What is Grave’s disease?
Grave’s disease is an autoimmune disorder that results in overproduction of the hormones of the thyroid gland, leading to hyperthyroidism. It usually affects woman under the age of 40.
However, Grave’s disease can affect anyone. The reason why the immune system works against the thyroid gland is unknown, or why the body produces an antibody to one part of the cells in the thyroid gland.
The thyrotropin receptor antibody (TRAb) acts like the regulatory pituitary hormone. TRAb causes an overproduction of thyroid hormones. Although anyone can be affected by this disease, some are at a greater risk of being affected by the Grave’s disease.
Risk factors include:
• Age – this disease usually affects younger people, under the age of 40
• Autoimmune disorders – people with other autoimmune disorders have a greater risk of suffering from Grave’s disease
• Gender – women are at a greater risk of suffering from Grave’s disease when compared to men
• Family history – this disease is more common among women of the same family. There is likely a gene or more than one gene that can increase the risk of suffering from Grave’s disease
• Smoking – people who smoke are at a greater risk of suffering from Grave’s disease
• Pregnancy – among women who are genetically predisposed to suffer from Grave’s disease, pregnancy or recent childbirth is a risk factor.
Signs and Symptoms of Grave’s disease
Thyroid hormones play a great role in a human’s body, affecting almost every organ. That is the reason why signs and symptoms associated with Grave’s disease can be wide ranging. The most common signs and symptoms include:
• Enlargement of the thyroid gland – goiter
• Grave’s ophthalmopathy – bulging eyes
• A fine tremor of the fingers and hands
• Irregular heartbeats
• Grave’s dermopathy – thick and red skin that shines
• Frequent bowel movements
• Erectile dysfunction
• Reduced sexual libido
• Change of the menstrual cycle
• Heat sensitivity and moist skin
• Weight loss, despite normal eating habits
How is Grave’s disease diagnosed?
When the disease is suspected, a wide range of examinations is available in order to diagnose it. Your health care provider will order you to do the following examinations:
• Physical examination – a detailed physical examination is necessary, which includes also the examination of the eyes for Grave’s ophthalmopathy.
• A blood sample – with the help of blood samples, levels of thyroid stimulating hormone TSH, pituitary hormones and the levels of the thyroid hormones, T3, T4, freeT3 are determined.
• Ultrasound of the thyroid gland – with the help of the ultrasound, your health care provider will see if the thyroid gland is enlarged or not.
• Imaging tests – CT-scan, MRI are used in cases when from the clinical assessment the diagnosis is not very clear.
• Radioactive iodine uptake – a small amount of radioactive iodine is given to you, followed by the measuring of the iodine amount in your thyroid gland. The amount of the radioactive iodine taken up by the thyroid gland will help determine the real cause of hyperthyroidism.
Treatment for Grave’s disease
The goal of the treatment in Grave’s disease is to stop the thyroid gland from overproducing the hormones. But also to stop these already produced hormones affect the organs of the human body. One of the treatment options includes per - oral intake of radioactive iodine. The radioactive iodine taken, by mouth, goes into the thyroid gland and destroys the overactive thyroid cells.
Gradually, the thyroid gland will shrink and will produce less thyroid hormone. The time from taking the radioactive iodine until lessening of the symptoms is from several weeks until several months.
• Anti - thyroid medication includes Propylthiouracil and Methimazole. These medications interfere with the thyroid’s use of iodine to produce the thyroid hormones.
• Beta – blockers are used in order to control the cardiac signs that Grave’s disease causes.
Surgery is often recommended and a total or partial thyroidectomy is performed. Thyroidectomy like any other surgery has its own risks and possible complications. In this case, there is the risk of damage to the parathyroid glands but also damage to the vocal cords. One of the major signs of Grave’s disease, the Grave’s ophthalmopathy can be managed by using artificial tears and lubricant gels.
If the signs and symptoms are more severe the use of corticosteroids, prisms, orbital radiotherapy, and even orbital decompression surgery are necessary.