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Graves’ Disease: A Comprehensive Introduction to this Autoimmune Disorder

Staying true to the rising thyroid disorders in India, Graves' disease is said to affect about 16.7% of adults.

The tiny, butterfly-shaped thyroid gland orchestrates the activities of nearly every organ. As a result, any disruption in its equilibrium can set off a cascade of chaos. A havoc situation that Graves' disease is unapologetically guilty of.



The condition is a clear case of the immune system going rogue. It launches an unprovoked attack on arguably the most vital gland—the thyroid gland. The consequences can range from facial abnormalities to serious heart complications. So, the quicker the situation is tamed, the better it is for your mental and physical sanity.

Here’s a detailed overview of Grave’s disease to keep you well-informed about what to expect.


What is Graves’ Disease?

Graves’ disease, aka Basedow's disease, is an autoimmune disease of the thyroid gland. The immune system strikes the healthy tissues of the gland, resulting in Hyperthyroidism. A health issue that happens when the thyroid gland overproduces thyroid hormones. The disorder derives its name from Robert Graves. He was an Irish physician, the first to describe the disease in the 1800s.


Graves’ Disease Symptoms

Given that the thyroid gland has a say on many organs, Graves’ disease affects diverse body parts.



The signs you get are pretty varied, the most common of which include:

  • Anxiety and irritation (rapid heartbeats)

  • Shaky hands/ fingers

  • Sensitivity to heat

  • Excessive perspiration

  • Warm, moist skin

  • Loss of weight (despite you eating your usual meals)

  • Graves' disease goiter (thyroid gland getting enlarged)

  • Menstrual cycle changes

  • Sleeping difficulties

  • Hair loss/ brittle hair

  • Erectile dysfunction

  • Frequent bowel movements

  • Fatigue

  • Graves' dermopathy (thick, red skin on top of your feet or shins)


Graves' Ophthalmopathy

About 30% of patients have Graves' ophthalmopathy, leading to inflammation and other abnormalities. Specifically on the muscles and tissues around the eyes.


Here is a list of common Graves’ disease eye signs to look out for to confirm Graves' ophthalmopathy.

  • Bulging eyes

  • Gritty feeling in the eyes

  • Pain/ pressure in the eyes

  • Sensitivity to light

  • Double vision

  • Loss of vision

  • Puffy lids

  • Inflamed eyes


Graves’ Disease Causes

Graves’ disease occurs due to a malfunction in the immune system. In normal situations, the defense mechanism prevents diseases by producing antibodies. It fights harmful viruses, bacteria, and foreign matter and keeps you safe.

In the case of Graves’ disease, the same system uses the weapon thyrotropin receptor antibody (TRAb). And not on some notorious substance, but on one of the cells of the thyroid gland. The latter, which was so far regulated by the pituitary gland, now comes under the control of TRAB. Leading to the overriding of normal regulation and eventually Hyperthyroidism.


Is Graves’ Disease Hereditary?

Unfortunately, the exact reason behind this abnormality remains unexplained. But if you have Graves’ disease in your family line, the chances of developing the issue get higher.

That being said, there are other factors contributing to the condition too.


Who Is At More Risk Of Getting Graves’ Disease?

  • Sex - Women are more fragile to the disorder than men.

  • Age- The problem can occur in children and aged adults. But people between 30 and 50 years old are at greatest risk.

  • Other autoimmune disorders- The following conditions expose you more to the problem:

  • Type 1 Diabetes

  • Rheumatoid Arthritis

  • Lupus (an inflammatory disease)

  • Celiac Disease (immune response to eating gluten)

  • Vitiligo (causes loss of skin color)

  • Stressful situations - A major illness or emotional stress in life may lead to the disorder. Especially for those who have a genetic composition that puts them more at risk.

  • Pregnancy- The onset of Graves’ disease may be a result of pregnancy and recent childbirth.

  • Smoking - People who smoke are more vulnerable to developing the problem. They are most likely to be accompanied by Graves' disease ophthalmopathy as well.


How is Graves’ Disease Diagnosed?

Your doctor will take note of the Graves’ disease symptoms at first. They will also ask for your past medical records. As well as your family history of thyroid complications. Post that, you may have to undergo a physical exam and some specific tests to confirm the condition.

  1. Thyroid blood tests- Graves' disease sees the thyroid gland making excess hormones. So, checking the thyroid hormone and TSH (thyroid-stimulating hormone) levels is the first step to identifying the issue. Low TSH signals a Graves' disease overactive thyroid situation.

  2. Thyroid antibody blood tests - These help recognize diverse autoimmune thyroid conditions.

  3. Thyroid uptake and scan- The thyroid gland absorbing too much iodine is a mark of Graves' disease. So, in this test, you will have to take radioactive iodine orally in smaller amounts. Following this, your doctor will see the absorption levels.

  4. Doppler ultrasound- This checks the increased flow of blood in your thyroid via sound waves.

Graves’ Disease Treatment

Graves’ disease is a lifelong companion and cannot be cured permanently. However, Graves’ disease medication available is quite efficient in limiting the damage. They control the overproduction of hormones and the subsequent harmful effects.

  1. Beta-blockers - These are not instrumental in stopping the overproduction of the hormone. But they are often the fine line of defense in its treatment. That’s because they safeguard your heart by regulating its rate. Until other pills start working to control the situation. Examples include propranolol and metoprolol.

  2. Antithyroid drugs - These are responsible for reducing thyroid hormone production. Methimazole and propylthiouracil are prime examples.

Note: Although effective on most, these can cause low white blood cells and skin rashes in some.

  1. Radioiodine therapy - This cure involves using radioactive iodine. You are asked to take the dose in the form of liquid or pills. The radiation kills the cells of the thyroid glands, normalizing the hormone levels.

Tip: If you are pregnant or breastfeeding, this cure is not recommended. Also, note that, in the long run, this therapy might result in an underactive thyroid. The condition is known as Hypothyroidism but is a lot easier to treat. Thanks to thyroid replacement hormone pills like levothyroxine.

  1. Surgery - This process surgically removes a segment or whole of the gland. This may also cause Hypothyroidism.

Final Thoughts

Graves' disease tops the list of primary causes behind Hyperthyroidism. If left untreated, it can lead to a host of complications, like:

  • Strokes

  • Heart failure

  • Weakened bones

It also significantly affects pregnancy, leading to:

  • Miscarriages

  • Low birth rates

  • Premature labor

  • Preeclampsia (high blood pressure, swelling, headaches, protein in urine, etc.)

Thankfully, with the advancement of medicine, we have great cures today. They not only reduce complications but also assist in living a better life in general. Graves' disease medication can indeed come with risks. But a specialist can answer your queries and help you opt for the best option.

 

The Author : Dr. Sunil Khattri

sunilkhattri@gmail.com

+91 9811618704


Dr. Sunil Khattri MBBS, MS(General Surgery), LLB, is a Medical doctor and is a practicing Advocate in the Supreme Court of India and National Consumer Disputes Redressal Commission, New Delhi.

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