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Grave's disease is a thyroid condition first identified by Sir Robert Graves in England in the early 19th century. It is the leading cause of hyperthyroidism, a condition of an over active thyroid where too many thyroid hormones are made. It is also called toxic diffuse goiter. It can come on suddenly and be chronic or can have a sudden remission. If someone gets prompt treatment for the hormone disease, there are no long term complications.
Grave's disease is a condition of elevated thyroid hormone production. The cause of this is an autoimmune disease with a twin-twin concordance rate of 20 percent. The antibodies in the autoimmune disease mimic the function of the thyroid hormone, giving the illusion of hyperthyroidism.
No one knows why the immune system begins to produce these antibodies. It is related to heredity and those who smoke have a higher risk of the disease. There is no single gene that causes Grave's disease and it is thought to have environmental factors, including stress.
If you have Grave's disease, you need to consider the following symptoms: There can be irritability or nervousness, fatigue or muscle weakness and heat intolerance. You can have trouble sleeping and hand tremors. There is a rapid and irregular heartbeat, weight loss and frequent diarrhoeal stools. One can notice exophthalmos or a bulging of the eyes. A goiter or enlarged thyroid gland can be found on exam. Some with Grave's disease also have a reddening and thickening of the skin on their shin bone area. It is called pretibial myxedema or sometimes "Grave's dermopathy".
Grave's ophthalmopathy or exophthalmos happens when the cells around the eye are attacked by immune cells and antibodies. The eye tissues are inflamed and tissue and fat builds up behind the eye socket. The optic nerve can be damaged in severe cases, which causes vision loss. Other problems with exophthalmos include irritated, dry eyes, double vision, puffy eyelids, light sensitivity, pain or pressure in the eyes and difficulty looking in different directions. Exophthalmos occurs in about twenty five percent of all patients with Grave's disease. It lasts one to two years and often goes away on its own. It can occur before, after or at the same time as other symptoms of Grave's disease.
The person with Grave's disease often is younger than age 40 and women are 5-10 times more likely to occur in women. Emotional distress and environmental stress seem to be related to those who develop Grave's disease. If you have family members with the disease, you are more likely to develop the condition yourself. Other autoimmune diseases predispose you to getting Grave's disease as well.
The diagnosis of Grave's disease is made by having a physical exam, which might show a goiter. Labe tests will show an elevation of thyroid hormones. An ultra-sensitive TSH test can show evidence of Grave's disease and will be low in value. T4 and T3 levels will be elevated in this disease. Radioactive thyroid hormone testing will show an increased uptake of radioactive iodine. This is used along with a thyroid scan that shows where iodine is distributed in the gland. In Grave's disease, the uptake is diffuse and is not nodular. A thyroid stimulating immunoglobulin test or TSH antibody test is used to measure the amount of autoantibodies in hyperthyroidism and Grave's disease. It is not seen in most people with Grave's disease but is seen in other forms of hyperthyroidism and thus can differentiate between the two diseases.
The treatment of Grave's disease breaks down to three different types of treatment. There is radioiodine therapy, where radioactive iodine-131 is taken by mouth and is taken up selectively by the thyroid gland. It kills off the thyroid tissue so that one is hypothyroid. Treatment for a low thyroid condition is then done and is maintained for life. Anti-thyroid drugs can be used. Beta blockers block the response of the hyperactive thyroid gland on the heart and on nervousness. Thyroid hormone production remains unabated. PTU and methimazole are two medications that interfere with the way the thyroid gland uses iodine. It is sometimes used in people as a pre-treatment for eventual treatment with radioactive iodine therapy. It is safer to use these medications than it is to have radioactive iodine treatment for those who are pregnant or breastfeeding. Anti-thyroid drugs have some side effects, including rashes and other allergic side effects. It can reduce white blood cell count and therefore can affect immunity.
Thyroid surgery is not used very often for Grave's disease but can be used in pregnant women who don't tolerate anti-thyroid drugs. The surgery removes the entire thyroid, leading to hypothyroidism, which is treated then with replacement therapy. Side effects of surgery include the possibility of the loss of the embedded parathyroid gland in the thyroid gland. The parathyroid gland affects the calcium and phosphorus levels in the bloodstream.
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