or any recent childbirth may increase the risk of developing Graves’ disease.

7. Smoking: Smoking can affect the immune system, which in turn increases the risk of developing Graves’ disease.

What Causes Graves Disease?

The exact causes of Graves’ disease are still not known. It is also hard to determine who will get it. Graves' disease involves the production of antibodies called thyroid-stimulating immunoglobulins by the immune system which will target the body’s healthy thyroid cells. People can inherit the ability to produce antibodies against their healthy thyroid cells. There is no proven cause for Graves’ disease.

What Are the Symptoms of Graves Disease?

Graves’ disease and hyperthyroidism have many similar symptoms. Symptoms include:

  • Weight loss.

  • Bulging eyes.

  • Tachycardia (rapid heart rate).

  • Heat intolerance.

  • Nervousness.

  • Irritability.

  • Fatigue.

  • Hand tremors.

  • Goiter (swelling of the thyroid gland).

  • Muscle weakness.

  • Difficulty sleeping.

  • Frequent bowel movements.

Graves’ Ophthalmopathy:

It occurs when the eyes are enlarged as a result of retraction of the eyelids. Eyes begin to bulge out from the eye sockets. Certain reports say that 30 percent of people who develop Graves’ disease are likely to get a mild case of Graves’ ophthalmopathy. About 5 percent of people with Graves’ disease may get severe Graves’ ophthalmopathy. The signs of Graves’ ophthalmopathy are,

  • Bulging eyes.

  • Pressure in the eyes.

  • Pain in the eyes.

  • Double vision.

  • Vision loss.

  • Reddened or inflamed eyes.

  • Puffy or retracted eyelids.

Graves’ Dermopathy:

People with Grave’s dermopathy may experience reddened and thickened skin on the shin or top of the feet.

How to Diagnose Graves Disease?

Doctors will diagnose Grave’s disease based on the symptoms and findings during a physical examination.

  • Blood Tests: Blood tests assess thyroid function by measuring the levels of thyroid hormones and antibodies present in the body. Antibodies are proteins generated by the immune system to combat foreign substances. Elevated levels of thyroid-stimulating hormone receptor antibodies in the bloodstream are an indicator of Graves' disease. these blood tests also assess for T3, T4, and TSH (thyroid stimulating hormone) levels.

  • Radioactive Iodine Uptake Test: The radioactive iodine uptake test is a diagnostic tool used to assess thyroid function by measuring the thyroid gland's uptake of radioactive iodine over a specific time. This test is conducted when blood tests indicate an overactive thyroid gland. Elevated iodine uptake results suggest an overactive thyroid, with Graves' disease being the most common underlying cause.

  • Thyroid Scan: A thyroid scan is a diagnostic test that uses a radioactive iodine tracer to investigate both the structure and function of the thyroid gland. This scan is often performed along with a radioactive iodine uptake test. At the time of examination, the patient ingests a small pill containing a minimal quantity of radioactive iodine, which they swallow. A scanner is then employed to detect the location and intensity of the radiation emitted by the radioactive material, generating images of the thyroid gland on a computer screen. Technetium may be used in place of radioactive iodine. Normal test results show thyroid gland of regular size, shape, and location. Any deviations in the characteristics of the thyroid gland can aid in identifying thyroid gland disorders

What Is the Treatment for Graves Disease?

There are many treatments available for Graves’ disease. Graves' disease is managed by reducing the excessive production of thyroid hormones through interventions directed at the thyroid gland.

  • Antithyroid Medication: This antithyroid medication helps to prevent the thyroid gland from producing excessive thyroid hormones by stopping the oxidation of iodine in the thyroid gland. Medication can be prescribed for 12-18 months so that the condition does not come back. In certain cases, medications can be prescribed for a while longer. The symptoms usually improve within four to six weeks of taking the medication. Antithyroid medication can be taken along with other therapies like radioactive iodine therapy or surgery.

  • Radioactive Iodine Therapy: Radioactive iodine therapy can be used to treat Graves’ disease. It is a non-invasive and very effective procedure. Iodine is used to produce thyroid hormones. Radioactive iodine can be taken orally, which directly targets the thyroid gland. The radioactive iodine slowly destroys the overactive thyroid cells.

  • Surgery: Surgery is now very rare as the other treatments for Graves’ disease have steadily improved in treating the condition. Surgery is typically advised when other treatments do not succeed in bettering the condition. Thyroidectomy is in which part of the thyroid gland or the whole of the thyroid gland is removed. It depends on the severity of the symptoms.

What Are the Complications of Surgery?

People after surgery may experience neck pain or weak voice. A scar may be present after surgery, depending on the type of surgery done. In case the whole thyroid gland is removed, then the body will not be able to produce thyroid hormones leading to a condition called hypothyroidism.

What Foods Should Be Avoided In People With Graves Disease?

Consulting with a doctor is needed for individuals dealing with Graves' disease, as they can provide personalized dietary guidance. Avoid foods containing gluten, as they may complicate treatment. Excessive iodine intake should be avoided, as it can potentially trigger hyperthyroidism, worsening the condition. To manage the disease effectively, it is often recommended to limit or avoid meat and other animal products, as these can sometimes exacerbate symptoms.

What Foods Are Better for People With Graves Disease?

Dietary changes cannot cure Graves' disease, but they can manage the symptoms. The foods that are good for people with Graves’ disease are

  • Calcium-rich foods (yogurt, milk, leafy Greens, cheese, almonds, oranges, Tofu, spinach)

  • Vitamin D-rich foods (egg yolk, liver, cow milk, yogurt, Salmon, cheese, mushroom)

  • Foods that are rich in Magnesium (spinach, pumpkin seed, almond, avocado, cashew bananas, dark chocolate )

  • Foods containing Selenium (brazil nut, brown rice, fish, sunflower seed, egg)

Conclusion

Graves’ disease is a common and serious disease of the thyroid. It causes discomfort both physically and mentally to the person who has it. Graves’ disease requires careful diagnosis and continuous monitoring. Graves’ disease, when treated properly, can be expected for the problem to be controlled and lead a normal life.

Frequently Asked Questions

1.

Can We Cure Graves’ Disease?

If curing does mean reducing the level of thyroid hormone in the blood, Graves’ disease can be cured with the help of thyroidectomy (surgical removal of the thyroid), antithyroid drugs, and radioactive iodine therapy. However, these can increase the chances of hypothyroidism which further requires treatment.

2.

Is Graves’ Disease Fatal?

Graves’ disease seldom produces fatal complications, but it can lead to cardiac problems and bone disorders if left untreated, resulting in fragile and thin bones.

3.

What Is the Leading Cause of Graves’ Disease?

Graves’ disease is a condition characterized by a dysfunction in the immune system of the body. Although the cause is not clear, family history, type 1 diabetes mellitus, and rheumatoid arthritis increase the risk. Also, women in the reproductive age group are more prone to get the disease.

4.

Can Graves’ Disease Reduce My Lifespan?

If not treated, Graves’ hyperthyroidism causes cardiovascular complications like heart attack, cardiac failure, and stroke. However, if the optimal level of the thyroid is maintained, it is unlikely to impact longevity. On the other hand, an elevated thyroid level will reduce the lifespan and increase the chances of early death.

5.

What Foods Are to Be Avoided in Graves’ Disease?

- Seafood and its additives like crabs, prawns, sea fish, seaweed, lobster, sushi, agar, alginate, algae, etc.
Iodized salt and iodized water.
- Egg yolks and whole eggs.
- Milk and dairy products.
- Gluten-containing foods like wheat, barley, rye, malt, etc.
- Baked food items that contain iodine dough conditioners, like bread.

6.

Does the Severity of Graves’ Disease Increase Over Time?

Graves’ hyperthyroidism worsens with time if left untreated and can lead to life-threatening complications which affect the person's quality of life. Graves’ ophthalmopathy profoundly varies with time; in some, it remains the same without any changes for years, while in others, it improves or worsens with time. It can also be associated with worsening periods and significantly improving periods.

7.

Can Eyes Return to Normal After Graves’ Disease?

In mild to moderate cases of Graves’ disease, Graves’ ophthalmopathy usually returns to normal spontaneously within a span of two to three years. However, rarely in some people, it worsens over the period.

8.

Does Stress Induce Graves’ Disease?

Stress increases the production of cortisol hormone, which induces the thyroid gland to produce more thyroid hormone, thereby worsening hyperthyroidism. Recent researches have also found a correlation between stress management and its positive effect on the prognosis of Graves’ disease.

9.

How Can We Maintain Weight With Graves’ Disease?

- Adequate intake of water.
- Proper sleep.
- Intake of fiber-rich food.
- Consume a gluten-free diet.
- Limit the consumption of processed and goitrogenic foods.
- Do regular exercises for at least an hour daily.
- Get to know the prescribed medications.

10.

What Is the Prevalence Rate of Graves’ Disease?

Graves’ disease is the leading cause of hyperthyroidism, with an increased predisposition to females. It has a prevalence rate of 0.5%.

11.

What Are the Triggering Factors of Graves’ Disease?

Factors like family history, female sex, pregnancy, smoking, emotional or physical stress, less than 40 years of age, and other autoimmune conditions increase the risk of developing Graves’ disease.

12.

Why Does Hyperthyroidism Occur in Graves’ Disease?

Thyrotropin receptor antibody produced in Graves’ disease overregulates thyroid hormone production by acting as a regulatory pituitary hormone, which results in hyperthyroidism.

13.

What Are the Effects of Graves’ Disease?

- Anxiety.
- Unexplained weight loss.
- Tremor of the hands and fingers.
- Irregular menstruation.
- Erectile dysfunction.
- Increased bowel movements.
- Enlarged thyroid gland.
- Heat sensitivity.
- Palpitations (irregular heartbeat).
- Eyeball protrusion.
- Thick, reddish skin on the feet.
- Fatigue.

14.

Can We Detect Graves’ Disease With the Help of a Blood Test?

Blood tests that measure the level of thyroid-stimulating hormone in blood, triiodothyronine, and thyroxine help diagnose Graves’ disease. If the diagnosis is uncertain even after that, imaging tests and other blood tests may be needed.

15.

Is Graves’ Disease Associated With Any Disability?

Graves’ disease itself is not a disability, but the arrhythmias which occur in Graves’ disease is a form of disability.
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Dr. Rahul Ramji Kackar
Dr. Rahul Ramji Kackar

Endocrinology

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