An Overview of Graves' Disease

There are a number of symptoms associated with Graves' disease. The symptoms of hyperthyroidism (due to any cause) include weight loss, increased appetite, diarrhea, insomnia, sweating, trouble concentrating, agitation, irritability, palpitations, high blood pressure.

There are, however, additional symptoms that commonly occur with Graves' disease but not other types of hyperthyroidism:

• Graves' ophthalmopathy: A condition that often appears as "bulging eyes," Graves' ophthalmopathy can cause pressure around the eyes, sensitive eyes, and decreased vision. This affects about one-third of people with Graves', and it results from swelling that is due to the autoimmune process behind the disease.
• Skin lesions: Thyroid dermopathy, also known as Graves' dermopathy, can produce thickening of the skin, swelling, and severe itching. In rare cases, thyroid dermopathy can progress to a condition called acropachy, which is characterized by deformities of the fingers and toes.

If you have untreated Graves' disease, osteoporosis (thinning of the bones) and heart disease can develop over time.

Thyroid storm is a rare and dangerous complication, characterized by a rapid heartbeat, high blood pressure, and high fever. Without immediate emergency medical treatment, this complication can be fatal.

The autoimmune process behind Graves' disease is like any other in that the body mistakenly produces antibodies (infection-fighting proteins) against itself.

There are several different thyroid antibodies, each resulting in a different thyroid condition. TSH receptor antibody (TSHR-Ab) is the antibody associated with Graves' disease.

Thyroid stimulating hormone (TSH) is released by the pituitary gland in the brain. TSH binds to TSH receptors on the thyroid gland to trigger it to produce thyroid hormone. TSHR-Ab acts like TSH, causing excess thyroid hormone production—even when it is not needed.

It is not clear why a person would develop Graves' disease, but there are several risk factors.

Age is one: Graves' is more common in those under age 40. Women are also more likely to develop Grave's disease than men, and there is an increased risk of this condition during pregnancy.

If you have a family history of Graves' disease or if you have another autoimmune condition, such as lupus, you are at an increased risk of developing Grave's disease as well.

Smoking is a strong risk factor for developing this condition. There has been some suggestion that stress could play a role, but the evidence is not consistent and a causative relationship remains uncertain.

If you have symptoms of Graves' disease, your doctor will use a few methods in addition to a review of your medical history for the risk factors mentioned above to diagnose your condition. Your physical examination and thyroid function blood tests can typically establish that you have hyperthyroidism and may narrow the cause down to Graves' disease. An imaging study or a biopsy may also be needed to distinguish Grave's disease from other types of hyperthyroidism.

If you have Graves' disease, your physical examination may show some signs of hyperthyroidism, such as a rapid heart rate, high blood pressure, and agitation. These are all signs of hyperthyroidism, but they do not confirm that you have Graves' disease.

If you have ophthalmopathy or dermopathy, your doctor may have a higher suspicion that you have Graves' disease, but these can occur with other types of hyperthyroidism as well. A goiter, similarly, suggests that you may have Graves' disease, but does not rule out another thyroid condition.

The most common thyroid tests include TSH, thyroxine (T4) and triiodothyronine (T3). A low TSH with a high T4 and/or high T3 is typical of hyperthyroidism. Your doctor may also request that you have thyroid antibody tests.

Graves' disease can produce a change in the appearance of the thyroid gland that may be distinguished from a normal thyroid gland or from other thyroid conditions. Imaging tests used in the evaluation of Graves' disease may include ultrasound, X-ray, a computerized tomography (CT) scan, and magnetic resonance imaging (MRI).

You might also receive radioactive iodine before an imaging test because this material enters the thyroid and can help improve visualization of the gland.

If there is still uncertainty about your diagnosis, you may have a biopsy, which is when a sample of tissue is removed for examination under a microscope. A biopsy is especially useful if your doctor is concerned about thyroid cancer.

If you have Graves' disease, there are several different treatment methods that your doctor may consider either simultaneously or over time as your condition evolves.

Among those options that can help reduce the overactivity of your thyroid gland:

• Anti-thyroid medication: There are a number of anti-thyroid medications. They work by preventing the thyroid gland from using iodine to produce thyroid hormones. The most common antithyroid medications include Tapazole(methimazole), carbimazole (which converts to methimazole), and Propylthiouracil (PTU). Methimazole, which is also called thiamazole, is also available in generic form.
• Radioactive iodine: Destruction of all or part of your thyroid gland using radioactive iodine (RAI) can decrease excessive thyroid hormone production. Sometimes, the destruction of the thyroid gland results in hypothyroidism (underactive thyroid).
• Surgery: Removal of all or part of the thyroid gland may be necessary if you cannot be treated with medication or RAI. This is not the typical treatment approach for Graves' disease, however.

If you continue to have hypertension and a rapid heart rate even after taking adequate antithyroid medication, RAI, or surgery, you may need to use medications such as beta blockers, which reduce heart rate and lower blood pressure. Other methods for managing hypertension include exercise, decreasing salt in your diet, weight loss, and relaxation techniques.

Treatment usually isn't needed for ophthalmopathy, but oral steroids or surgery can relieve swelling, if needed.

Thyroid dermopathy is treated with topical (on the surface of the skin) steroids.

You may also need medication to reduce diarrhea, as well as dietary adjustments or calorie supplements to prevent weight loss.

Graves' disease requires modification of some lifestyle issues to help you cope.

Hyperthyroidism may cause weight loss and an increased appetite. To avoid losing too much weight, you may need to increase your caloric intake. It is best to talk you your doctor or a dietitian to help you come up with a dietary plan to maintain a healthy weight.

If you increase your food intake, be sure to maintain a balanced diet and to eat foods that are rich in vitamins, minerals, carbohydrates, and protein, rather than consuming processed or deep-fried foods. Hyperthyroidism can reduce your cholesterol, so your dietician may give you permission to eat a higher proportion of fat-containing foods than what is normally recommended in a healthy diet.

Some foods are known to be goitrogens, which interfere with the body's ability to use iodine. This causes hypothyroidism. If you have Graves' disease, you need to maintain moderation when it comes to goitrogens, as consuming too much of these foods can reduce your thyroid hormone levels, especially if your condition is adequately treated.

Hyperthyroidism can cause anxiety, irritability, and restlessness. If you experience these issues, be sure to talk with your doctor. Often, antithyroid medications are enough to reduce these symptoms, but sometimes, other coping mechanisms, such as meditation, biofeedback, exercise, and counseling are needed.