What does it have to do with your thyroid?
For a couple of weeks, you notice that you have a slight tremor to your hands and have been feeling more anxious than usual. One morning after waking up, you realize that your neck seems to have a large lump in it, so you go to the doctor. After running tests, she tells you that you have Graves’ Disease. What is this? How is it treated?
Definition
Graves’ disease is a disorder of the immune system that results in the overproduction of thyroid hormones. It’s the most common cause of hyperthyroidism. The thyroid gland is normally regulated by hormones released from the pituitary gland. Normally, the immune system produces antibodies to fight viruses, bacteria, and other foreign substances. In a person with Graves’ disease, the immune system produces an antibody, thyrotropin receptor antibody (TRAb), that overrides the normal process by acting like the regulatory pituitary hormone.
Since thyroid hormones affect many body functions, symptoms can vary greatly. Some possible ones are anxiety, irritability, fine tremor of hands/fingers, heat sensitivity, increased perspiration, weight loss (despite normal eating habits), enlargement of the thyroid gland (goiter), frequent bowel movements, fatigue, sleep disturbances, rapid/irregular heartbeat, changes in menstrual cycles, erectile dysfunction, and reduced libido. Some individuals with Graves’ disease, around 30%, have Graves’ ophthalmopathy, which is when the disease causes inflammation and other immune system reactions to the muscles and tissues around your eyes. Symptoms of this are bulging eyes, gritty sensation in the eyes, eye pain/pressure, puffy/retracted eyelids, light sensitivity, double vision, reddened/inflamed eyes, and vision loss. This can appear simultaneously as other Graves’ symptoms, several months after they’ve started, before any other symptoms, or without any other symptoms. Another possible manifestation, although uncommon, is Graves’ dermopathy. This results in the reddening and thickening of the skin, usually on the shins or tops of the feet.
Some factors can increase your chances of developing Grave’s disease. Certain ones are out of your control, such as a family history of the disorder, being a woman, being under 40, or having other autoimmune disorders. Other aspects you have more influence over, like not smoking, managing stress well, and being pregnant. Grave’s disease can result in several complications. If the disorder isn’t treated, it can cause heart rhythm problems and changes to the heart muscles’ structure/function, triggering the heart not being able to pump effectively. Another problem if the disorder is left untreated is osteoporosis. When you have too much thyroid hormone in your body, it can’t absorb calcium into your bones the way it’s supposed to, making them weak and more likely to break. The disease can also negatively affect pregnancy. It can cause miscarriage, preterm birth, poor fetal growth, fetal thyroid dysfunction, maternal heart failure, and preeclampsia (dangerously high blood pressure and other symptoms for the mother). A rare, life-threatening complication is thyroid storm (accelerated hyperthyroidism or thyrotoxic crisis), resulting from a sudden and extreme increase in thyroid hormones. It requires immediate emergency care. Symptoms of thyroid storm include fever, sweating, vomiting, diarrhea, delirium, severe weakness, irregular heartbeat, seizures, jaundice (yellow skin/eyes), drastically low blood pressure, and coma.
Treatment
Graves’ disease treatment is focused on stopping the production of thyroid hormones and blocking the effect of the hormones on the body. There are several options to help achieve these goals. One choice is radioactive iodine therapy. Your thyroid needs iodine to produce hormones, so when you ingest radioiodine, it gets absorbed by your thyroid and the radiation destroys the overactive cells. Over time, several weeks to months, this results in the thyroid gland shrinking and your symptoms lessening. Due to the decline in thyroid activity, at some point, you’ll need treatment to replenish your thyroid hormones to normal amounts. Since this therapy uses radiation, women who are pregnant or breastfeeding can’t receive it. With this therapy, those with Graves’ ophthalmopathy should look for new or worsening symptoms—this is usually mild and temporary.
Another treatment possibility is medications. The first class are anti-thyroids that interfere with the thyroid’s ability to use iodine to produce hormones. The two main drugs are propylthiouracil and methimazole. If they’re taken alone without other treatments, a relapse of hyperthyroidism is possible. However, if either one is taken for longer than a year, the long-term result is usually better. Sometimes these drugs are used before or after radioiodine therapy. The second class of medications are beta-blockers. Instead of stopping thyroid hormone production, these block the effect of the hormones on the body. This means they can relieve irregular heartbeats, tremors, anxiety, irritability, heat intolerance, sweating, diarrhea, and muscle weakness. They can’t be used by individuals with asthma since they can trigger an asthma attack. Some examples of beta-blockers are propranolol, atenolol, metoprolol, and nadolol.
One final treatment alternative is surgery to remove part or all of your thyroid. Complications of the procedure are rare. However, since you no longer have your thyroid, you’ll need to take thyroid medication to replace what your body is missing.
Treatment for Graves’ ophthalmopathy depends on if the symptoms are severe. For mild symptoms, you can use over-the-counter artificial tears during the day and lubricating gels at night. It’s also helpful to apply cool compresses to your eyes, wear sunglasses, elevate the head of your bed, and not smoke. If you have severe symptoms, your doctor will recommend corticosteroids to reduce swelling. If you have double vision, you can try prisms in your glasses. Another option is orbital decompression surgery to remove the bone between your eye sockets and sinuses to give your eyes room.
If you have Graves’ dermopathy, try over-the-counter hydrocortisone creams or ointments. This will help to reduce swelling and reddening. You can also use compression wraps, which will help relieve swelling as well.
Prevention
Unfortunately, there isn’t a way to prevent Graves’ disease from happening. The best thing to do is live a healthy lifestyle because if you develop the condition, you’ll be less likely to have as many complications. It’s important to exercise regularly, eat healthily, manage stress, and get adequate amounts of sleep. It would be best if you didn’t smoke or use illegal drugs. If you drink alcohol, do so moderately.
Having Graves’ disease might seem challenging, but it can be corrected. If you have any questions or concerns about Grave’s disease, please speak with your doctor. If you would like more information, please visit the American Thyroid Association’s Graves’ disease page at https://www.thyroid.org/graves-disease/