Graves' Disease: Causes and Treatment

Graves' Disease: An Overview

Graves' disease is an immune system (autoimmune) disorder that results in the overproduction of thyroid hormones. It is most common in women under the age of 40. The goal of treatment is to reduce thyroid hormone production and lessen the severity of symptoms.

Symptoms of Graves' Disease

• Anxiety and irritability,
• Tremor of the hands and fingers,
• Sweating,
• Moist skin,
• Weight loss despite normal eating,
• Muscle weakness,
• Goiter,
• Menstrual irregularities,
• Erectile dysfunction and reduced sex drive,
• Diarrhea,
• Palpitations,
• Bulging, shiny eyes (Graves' ophthalmopathy),
• Thick, red skin on the feet.

Graves' Ophthalmopathy (Bulging Eyes): In up to 30% of people with Graves' disease, the immune system and inflammation affect the muscles and fatty tissue around the eyes. Complications can include bulging eyes, a staring gaze, pressure or pain in the eyes, puffy or retracted eyelids, red eyes, sensitivity to light, double vision and vision loss.

Diagnosis of Graves' Disease

The diagnosis is easily made by measuring thyroid hormones in the blood, a thyroid ultrasound and, when necessary, thyroid scintigraphy and an uptake test.

Treatment of Graves' Disease

Options include medication, radioactive iodine therapy and surgery. Your doctor will explain the treatment options to you.

Anti-Thyroid Medications

These medications prevent the thyroid gland from using iodine, which reduces thyroid hormone production. They can be used as the primary treatment option with long-term use of 9 to 24 months. The likelihood of complete recovery with medication is around 50%. They also have side effects such as rash, joint pain and abdominal pain.

Beta-Blockers

These medications do not reduce hormone production; they block the effects of the hormones on the body. They relieve symptoms such as palpitations, sweating, irritability and muscle weakness. They are not suitable for patients with asthma.

Radioactive Iodine Therapy

In this treatment, you take radioactive iodine by mouth. The radioactive iodine enters the thyroid cells and, over time, destroys the overactive thyroid cells. It is not used in pregnant women, breastfeeding mothers or in moderate to severe Graves' ophthalmopathy. Because it reduces thyroid activity, you may need thyroid hormone supplements later on.

Surgery

This is the removal of the thyroid gland. It is recommended that the operation be performed by experienced surgeons. Risks include bleeding, wound infection, hoarseness and damage to the parathyroid glands.

Because permanent hypothyroidism will develop after the operation, you will need thyroid hormone supplements.

Treatment of Graves' Ophthalmopathy (Bulging Eyes)

For patients with mild Graves' ophthalmopathy, recommendations such as using artificial tears, quitting smoking, raising the head of the bed and wearing sunglasses may be enough. In moderate to severe Graves' ophthalmopathy, the treatment of choice is corticosteroids. Side effects include raised blood sugar, raised blood pressure, weight gain and mood changes. In some cases, eye surgery or radiation therapy may be needed. It is advisable for the patient to be evaluated by an ophthalmologist experienced in neuro-ophthalmology.

Graves' ophthalmopathy does not always improve with treatment of Graves' disease. It may get worse during the first 3–6 months. It usually stabilizes within a year and then often begins to improve on its own.