Graves disease is an autoimmune condition affecting the thyroid gland that results in abnormally high levels of thyroid hormone to be released into the body causing hyperthyroidism. There is no cure for Graves but progression of the disease can be halted by removing the thyroid gland. Mild to moderate cases may be successfully treated through drug therapies.
How Common is Graves Disease?
Graves disease affects up to 1% of the U.S. population or up to 3-million people, which is about 5 in every 10,000 people and is 7 times more common in women than in men. Graves patients are among the 190 million people worldwide who experience goiters but in the case of Graves the goiter is toxic (toxic diffuse goiter), meaning it is causing abnormally high thyroid hormone levels or thyrotoxicity (hyperthyroidism). Graves patients can experience complications from the disease, including an inflammatory condition in the eyes called Thyroid Eye Disease or Graves Ophthalmology. It is estimated that about half (50%) of all Graves patient will develop this complication of the disease affecting the eyes. How Many Americans Suffer Thyroid Disorders?-Suite101
Is Hyperthyroidism Present in all Graves Patients?
The point at which hyperthyroidism sets in varies among those found to have the auto-antibodies causing Graves disease, called Thyroid Stimulating Immunglobuins (TSI). Most patients may be positive for these thyroid antibodies months or years before the level of them becomes elevated enough to cause hyperthyroidism. The reason this may be the case is due to the fact that most people who are found to have Graves, are tested because they are already manifesting the signs or symptoms of hyperthyroidism. There are cases in which Graves patients experience mild, early-onset goiters before their thyroid hormone levels become abnormally high.
Thyroid Antibodies common to both Graves and Hashimotos
The TSI are not the only antibodies present with Graves but will co-exist with other thyroid antibodies that cause thyroid cell destruction, including the anti-thyroidperoxidase (Anti-TPO) and/or the anti-thyroglobulin (Anti-TG). These latter two mentioned antibodies are also present in Hashimotos thyroiditis (autoimmune hypothyroidism) patients but are usually found in lower titers (positive lab measurements) in Graves patients. Some Hashimotos patients in fact are also found to be positive for TSI antibodies that typically cause Graves but are in lower titers and may cause temporary hyperthyroid phases (Hashitoxicosis). These facts demonstrate how closely related these two autoimmune thyroid diseases are. It also offers explanation as to why some Graves patients transition to Hashimotos over time and the reverse has also been know to happen, although not common.
Symptoms and Treatment for Graves Hyperthyroidism
When thyroid hormone levels have become abnormally high, causing the bodys metabolism to become sped up, hyperthyroidism symptoms will develop. These include increased energy, nervousness and anxiety, rapid heart rate, hypertension, excessive sweating, diarrhea and weight loss. If Thyroid Eye Disease develops, the additional symptoms may include bulging, dryness, double vision (diplopia), and irritation of the eyeballs.
Some cases of Graves-caused hyperthyroidism are successfully treated with anti-thyroid drugs, which block thyroid hormone, reducing the amount entering the cells of the body and/or beta-blockers, which block the effects of epinephrine (adrenaline). When epinephrine is elevated in the body, it can cause cardiac arrhythmias and hypertension and elevated thyroid hormone levels speed up all bodily functions as a whole. Determining which drug is needed or if a combination of them is needed, depends on how severe the hyperthyroidism is. Severe cases of Graves hyperthyroidism that cannot be successfully treated with drug therapies may require surgical removal of the gland (thyroidectomy) or destruction of the gland using radioactive iodine (ablation). Afterward, patients will need thyroid hormone levels corrected with replacement therapy.
Treatment for Graves Ophthalmology (Thyroid Eye Disease)
Thyroid Eye Disease (TED) is often treated using anti-inflammatory steroids (corticosteroids) to reduce inflammation, such as Prednisone. Eye drops may also be prescribed to keep dry eyes moistened. In cases when the disease is causing significant pressure on the optic nerve and presents the danger of vision loss, eye surgeries called orbital radiotherapy and/or orbital decompression may be necessary. If eye protrusion is causing inability for a patient to close their eyes, surgery may be required to lengthen their eyelids. Many cases of TED have a duration of from several months up to about 3 years and will improve spontaneously or with the aid of treatment depending on the severity. Studies of TED have shown that Graves patients who smoke more often experience TED or cases that are more severe.