I Think I Have Graves' Disease

Graves' disease, more common in women than men, is a type of hyperthyroidism (the body has too much thyroid hormone).  It usually occurs in young and middle-aged women and does not cause severe illness.  The exact cause of Graves’ disease is not known; however, it mimics autoimmune diseases, in which, the body's defenses against infection attack the body's own tissue. In the case of Graves' disease, the body makes antibodies that cause the thyroid gland to make too much hormone.  There is no known way to prevent Graves' disease.

Hormones made by the thyroid gland control your metabolism (the chemical processes your body uses to turn the food you eat into energy). Metabolism affects your heart rate, the amount of calories you burn when you are resting, your energy level, and other body functions. When your thyroid is not working properly, the effects on your body can be dramatic.

The most common symptoms of Graves' disease are:

• weight loss
• rapid heart rate
• anxiety
• feeling hot
• Sweating a lot.

Many people feel nervous or not able to control their emotions. Some feel muscle weakness, especially in the thigh muscles when they climb stairs. A few people have a swelling in their neck (goiter) because of an enlarged thyroid gland.

Frequently, people with Graves' disease have an eye problem called exophthalmia.  The eyelids do not completely close over the eye and the eyes may protrude or appear to protrude from their sockets.  Even if the eyes are not protruding, they may look like they are bulging because the eyelid closes over less of the eye. When the eyelid does not close over the entire eye, eyes may become dry and irritated. Sometimes the eye muscles are affected, which may limit movement of the eyeballs. Sometimes just one eye has symptoms, but usually both eyes are affected.

If you think you may have symptoms of Graves’ disease, visit your healthcare provider. A serious problem called thyroid storm can happen, if Graves’ disease is not treated.  Thyroid storm is the buildup of thyroid hormone causing severe restlessness, fever, confusion, sweating, and diarrhea, tachycardia, and hypertension. Thyroid storm can be a life-threatening emergency.

To diagnose Graves’ disease, healthcare providers may order blood test to check thyroid hormone levels and for antibodies that attack the thyroid gland.  Healthcare providers will likely perform a physical exam checking for a goiter, muscle strength, heart rate, and blood pressure.  Healthcare providers may also order other test such as a radioactive iodine scan, or RAI uptake. This test shows if there are areas of the thyroid gland making more or less hormone than normal. A scan of the thyroid gland with ultrasound is another way to look at the thyroid gland. The ultrasound scan can show cysts or tumors in the gland. It can also be used to measure the size of the gland.

Medications to treat Graves’ disease help the body to achieve a normal level of thyroid hormone and control hyperthyroidism symptoms. Two anti-thyroid drugs used to stop the thyroid gland from making too much hormone are propylthiouracil (PTU) and methimazole (Tapazole). Anti-thyroid drugs can cause a decrease in white blood cells and thus require frequent follow-ups to check for unwanted side effects or the need for dosage adjustments.  

In addition to anti-thyroid medications, beta-blockers such as Inderal may be used to slow heart rate, lower blood pressure, and may help calm feelings of anxiety. Beta-blockers do not change how much thyroid hormone is made.  For eye problems caused by hyperthyroidism, sometimes, a steroid medicine (prednisone) is prescribed.  Keeping the eyes moist is important and eye-drops maybe recommended.

If Graves’ disease symptoms are severe, healthcare providers may recommend destroying some of the hormone producing cells of the thyroid gland.  This is accomplished in either one of two procedures. The preferred method, and the one the method with the least complications uses radioactive iodine to kill some of the cells in the thyroid gland.  The other treatment for severe or long-term hyperthyroidism is surgery to remove the thyroid gland. Because there are so many important structures in the area of the thyroid gland, the surgery can have some serious complications.  Either treatment can possibly result in taking replacement thyroid hormone for life.  The other treatment for severe or long-term hyperthyroidism is surgery to remove the thyroid gland. Because there are so many important structures in the area of the thyroid gland, the surgery can have some serious complications. You can reduce the risk by choosing an experienced thyroid surgeon who does the surgery often. After surgery, you will need to take thyroid hormone for the rest of your life.