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GRAVES’ DISEASE

Posted Mar 05 2010 12:00am
Mar
05

          Graves’ disease is one of the most common autoimmune diseases, affecting 13 million people and targeting women seven times as often as men.  Patients with Graves’ disease produce an excessive amount of thyroid hormone.  It is a type of autoimmune disease in which the immune system over stimulates the thyroid gland, causing hyperthyroidism.  Over-activity of the thyroid gland is also sometimes called “diffuse toxic goiter.”  The thyroid gland helps set the rate of metabolism (the rate at which the body uses energy), and when it is over-stimulated, it produces more thyroid hormones than the body needs.

          Graves’ disease affects 2 percent of all women at some time in their lives.  The disorder also tends to affect women between the ages of 20 and 40, although it can occur in infants, children and the elderly.  Risk factors for Graves’ disease include family history of hyperthyroidism or various other autoimmune disorders, high iodine intake, stress, use of sex steroids and smoking.   This is an extremely rare disease; the incidence is about 5 in 10,000 people.  It is named after Robert Graves, the 19th century Irish physician who first discovered the condition.

          High levels of thyroid hormones can cause difficult side effects.  The illness is classically characterized by the triad of goiter (abnormally enlarged thyroid gland that can result from underproduction or overproduction of hormone or from a deficiency of iodine in the diet), exophthalmos (bulging of the eyes anteriorly out of the orbit) and pretibial myxedema (a skin condition characterized by swollen, itchy patches of skin on the front of the lower legs or shins).  Other common symptoms of the disease include trouble sleeping, fatigue, problems with getting pregnant, frequent bowel movements, irritability, weight loss without dieting, heat sensitivity, increased sweating, muscular weakness, changes in vision, lighter menstrual flow, rapid heart beat and hand tremors.

           Thyroid storm  is a rare and potentially fatal complication of hyperthyroidism.  It typically occurs in patients with untreated or partially treated thyrotoxicosis who experience a precipitating event such as surgery, infection or trauma.  Thyroid storm must be recognized and treated on clinical grounds alone, as laboratory confirmation often cannot be obtained in a timely manner.  Patients typically appear markedly hypermetabolic with high fevers, tachycardia, nausea and vomiting, tremulousness, agitation and psychosis.  Late in the progression of disease patients may become stuporous or comatose with hypotension (low blood pressure).

          There are three treatments for Graves’ disease:

  • Medicine.  There are some medicines called antithyroid drugs that can lower the amount of thyroid hormones made by the thyroid, causing it to make, normal levels.  A doctor must give these medicines to you.  Some patients who take an acute thyroid drug for 1 to 2 years have a remission from Graves’ disease; their thyroid function may remain normal even without medication.
  • Radioactive iodine.  The radioactive iodine damages thyroid cells, shrinking and eventually destroying the thyroid gland in order to reduce hormone levels.  Like surgery, this condition usually leads to hypothyroidism, so that thyroid hormone supplement medication is needed for the rest of the patient’s life.
  • Surgery.  All of the thyroid gland will be removed.  In most cases, people who have surgery for Graves’ disease will develop an under-active thyroid (hypothyroidism, the opposite of hyperthyroidism), and will have to take thyroid replacement hormones for the rest of their lives.

          As one can see, Graves’ disease can have an effect on many parts of the body such as the nervous system, eyes, skin, hair/nails, lungs, digestive system, muscles/bones and reproductive system.  If you suspect that you might have the disease, go to the doctor.  In the examination, the doctor will look for a goiter (enlarged thyroid gland), a rapid pulse, tremor and any other evidence of the disorder.  Blood tests will be performed to assess thyroid function.  Your physician may also order a radioactive-iodine uptake test and thyroid scan.  These tests can help determine if the entire thyroid gland is overactive, or whether just a portion of the gland is overactive.

WORKS CITED       

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