Discover Grave's Disease, its symptoms, causes, and treatments. Manage the condition with insights from Meri Sehat, your go-to health resource.

Graves’ Disease

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Syed Intisar Hussain

Overview

Graves&#39; disease is an autoimmune disorder characterized by <a href="https://merisehat.pk/disease/hyperthyroidism">hyperthyroidism</a>, or an overactive thyroid. 
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Named after Sir Robert Graves, an Irish physician, Graves&#39; disease is the most common cause of hyperthyroidism in developed countries, affecting approximately 2-3% of the general population<a href="#accordion">[4]</a>.

The incidence of Graves&#39; disease varies depending on the population being studied. In the United States, the incidence is estimated to be around 30 cases per 100,000 people per year<a href="#">[5]</a>.

However, the incidence is higher in certain populations, such as people with a family history of thyroid disease and those with other autoimmune disorders. Additionally, women are 7 to 8 times more likely than men to develop Graves&#39; disease, with a peak incidence at 20-40 years<a href="#">[5]</a>. That said, the disorder can affect children, adolescents, and the elderly as well. 
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Signs And Symptoms

The condition is characterized by the presence of antibodies that stimulate the thyroid gland to produce excess thyroid hormone. These antibodies are known as thyroid-stimulating immunoglobulins (TSIs) and they bind to and activate the thyroid-stimulating hormone&nbsp;(TSH) receptors. As a result, the thyroid gland swells and the thyroid follicles increase the synthesis of the thyroid hormone. An increase in the production of the thyroid hormone then leads to a variety of signs and symptoms.&nbsp;

The symptoms of Graves&#39; disease vary widely and not everyone with the disease experiences all of the symptoms. Some of the most common symptoms of Graves&#39; disease include<a href="#accordion">[1]</a>: 
&nbsp;

<ul>
	<li><a href="https://merisehat.pk/disease/anxiety">Anxiety</a></li>
	<li>Moodiness</li>
	<li>Rapid or irregular heartbeat</li>
	<li>Weight loss despite increased appetite</li>
	<li>Hair loss</li>
	<li>Sweating</li>
	<li>Breast enlargement in men</li>
	<li>Tremor</li>
	<li>Fatigue or muscle weakness</li>
	<li>Shortness of breath with activity</li>
	<li>Difficulty sleeping</li>
	<li>Frequent bowel movements</li>
	<li>Increased sensitivity to heat</li>
	<li>Changes in the menstrual cycle</li>
	<li>Memory loss or decreased concentration</li>
	<li>Bulging eyes (also known as exophthalmos)</li>
	<li>Eyes feel irritated or tear more frequently</li>
	<li>Blurred or double vision</li>
	<li>Puffy eyes</li>
	<li>Pressure or pain in the eyes</li>
	<li>Infertility or difficulty becoming pregnant</li>
	<li>Reddish, thick skin with a rough texture (Graves&rsquo; dermopathy)</li>
</ul>

&nbsp;

Note: While Graves&#39; disease (GD) is commonly associated with hyperthyroidism, there have been instances where patients experience a transition from hyperthyroidism to hypothyroidism. Although rare, there have also been reported cases of individuals with GD initially presenting with hypothyroidism and later developing hyperthyroidism. 
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Causes

The exact cause of Graves&#39; disease is not fully understood, but it is believed to be caused by a combination of multiple factors. The following are some of the potential causes of Graves&#39; disease: 
&nbsp;

<ol>
	<li>Genetics: There is evidence to suggest that a genetic predisposition may play a role in the development of Graves&#39; disease. Certain variations in genes that are involved in the immune system, such as the HLA-DRB1 gene, have been linked to an increased risk of developing Graves&#39; disease. 
	&nbsp;</li>
	<li>Autoimmunity: Graves&#39; disease is an autoimmune disorder, which means that the immune system mistakenly attacks the body&#39;s tissues. In Graves&#39; disease, the immune system produces antibodies that stimulate the thyroid gland to produce excessive amounts of thyroid hormone. 
	&nbsp;</li>
	<li>Environmental factors: Environmental factors, such as stress or exposure to certain viruses or bacteria, may trigger the development of Graves&#39; disease in individuals who are genetically predisposed to the condition. 
	&nbsp;</li>
</ol>
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There are no screening tests for Graves&rsquo; disease. However, if the doctor suspects the condition, they may conduct thyroid function tests which measure the levels of TSH, T3, and T4 in the blood. 
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Diagnosis

The following are the most common methods used for the diagnosis of Graves&#39; disease: 
&nbsp;

<ol>
	<li>Physical Examination: During a physical exam, the healthcare provider examines the neck for signs of an enlarged thyroid gland or a thyroid nodule. They also check for other symptoms such as protruding eyes or increased heart rate.</li>
	<li>Thyroid-Stimulating Hormone (TSH) Test: This test measures the level of TSH in the blood. TSH is a hormone produced by the pituitary gland that stimulates the thyroid gland to produce thyroid hormones. In Graves&#39; disease, the level of TSH is usually low or undetectable because the thyroid gland is overactive.</li>
	<li>Thyroid Hormone Levels: This test measures the levels of thyroid hormones in the blood, including triiodothyronine (T3) and thyroxine (T4). In Graves&#39; disease, the levels of T3 and T4 are usually high due to the overactive thyroid gland.</li>
	<li>Thyroid Antibody Tests: This test measures the levels of antibodies that are produced by the immune system in response to the thyroid gland. In Graves&#39; disease, the levels of thyroid antibodies are usually high.</li>
	<li>Radioactive Iodine Uptake Test: This test involves administering a small amount of radioactive iodine orally and then measuring the amount of iodine taken up by the thyroid gland using a special scanner. In Graves&#39; disease, the thyroid gland will typically take up more iodine than normal.</li>
	<li>Thyroid Ultrasound: A thyroid ultrasound can help to visualize the thyroid gland and detect any abnormalities, such as nodules or an enlarged thyroid gland. It is often used in pregnant women as they cannot undergo the radioactive iodine uptake test.</li>
	<li>Fine Needle Aspiration Biopsy: If a nodule or other abnormality is detected on the thyroid gland, an FNA biopsy may be performed to collect a sample of cells for examination under a microscope.</li>
	<li>Thyroid Function Tests: Additional thyroid function tests may be performed, such as a TRH stimulation test or a T3 suppression test, to further evaluate thyroid function and confirm the diagnosis of Graves&#39; disease. 
	&nbsp;</li>
</ol>

NOTE: Not all individuals with Graves&#39; disease present with the same symptoms and hence the diagnosis may require a combination of different methods. Therefore, it is important to consult with a healthcare provider if you are experiencing symptoms of hyperthyroidism or if you have a family history of thyroid disorders. 
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Treatment

The following are the general reference ranges for TSH, T3, and T4: 
&nbsp;

<ol>
	<li>TSH: The normal range for TSH levels in the blood is between 0.4 and 4.0 milli-international units per liter (mIU/L) in most adults. However, the optimal TSH level can vary depending on the individual and the presence of other medical conditions.</li>
	<li>T3: The normal range for T3 levels in the blood is between 80 and 200 nanograms per deciliter (ng/dL).</li>
	<li>T4: The normal range for T4 levels in the blood is between 5 and 12 micrograms per deciliter (mcg/dL).</li>
</ol>

NOTE: These reference ranges may vary depending on the laboratory and testing method used. It is best to consult with a healthcare professional for personalized information regarding your specific hormone levels and what they may indicate.

The following strategies are used to treat Graves&rsquo; disease<a href="#accordion">[1][2][3]</a>. 
&nbsp;

<h5>Medications</h5>

Medications that block the production of thyroid hormones, such as methimazole and propylthiouracil, are often the first line of treatment for Graves&#39; disease. These medications help improve symptoms, but they may take several weeks or months to take effect. 
&nbsp;

<h5>Radioactive Iodine Therapy</h5>

Radioactive iodine therapy involves taking a dose of radioactive iodine, which is absorbed by the thyroid gland and destroys the cells that produce thyroid hormone. This treatment is usually very effective, but it can take several months for the thyroid gland to return to normal function and some people may even need to take thyroid hormone replacement medication for the rest of their lives. 
&nbsp;

<h5>Surgery</h5>

Thyroidectomy is recommended in some cases, particularly if other treatments are not effective or if there is an enlarged thyroid gland that is causing breathing or swallowing difficulties. After surgery, thyroid hormone replacement medication is necessary to replace the function of the removed thyroid gland. 
&nbsp;

<h5>Graves&rsquo; Ophthalmopathy</h5>

In patients with severe symptoms of Graves&rsquo; ophthalmopathy, doctors may prescribe steroids or orbital decompression surgery. Mild cases are usually treated with over-the-counter artificial tears and lubricating gels.

Overall, the outlook for people with Graves&#39; disease is generally good with appropriate treatment. However, if left untreated, Graves&#39; disease can lead to serious complications. For this reason, it is important to seek medical attention, especially if symptoms are persistent or severe. 
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Graves&#39; disease is a condition that affects the thyroid gland, leading to the overproduction of thyroid hormones. If left untreated or poorly managed, Graves&#39; disease can lead to several complications: 
&nbsp;

<ol>
	<li>Thyroid Eye Disease: Graves&#39; disease can cause inflammation in the tissues surrounding the eyes, leading to a condition known as thyroid eye disease or Graves&#39; ophthalmopathy. This can cause eye pain, double vision, and in severe cases, vision loss. 
	&nbsp;</li>
	<li>Pretibial Myxedema: This is a rare complication of Graves&#39; disease that causes thickening and swelling of the skin, usually on the shins. It is associated with discomfort and cosmetic concerns. 
	&nbsp;</li>
	<li>Cardiovascular Complications:&nbsp;Hyperthyroidism, which is often associated with Graves&#39; disease, can cause an increased heart rate and <a href="https://merisehat.pk/disease/hypertension-57">high blood pressure</a>. This can increase the risk of arrhythmias and <a href="https://merisehat.pk/disease/stroke">stroke</a>. 
	&nbsp;</li>
	<li>Osteoporosis: Graves&#39; disease can lead to a loss of bone density, increasing the risk of fractures and <a href="https://merisehat.pk/disease/osteoporosis-80">osteoporosis</a>. 
	&nbsp;</li>
	<li>Thyroid Storm: This is a rare but life-threatening complication of Graves&#39; disease that occurs when the body produces too much thyroid hormone. Symptoms include high fever, rapid heart rate, and delirium. It requires immediate emergency treatment. 
	&nbsp;</li>
	<li>Pregnancy Complications: Women with Graves&#39; disease who become pregnant may experience complications, such as miscarriage, premature birth, and preeclampsia. 
	&nbsp;</li>
	<li>Psychiatric Complications: Hyperthyroidism can cause symptoms, such as anxiety, irritability, and <a href="https://merisehat.pk/disease/insomnia">insomnia</a>. In some cases, it may also lead to depression and other psychiatric disorders. 
	&nbsp;</li>
</ol>
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While the exact cause of Graves&#39; disease is not fully understood, several factors increase a person&#39;s risk of developing the condition: 
&nbsp;

<ol>
	<li>Gender: Graves&#39; disease is more common in women than in men.</li>
	<li>Age: Graves&#39; disease can occur at any age, but it is most commonly diagnosed between the ages of 20 and 40.</li>
	<li>Family History: Having a family history of autoimmune disorders, such as Graves&#39; disease, increases the risk of developing the condition.</li>
	<li>Smoking: It is thought that smoking can trigger an immune response that leads to the development of the disease.</li>
	<li>Stress: Psychological stress has been linked to the development of autoimmune disorders, including Graves&#39; disease.</li>
	<li>Infection: In some cases, an infection may trigger an autoimmune response that leads to the production of antibodies that attack the thyroid gland.</li>
	<li>Radiation Exposure: Frequent exposure to high levels of ionizing radiation, such as during certain medical treatments, increase the risk of developing Graves&#39; disease.</li>
	<li>Other Autoimmune Disorders: People with other autoimmune disorders, such as type 1 diabetes or rheumatoid arthritis, may be at higher risk of developing Graves&#39; disease. 
	&nbsp;</li>
</ol>

Since the exact cause of the condition is not fully understood, it is difficult to identify specific steps that can be taken to prevent it from occurring. However, certain lifestyle factors can help: 
&nbsp;

<ol>
	<li>Eating A&nbsp;Healthy Diet: A diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats offers plenty of vitamin D, selenium, and omega-3 fatty acids that are particularly beneficial in supporting the immune system and reducing inflammation.</li>
	<li>Managing Stress: Chronic stress can trigger or worsen the symptoms of Graves&#39; disease. Engaging in stress-reducing activities such as yoga, meditation, or mindfulness practices can help.</li>
	<li>Quitting Cigarette Smoking: Smoking is linked to an increased risk of developing Graves&#39; disease. Quitting smoking or avoiding exposure to secondhand smoke helps.</li>
	<li>Getting Regular Exercise: Exercise has numerous health benefits, including reducing inflammation and supporting immune function. Regular exercise can reduce the risk of developing Graves&#39; disease.</li>
	<li>Getting Enough Sleep: Chronic sleep deprivation is linked to an increased risk of developing autoimmune disorders. Getting adequate sleep is important for overall health and immune function.</li>
	<li>Eye Care: In some cases, Graves&#39; disease can cause eye problems, including bulging eyes and double vision. Working with an ophthalmologist or other eye specialist can help manage it. 
	&nbsp;</li>
</ol>
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In 2020, the U.S. Food and Drug Administration (FDA) approved the first treatment for Graves&rsquo; ophthalmopathy<a href="#accordion">[6]</a>. The drug Tepezza (teprotumumab-trbw) provides a non surgical treatment option for the debilitating disease. However, it cannot be administered in pregnant women. Moreover, women are advised to avoid conceiving during treatment and for 6 months after the last dose of the drug. 
&nbsp;

Key Points

<ul>
	<li>Graves&#39; disease is an autoimmune disorder characterized by hyperthyroidism, and is the most common cause of diffuse toxic goiter .</li>
	<li>Graves&#39; disease is the most common cause of hyperthyroidism in developed countries, affecting approximately 1-2% of the population.</li>
	<li>Some of the most common symptoms of Graves&#39; disease include anxiety and irritability, rapid or irregular heartbeat, and weight loss despite increased appetite.</li>
	<li>Environmental factors, such as stress or exposure to certain viruses or bacteria, may trigger the development of Graves&#39; disease in individuals who are genetically predisposed to the condition.</li>
	<li>Blood tests can help measure levels of T3, T4, TSH, and thyroid antibodies.</li>
	<li>Medications that block the production of thyroid hormones, such as methimazole and propylthiouracil, are often the first line of treatment for Graves&#39; disease.</li>
	<li>Pretibial myxedema is a rare complication of Graves&#39; disease that causes thickening and swelling of the skin, usually on the shins. 
	&nbsp;</li>
</ul>

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