| | | | | produces more and more hormone. Common |
| Graves' disease is a thyroid-specific autoimmune | | | | symptoms of hyperthyroidism include weight loss, |
| disorder in which the body makes antibodies to | | | | nervousness, irritability, sweating, dislike of hot |
| the thyroid-stimulating hormone receptor (TSHR), | | | | weather, shakiness, and rapid pulse. About 50% |
| leading to hyperthyroidism, or an abnormally | | | | of patients have red, watery, bulging eyes (the |
| strong release of hormones from the thyroid | | | | actor Marty Feldman had a severe case). |
| gland. Normally, the release of thyroid hormones is | | | | Excessive sweating |
| mediated by thyroid-stimulating hormone (TSH), a | | | | Heat intolerance |
| hormone secreted by the pituitary gland that | | | | Increased bowel movements |
| binds to TSHR to stimulate the thyroid to release | | | | Tremor (usually fine shaking) |
| thyroid hormones. This normal cycle is | | | | Nervousness; agitation |
| self-regulating: the hormones secreted by the | | | | Rapid heart rate |
| thyroid keep more TSH from being produced | | | | Treatment of Graves Disease |
| Causes of Graves Disease | | | | Antithyroid drugs |
| Normally, your immune system uses naturally | | | | The main antithyroid drugs are carbimazole (UK), |
| occurring proteins (antibodies) and white blood cells | | | | methimazole (US), and propylthiouracil (PTU). |
| (lymphocytes) to help eliminate viruses, bacteria | | | | These drugs block the binding of iodine and |
| and foreign substances (antigens) that invade | | | | coupling of iodotyrosines. The most dangerous |
| your body. | | | | side-effect is agranulocytosis (1/250, more in |
| If the body makes too much thyroid hormone, | | | | PTU); this is an idiosyncratic reaction which does |
| the condition is called hyperthyroidism. (An | | | | not stop on cessation of drug. Others include |
| underactive thyroid leads to hypothyroidism.) | | | | granulocytopenia (dose dependent, which |
| Graves disease is the most common cause of | | | | improves on cessation of the drug) and aplastic |
| hyperthyroidism. The production of thyroid | | | | anemia. Patients on these medications should see |
| hormone is increased, causing a wide range of | | | | a doctor if they develop sore throat or fever. |
| symptoms from anxiety and restlessness to | | | | The first treatment is about 20-30% effective, |
| insomnia and weight loss. In addition, the eyeballs | | | | and the latter two treatments result in about a |
| may begin to stick out (exophthalmos), causing | | | | 90-95% resolution rate of the disease. In a few |
| eye irritation and tearing. | | | | cases, the treatments must be repeated. In all |
| Exactly why the immune system begins to | | | | cases, lifetime follow-up laboratory studies must |
| produce these aberrant antibodies is unclear. | | | | be done, and in almost all cases, lifetime |
| Heredity and other characteristics seem to play a | | | | replacement thyroid hormone must be taken. |
| role in determining susceptibility. Studies show, for | | | | Surgery -- In severe cases, surgery to remove |
| example, that if one identical twin contracts | | | | the thyroid, called thyroidectomy, may be |
| Graves' disease, there is a 20% likelihood that the | | | | performed. If the thyroid is removed, |
| other twin will get it, too. Also, women are more | | | | replacement thyroid hormones must be taken for |
| likely than men to develop the disease. And | | | | the rest of a person's life. Candidates for surgery |
| smokers who develop Graves' disease are more | | | | may include pregnant hyperthyroid patients |
| prone to eye problems than nonsmokers with the | | | | intolerant of antithyroid drugs, patients desiring |
| disease. No single gene causes Graves’ | | | | definitive therapy without the use of radioactive |
| disease. | | | | iodine, children and patients with very large or |
| What are the symptoms? | | | | nodular goiters. |
| The thyroid gland grows larger (goiter) as it | | | | |