October 19, 2009
Graves' disease is a disorder in which the body's immune system mistakenly attacks the thyroid gland and causes it to make too much of the hormone thyroxine. Because the thyroid gland regulates the body's metabolism, weight, energy, mood and organ functions can be affected when there is a problem. Dr. Asha Thomas, an internal medicine specialist at Sinai Hospital with a sub-specialty in endocrinology and metabolism, writes about the condition.
* Graves' disease can develop in anyone at any age, but it develops most often in women after the age of 20. A family history of thyroid disease is associated with increased incidence of Graves' disease. Women are between eight and 10 times more likely than men to develop it. Hormones, age, infections and intense emotional stress are other factors.
* The classic symptoms are a fast heartbeat, anxiety, irritability, difficulty sleeping, fatigue, tremors, sweating, weight loss, brittle hair, thyroid gland enlargement, change in menstrual cycles and/or frequent bowel movements. Some patients will also develop Graves' ophthalmopathy, in which the eyeballs bulge out past their orbits. This condition may cause difficulty with dry eyes and vision problems.
* Doctors usually conduct a physical examination and order a blood test to confirm Graves' disease. Generally, it is treated in three ways. Beta-blockers are used to help with the symptoms of hyperthyroidism, such as heart palpitations and tremors. Medications, such as methimazole or propothiouracil, are given to prevent the thyroid from producing excessive amounts of hormones. However, both drugs have potential effects on liver function. Methimazole can also cause a low white blood cell count in a small percentage of patients.
Radioactive iodine is another treatment option. The iodine collects in the thyroid gland, and over time, the radioactivity destroys overactive thyroid cells and causes the thyroid gland to shrink. In turn, that decreases the production of the thyroid hormone. This is an outpatient procedure. The most common side effect is ultimate hypothyroidism (underactive thyroid).
Surgery is an option if patients are not able to tolerate the medications and defer on the radioactive iodine. After surgery, patients need lifelong thyroid hormone replacement. Risks of this surgery include potential damage to the vocal cords and parathyroid glands, which produce a hormone that controls calcium levels. The risk is low in the hands of an experienced thyroid surgeon.
* If Graves' disease is treated incorrectly or not treated at all, complications can include osteoporosis, heart problems, and/or emotional challenges. Untreated Graves' disease can even be deadly.
