Graves' Disease

The thyroid gland is a butterfly-shaped gland located in the center of the neck, in front of the trachea (windpipe). The thyroid has a left and a right lobe and uses iodine to make hormones that help regulate body metabolism, temperature, heart rate, and growth rate. Graves' disease is an immune system disorder that results in the thyroid overproducing thyroid hormones.

This disease is more common in women, and generally affects people before the age of 40.

Causes of Graves' Disease

Graves' disease is caused by a dysfunction in the immune system. Antibodies produced by the immune systems, which are supposed to fight foreign pathogens, begin to attack the protein of the surface cells in the thyroid. The particular antibody that attacks these proteins in Graves’ disease is called thyrotropin receptor antibody (TRAb). TRAb overrides normal regulation of the thyroid and results in overproduction of thyroid hormones (hyperthyroidism). 

The exact reason why they body’s immune system begins to create the antibody TRAb is not well understood.

Risk Factors

A risk factor is anything that increases a person's chance of getting a disease. Different diseases have different risk factors. Some risk factors can be controlled with lifestyle changes. Other risk factors cannot be changed.

Although anyone can develop Graves' disease, risk factors associated with the disease include: 
  • Family history 
  • Gender: Women are much more likely to develop Graves' disease than are men. 
  • Age: Graves' disease usually develops in people younger than 40. 
  • Other autoimmune disorders: Patients who have already have a type of immune disorder, such as rheumatoid arthritis, are at an increased risk for developing Graves’ disease. 
  • Emotional or physical stress: Stressful events or illness may trigger the onset of Graves’ disease among people who have a genetic propensity to develop the disease. 
  • Pregnancy: Pregnancy or recent childbirth may increase the risk of the disorder, particularly among women who are genetically susceptible. 
  • Smoking 
Having one or more of the above risk factors does not mean that you will develop Graves’ disease. Understanding your risk factors will help you determine, what, if any, precautions and special screening you should consider.

Symptoms

Thyroid hormones affect many different body systems and their functions, such as metabolism (the processing of nutrients to create energy for cells), heart and nervous system function, and muscle strength. Therefore, the symptoms of Graves’ disease are wide ranging and numerous. 

The most common symptoms include: 
  • Anxiety 
  • Irritability 
  • Difficulty sleeping 
  • Fatigue 
  • A rapid or irregular heartbeat 
  • A fine tremor in the hands or fingers 
  • An increase in perspiration 
  • Warm, moist skin 
  • Sensitivity to heat 
  • Unexplained weight loss 
  • Enlarged thyroid gland 
  • Change in menstrual cycles 
  • Erectile dysfunction or reduced libido 
  • Frequent bowel movements or diarrhea 
  • Bulging eyes (Graves' ophthalmopathy) 
  • Thick, red skin usually on the shins or tops of the feet (Graves' dermopathy)
Graves' Ophthalmopathy: Not all people with Graves’ disease will get Graves’ ophthalmopathy. With Graves’ disease, inflammation and other issues with the immune system can affect muscles and other tissues around the eyes, which can result in: 
  • Excess tearing 
  • Bulging eyes 
  • Dry, irritated eyes 
  • Gritty sensation in the eyes 
  • Pressure or pain in the eyes 
  • Puffy eyelids 
  • Reddened or inflamed eyes 
  • Light sensitivity 
  • Double vision 
  • Limited eye movements, resulting in a fixed stare 
  • Blurred or reduced vision (rare) 
  • Ulcers on the cornea (rare)
Having one or more of the above symptoms does not mean that you have Graves’ disease. Other conditions can cause the same or similar symptoms. If you think you have Graves’ disease, call your doctor

Treatment

Thyroidectomy is one of several treatments that can be used for Graves’ disease. Other treatments may include radioactive iodine or antithyroid medications. Determining which treatment is best for you should involve a discussion with your endocrinologist and possibly your surgeon.