GRAVES’ DISEASE

Graves' disease is an autoimmune disease in which the patient's own immune
system attacks the thyroid gland, causing it to produce too much thyroid hormones.
Most common form of HYPERTHYROIDISM.
The thyroid gland is part of the endocrine system, and is located in the neck, below
the Adam's apple. It produces hormones which help to regulate growth and the rate
of chemical reactions by which the body uses energy. The thyroid gland produces
thyroxine and triiodothyronine.
Thyroxine affects many body systems and has a key role in regulating our body's
metabolic rate - the rate at which chemical reactions occur in our body; the rate at
which our bodies break things down to produce energy, and build new tissue
(metabolism). When thyroxine levels are high the patient's metabolic rate increases;
this can have an effect on their physical appearance as well as moods.
Healthy people's immune systems attack pathogens; organisms and substances
that are bad for us, such as some bacteria, viruses, parasites, cancer cells and
fungi. If the person's immune system starts attacking good tissue they
have an autoimmune disease - the immune system is attacking parts of the
person's body that are needed for good health.
The antibody associated with Graves' disease — thyrotropin receptor antibody
(TRAb) — acts like the regulatory pituitary hormone. That means that TRAb
overrides the normal regulation of the thyroid, causing an overproduction of thyroid
hormones (hyperthyroidism).
Common signs and symptoms of Graves' disease include:

Anxiety and irritability

A fine tremor of your hands or fingers

Heat sensitivity and an increase in perspiration or warm, moist skin

Weight loss, despite normal eating habits

Enlargement of your thyroid gland (goiter)

Change in menstrual cycles

Erectile dysfunction or reduced libido

Frequent bowel movements

Bulging eyes (Graves' ophthalmopathy)

Thick, red skin usually on the shins or tops of the feet (Graves' dermopathy)

Rapid or irregular heartbeat (palpitations)

Graves' ophthalmopathy

particularly among women who are genetically susceptible. Smokers who have Graves' disease are also at increased risk of developing Graves' ophthalmopathy. Because a family history of Graves' disease is a known risk factor.  Emotional or physical stress.  Pregnancy. is the reddening and thickening of the skin. In Graves' ophthalmopathy. Pregnancy or recent childbirth may increase the risk of the disorder. increases the risk of Graves' disease. Risk factors:  Family history. Stressful life events or illness may act as a trigger for the onset of Graves' disease among people who are genetically susceptible. have an increased risk. People with other disorders of the immune system. called Graves' dermopathy. there is likely a gene or genes that can make a person more susceptible to the disorder. Cigarette smoking. For every male with Graves' disease there are seven females with the disease  Age. most often on your shins or the tops of your feet.  Other autoimmune disorders. Women are much more likely to develop Graves' disease than are men. Graves' disease usually develops in people younger than 40. such as type 1 diabetes or rheumatoid arthritis.  Gender.About 30 percent of people with Graves' disease show some signs and symptoms of a condition known as Graves' ophthalmopathy. . inflammation and other immune system events affect muscles and other tissues around your eyes. The resulting signs and symptoms may include:  Bulging eyes (exophthalmos)  Gritty sensation in the eyes  Pressure or pain in the eyes  Puffy or retracted eyelids  Reddened or inflamed eyes  Light sensitivity  Double vision  Vision loss Graves' dermopathy An uncommon manifestation of Graves' disease. which can affect the immune system.  Smoking.

THS is a hormone which stimulates the thyroid gland .iodine is needed by the human body to produce thyroxine. Elevated levels of TRAb.if the patient does not receive treatment their bones will become weak and they may develop osteoporosis. maternal heart failure and preeclampsia.  Blood test . The thyroid is examined to determine whether it is enlarged.  Thyrotoxic crisis/ Thyroid storm/ Accelerated Hyperthyroidism . During the interview the patient will be asked about their symptoms. mimics TSH. fetal thyroid dysfunction. primary care physician) or specialist examines the patient's eyes to see whether they are bulging or irritated. accelerated heartbeat. severe low blood pressure. vomiting.Complications:  Heart problems . making the thyroid gland overproduce thyroxine.  Brittle bones . When calcium and mineral levels in bones drop they become weak. The doctor can determine the rate at which the thyroid .it is produced and released by the pituitary gland. an antibody.the patient may develop tachycardia (fast heartbeat). atrial fibrillation (a heart rhythm disorder). A doctor may diagnose Graves' disease if the patient has low levels of TSH and high levels of thyroxine. Overproduction of thyroid hormone interferes with the body's ability to get calcium into bones. seizures. medical and family medical histories.  Radioactive iodine uptake . The doctor will also check the patient's heart rate and blood pressure. poor fetal growth.  Pregnancy issues. The patient may develop a fever. and congestive heart failure (the heart fails to pump enough blood for the whole body's requirements). preterm birth. confusion and even delirium.Possible complications of Graves' disease during pregnancy include miscarriage. Test and Diagnosis  Physical examination . Preeclampsia is a maternal condition that results in high blood pressure and other serious signs and symptoms. even when TSH levels are low. profuse sweating. diarrhea.the GP (general practitioner. severe weakness.this is a sudden increase in the severity of signs and symptoms. With the right kind of treatment these complications are reversible. The physician will check for signs of trembling of the hands or fingers (tremor).these are carried out to find out what the levels of TSH (thyroidstimulating hormone) and thyroxine are. This rare complication should be treated immediately.

may also be used. a lot can be done to ease symptoms and lower the production of thyroxine or block its action. and is most useful in people who can't undergo radioactive iodine uptake.corticosteroids to reduce swelling behind the eyes. The possible treatments include: Beta blockers .Ultrasound uses high-frequency sound waves to produce images of structures inside the body. Beta blockers are generally effective medications for relieving the signs and symptoms of hyperthyroidism. Surgery . . and tremors. atenolol (Tenormin).this occurs in Graves' disease. and a lower production of thyroid hormone. such as CT scan.examples include propylthiouracil and methimazole (Tapazole). Treatment: There are no medications or treatment currently available today that can stop the patient's immune system from attacking the thyroid gland and causing Graves' disease. If the uptake of radioactive iodine is high it means that the patient's thyroid gland is producing excessive amounts of thyroxine .examples include propranolol (Inderal). anxiety and nervousness. However.iodine is needed for the gland to produce thyroid hormone. The radioactivity slowly destroys the overactive thyroid cells. Magnetic resonance imaging (MRI).this involves surgically removing the thyroid gland (thyroidectomy) Graves' ophthalmopathy (when eyes are affected) Dry eyes . resulting in a smaller thyroid gland. In some other causes of hyperthyroidism the uptake of iodine is low. Anti-thyroid drugs . such as accelerated heartbeat.gland takes up iodine by giving the patient a small amount of radioactive iodine and then measuring the level of it in the thyroid gland after a set period. your doctor may order an imaging test. giving the eyes more space so they can move back in. such as pregnant women. a specialized X-ray technology that produces thin cross-sectional images.the bone between the orbit (eye socket) and the sinuses is removed. Drugs . They prevent the thyroid gland from producing excessive amounts of thyroid hormone Radioactive iodine treatment . If a patient receives radioactive iodine it soon accumulates in the thyroid gland. Orbital decompression surgery . metoprolol (Lopressor) and nadolol (Corgard). which uses magnetic fields and radio waves to create either cross-sectional or 3-D images.  Imaging tests.  Ultrasound. Ultrasound can show if the thyroid gland is enlarged..If the diagnosis of Graves' ophthalmopathy isn't clear from a clinical assessment.patients with mild symptoms will most likely be prescribed artificial tears for daytime use and a lubricating gel to help keep eyes moist during sleep.

using compression wraps on your legs may help. use over-the-counter creams or ointments containing hydrocortisone to relieve swelling and reddening.prisms in glasses may correct double vision. Orbital radiotherapy . .the aim here is to destroy tissue behind the eyes by targeting X-rays over a course of several days.Eye muscle surgery . Graves' dermopathy If the disease affects your skin (Graves' dermopathy). giving the patient better eye alignment and movement.the muscle that is attached to the eyeball is cut and reattached further back. In addition. Prisms .