What is Graves’ disease?

Graves' disease is an autoimmune disorder that primarily affects the thyroid gland, a butterfly-shaped organ located in the neck. This condition leads to the overproduction of thyroid hormones, resulting in a state of hyperthyroidism. Some key characteristics and aspects of Graves' disease include:

• Autoimmune origin: Graves' disease occurs when the body's immune system mistakenly identifies the thyroid gland as a threat and produces antibodies that stimulate the thyroid to release excess hormones.

• Hyperthyroidism: The overproduction of thyroid hormones (thyroxine, or T4, and triiodothyronine, or T3) leads to various symptoms, including rapid heartbeat, weight loss, anxiety, and heat sensitivity.

• Goiter formation: In many cases, Graves' disease results in the enlargement of the thyroid gland, causing a noticeable swelling in the neck known as a goiter.

• Eye and skin symptoms: Some individuals with Graves' disease may experience eye-related issues, such as bulging eyes (exophthalmos) and skin problems, like redness and swelling around the eyes.

• Treatment options: Treatment for Graves' disease typically involves the use of antithyroid medications, radioactive iodine therapy, or, in some cases, surgery to remove part or all of the thyroid gland.

• Ongoing monitoring: Managing Graves' disease may require long-term care and monitoring of thyroid hormone levels to ensure they remain within a normal range.

Graves' disease is a chronic condition, but with proper medical management and treatment, you can lead normal, healthy lives. If you suspect you have Graves' disease or are experiencing symptoms, consult with an endocrinologist for a proper diagnosis and treatment plan.

Symptoms of Graves’ disease

Graves' disease is associated with a variety of symptoms, and these can vary in severity from person to person. The most common symptoms of Graves' disease include:

• Hyperthyroidism symptoms:

  • Rapid or irregular heartbeat (palpitations)

  • Increased heart rate (tachycardia)

  • Tremors in the hands and fingers

  • Unexplained weight loss, despite an increased appetite

  • Anxiety and restlessness

  • Difficulty sleeping (insomnia)

  • Sweating excessively

  • Sensitivity to heat

  • Fatigue and muscle weakness

• Goiter: Many individuals with Graves' disease develop a goiter, which is the visible enlargement of the thyroid gland in the neck. This can lead to swelling and discomfort.

• Eye changes (Ophthalmopathy): Some people with Graves' disease experience eye-related symptoms, including:

  • Bulging or protruding eyes (exophthalmos)

  • Redness and irritation

  • Double vision

  • Light sensitivity

  • Grittiness in the eyes

• Skin changes: 

  • Redness and swelling of the shins (pretibial myxedema)

  • Thickening and reddening of the skin on the tops of the feet

  • Itching

• Emotional and psychological symptoms:

  • Nervousness

  • Mood swings

  • Irritability

  • Difficulty concentrating

  • Changes in menstrual cycles

Causes of Graves’ disease

Graves' disease is an autoimmune disorder, and its exact cause is not fully understood. However, it is believed to result from a combination of genetic, environmental, and immunological factors. Here is an overview of the potential causes and contributing factors:

• Genetics

• Autoimmune response

• Environmental triggers, like infections, stress, and pregnancy

• Women, between the ages of 30 and 50

• Excessive iodine intake

• Emotional stress

How do you diagnose Graves’ disease?

• The first step in diagnosing Graves' disease is often a discussion with your endocrinologist about your medical history and symptoms. This includes a detailed review of symptoms such as rapid heartbeat, weight loss, anxiety, tremors, and any family history of thyroid disorders.

• A physical examination is conducted to check for signs of Graves' disease, including the presence of a goiter (enlarged thyroid gland) in the neck and any eye changes, such as bulging eyes.

• The primary tests used to diagnose Graves' disease are blood tests that measure thyroid function. These tests include:

  • Thyroid Stimulating Hormone (TSH): In Graves' disease, TSH levels are typically low because the autoimmune response leads to overproduction of thyroid hormones. Low TSH levels are a hallmark of hyperthyroidism.

  • Free Thyroxine (Free T4) and Free Triiodothyronine (Free T3): These tests measure the levels of the thyroid hormones T4 and T3 in the blood. In Graves' disease, these levels are often elevated.

• To confirm the autoimmune nature of Graves' disease, healthcare providers may perform antibody tests, including Thyroid Stimulating Immunoglobulins (TSIs). Elevated TSIs in the blood indicate the presence of antibodies that stimulate the thyroid gland, contributing to the overproduction of thyroid hormones.

• In some cases, a radioactive iodine uptake test may be performed. This test measures how much iodine the thyroid gland absorbs. In Graves' disease, the thyroid gland often takes up an excessive amount of iodine.

• A thyroid ultrasound may be used to visualize the size and condition of the thyroid gland, helping to identify the presence of a goiter or nodules.

Once the diagnosis is confirmed, a St. Luke’s Health endocrinologist will work with you to develop an appropriate treatment plan. 

Graves’ disease treatment

The treatment of Graves' disease aims to restore normal thyroid function, alleviate symptoms, and address the autoimmune response. There are several treatment options available, and the choice of treatment depends on individual factors, including the severity of the condition and the patient's preferences. Here are the primary treatment options for Graves' disease:

• Antithyroid medications:

  • Methimazole (Tapazole) or Propylthiouracil (PTU): These medications are commonly prescribed to reduce the production of thyroid hormones. They inhibit the activity of the thyroid gland and can help bring thyroid hormone levels back to normal.

  • Beta-blockers: These drugs, such as propranolol, are often prescribed to manage symptoms like rapid heartbeat, tremors, and anxiety while the antithyroid medications take effect.

• Radioactive Iodine Therapy (RAI):

  • RAI is a common treatment for Graves' disease, particularly in cases where medications do not effectively control thyroid hormone levels. It involves the oral administration of radioactive iodine, which is taken up by the overactive thyroid cells. The radiation gradually reduces thyroid activity, often leading to hypothyroidism (underactive thyroid).

  • Patients with RAI therapy may need to take thyroid hormone replacement medication after treatment to maintain normal thyroid function.

• Thyroid surgery:

  • In some cases, surgical removal of all or part of the thyroid gland may be necessary. This option is considered when other treatments are not appropriate, or if there are concerns about side effects or complications associated with antithyroid medications or RAI.

  • After surgery, patients will need lifelong thyroid hormone replacement therapy to maintain normal thyroid function.

• Monitoring and follow-up: Regardless of the treatment chosen, close monitoring is essential. Patients will undergo regular blood tests to check thyroid hormone levels and adjust medication as needed.

• Eye care: For individuals with Graves' ophthalmopathy (eye changes), eye care may include artificial tears, medications to reduce inflammation, and sometimes surgery to correct eye-related issues.

• Supportive care: Lifestyle modifications can also help manage Graves' disease. These may include managing stress, maintaining a well-balanced diet, and addressing any specific symptoms or concerns related to the condition.

What lifestyle changes should I make with Graves’ disease?

Lifestyle changes can be beneficial for individuals with Graves' disease, helping to manage symptoms and improve overall well-being. Here are some lifestyle modifications to consider:

• Stress management: Practicing stress-reduction techniques like deep breathing, meditation, yoga, and progressive muscle relaxation can be helpful. Finding healthy outlets for stress, such as hobbies or exercise, is also important.

• Dietary choices: 

  • Iodine intake: Be cautious with iodine-rich foods and supplements, as excessive iodine can worsen thyroid function.

  • Soy and cruciferous vegetables: Limit the consumption of soy products and cruciferous vegetables (e.g., broccoli, cabbage, Brussels sprouts) as they can interfere with thyroid function.

• Regular exercise: Engage in regular physical activity, as it can help improve mood, manage weight, and promote overall well-being. However, be mindful of your energy levels and consult with your healthcare provider about an appropriate exercise regimen.

• Adequate sleep: Ensure you get enough quality sleep. Insomnia is a common symptom of Graves' disease, so practicing good sleep hygiene can be essential.

• Limit caffeine and alcohol: Excessive caffeine and alcohol consumption can exacerbate symptoms like anxiety and heart palpitations. Reducing or eliminating these substances from your diet may help.

• Eye care: If you have Graves' ophthalmopathy (eye changes), follow your healthcare provider's recommendations for eye care, which may include using lubricating eye drops, wearing sunglasses, and, in some cases, receiving treatments to manage eye symptoms.

Consult with your endocrinologist before making significant modifications to your diet or exercise routine, as they can provide personalized recommendations based on your specific condition and treatment plan.