06/08/2024
Graves disease.
Graves' disease is an immune system condition that affects the thyroid gland. It causes the body to make too much thyroid hormone. That condition is called hyperthyroidism.
Thyroid hormones affect many organs in the body. So Graves' disease symptoms also can affect those organs. Anyone can get Graves' disease. But it's more common in women and in people older than 30.
SIGNS AND SYMPTOMS
Common symptoms of Graves' disease include:
Feeling nervous and irritable.
Having a slight tremor of the hands or fingers.
Being sensitive to heat with an increase in sweating or warm, moist skin.
Losing weight, despite wanting to eat more.
Having an enlarged thyroid gland, also called goiter.
Having changes in menstrual cycles.
Not being able to get or keep an er****on, called erectile dysfunction, or having less desire for s*x.
Having bowel movements often.
Having bulging eyes — a condition called thyroid eye disease or Graves' ophthalmopathy.
Being tired.
Having thick, discolored skin mostly on the shins or tops of the feet, called Graves' dermopathy.
Having fast or irregular heartbeat, called palpitations.
Not sleeping well.
When to see a doctor.
Other medical conditions can cause symptoms like those of Graves' disease. See your healthcare professional if you have any symptoms of Graves' disease to get a prompt diagnosis.
Seek medical care right away if you have heart-related symptoms, such as a fast or irregular heartbeat, or if you have vision loss.
CAUSES.
Graves' disease is caused by the body's disease-fighting immune system not working correctly. Experts don't know why this happens.
The immune system makes antibodies that target viruses, bacteria or other foreign substances. In Graves' disease, the immune system makes an antibody to one part of the cells in the hormone-making gland in the neck, called the thyroid gland.
A tiny gland at the base of the brain, called the pituitary gland, makes a hormone that controls the thyroid gland. The antibody linked with Graves' disease is called thyrotropin receptor antibody (TRAb). TRAb takes over the work of the pituitary hormone. That leads to more thyroid hormone in the body than the body needs. That condition is called hyperthyroidism.
RISK FACTORS.
Factors that can increase the risk of Graves' disease include:
Family history. People who get Graves' disease often have a family history of thyroid conditions or an autoimmune condition.
S*x. Women are much more likely to get Graves' disease than are men.
Age. Graves' disease mostly happens between the ages of 30 and 60.
Another autoimmune condition. People with other conditions of the immune system, such as type 1 diabetes or rheumatoid arthritis, have a higher risk.
Smoking. Cigarette smoking, which can affect the immune system, raises the risk of Graves' disease. People who smoke and have Graves' disease are at higher risk of getting thyroid eye disease.
COMPLICATIONS.
Factors that can increase the risk of Graves' disease include:
Family history. People who get Graves' disease often have a family history of thyroid conditions or an autoimmune condition.
S*x. Women are much more likely to get Graves' disease than are men.
Age. Graves' disease mostly happens between the ages of 30 and 60.
Another autoimmune condition. People with other conditions of the immune system, such as type 1 diabetes or rheumatoid arthritis, have a higher risk.
Smoking. Cigarette smoking, which can affect the immune system, raises the risk of Graves' disease. People who smoke and have Graves' disease are at higher risk of getting thyroid eye disease.
WHAT TO LOOK(DIAGNOSIS).
To diagnose Graves' disease, your healthcare professional may do a physical exam and ask about your medical and family history. Tests might include:
Blood tests. Blood tests show the levels of thyroid-stimulating hormone (TSH) and thyroid hormones in the body. TSH is the pituitary hormone that spurs the thyroid gland. People with Graves' disease most often have lower than usual levels of TSH and higher levels of thyroid hormones.
Radioactive iodine uptake. The body needs iodine to make thyroid hormones. This test involves taking a small amount of radioactive iodine. Later, a special scanning camera shows how much of the iodine gets into the thyroid gland. This test can show how fast the thyroid gland takes up iodine.
The amount of radioactive iodine the thyroid gland takes up helps show whether Graves' disease or another condition is the cause of the hyperthyroidism. This test may be used with a radioactive iodine scan to show a picture of the uptake pattern.
TREATMENT.
Radioactive iodine therapy
With this therapy, you take radioactive iodine, called radioiodine, by mouth. The radioiodine goes into the thyroid cells. Over time, it destroys the cells that make thyroid hormone. This causes your thyroid gland to shrink. Symptoms ease little by little, most often over several weeks to several months.
Radioiodine therapy may raise the risk of thyroid eye disease or make its symptoms worse. This side effect most often is mild and doesn't last. But the therapy might not be for you if you have moderate to severe eye symptoms.
Other side effects may include a tender neck and a brief rise in thyroid hormones. Radioiodine therapy isn't used for treating pregnant people or those who are breastfeeding.
This treatment destroys cells that make thyroid hormone. After the treatment, you'll likely need to take daily hormone medicine to get the thyroid hormones your body needs.
Anti-thyroid medicines
Anti-thyroid medicines block the thyroid from using iodine to make hormones. These prescription medicines include propylthiouracil and methimazole.
Because the risk of liver failure is more common with propylthiouracil, methimazole is most often the first choice. But methimazole has a slight risk of birth defects. So propylthiouracil might be prescribed during the first trimester of pregnancy. Pregnant people typically take methimazole after the first trimester.
When either of these medicines are used without other treatments, hyperthyroidism may come back. These medicines may work better when they are taken for longer than a year. Anti-thyroid medicines may be used before or after radioiodine therapy as an added treatment.
Side effects of both medicines include rash, joint pain, liver failure or a decrease in disease-fighting white blood cells.
Beta blockers
These medicines don't stop the body from making thyroid hormones. But they block the effect of hormones on the body. They may work quickly to ease irregular heartbeats, tremors, anxiety, irritability, heat intolerance, sweating, diarrhea and muscle weakness.
Beta blockers include:
Propranolol (Inderal LA, InnoPran XL, Hemangeol).
Atenolol (Tenormin).
Metoprolol (Lopressor, Toprol-XL).
Nadolol (Corgard).
Beta blockers aren't often given to people with asthma because they can cause an asthma attack. These medicines also might make it harder to manage diabetes.
Surgery
Surgery to remove the thyroid, called thyroidectomy, can treat Graves' disease. You need to take thyroid medicine for the rest of your life after this surgery.
Risks of this surgery include damage to the nerve that controls the vocal cords and damage to the tiny glands that sit next to the thyroid gland, called the parathyroid glands. The parathyroid glands make a hormone that controls the level of calcium in the blood. Complications are rare with surgeons who have done a lot of thyroid surgeries.
Treating thyroid eye disease
For mild symptoms of thyroid eye disease, using artificial tears during the day may be helpful. You can buy artificial tears without a prescription. Use lubricating gels at night.
For symptoms of thyroid eye disease that are worse, treatment might include:
Corticosteroids. Treatment with corticosteroids given through a vein may ease swelling behind the eyeballs. Side effects might include fluid buildup, weight gain, high blood sugar, high blood pressure and mood swings.
Teprotumumab (Tepezza). This medicine is given eight times. It's given through an IV in the arm every three weeks. It can cause side effects such as hearing loss, nausea, diarrhea, muscle spasms and high blood sugar.
Prisms. You may have double vision either because of Graves' disease or as a side effect of surgery for Graves' disease. Though they don't work for everyone, prisms in your glasses may correct double vision.
Orbital decompression surgery. In this surgery, a surgeon removes the bone between the eye socket, called the orbit, and the air spaces next to the orbit, called the sinuses. This gives the eyes room to move back to their usual place.
This treatment is mainly used if pressure on the optic nerve might cause loss of vision. Possible complications include double vision.
Orbital radiotherapy. This was once a common treatment for thyroid eye disease, but how it helps isn't clear. It uses X-rays over several days to destroy some of the tissue behind the eyes. Your healthcare professional might suggest this treatment if your eye problems are getting worse and corticosteroids aren't working, or they cause too many side effects.
Thyroid eye disease doesn't always get better with treatment of Graves' disease. Symptoms of thyroid eye disease may even get worse for 3 to 6 months. After that, the symptoms of thyroid eye disease most often stay the same for a year or so. Then the symptoms begin to get better, often on their own.
Everything has a solution so stay safe good people (LOL 😍)
