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Graves' Disease

Graves' Disease




overview


Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves' disease is a common cause.


Thyroid hormones affect many body systems, so signs and symptoms of Graves' disease can be wide ranging. Although Graves' disease may affect anyone, it's more common among women and in people younger than age 40.


The primary treatment goals are to reduce the amount of thyroid hormones that the body produces and lessen the severity of symptoms.


Symptoms 


Common signs and symptoms of Graves' disease include:


*Anxiety and irritability

*A fine tremor of the hands or fingers

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

*Weight loss, despite normal eating habits

*Enlargement of the thyroid gland (goiter)

*Change in menstrual cycles

*Erectile dysfunction or reduced libido

*Frequent bowel movements

*Bulging eyes (Graves' ophthalmopathy)

*Fatigue

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

*Rapid or irregular heartbeat (palpitations)

*Sleep disturbance


Graves' ophthalmopathy


About 30% of people with Graves' disease show some signs and symptoms of Graves' ophthalmopathy. In Graves' ophthalmopathy, inflammation and other immune system events affect muscles and other tissues around your eyes. Signs and symptoms may include:


*Bulging eyes

*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, called Graves' dermopathy, is the reddening and thickening of the skin, most often on your shins or the tops of your feet.


causes


Graves' disease is caused by a malfunction in the body's disease-fighting immune system. It's unknown why this happens.


The immune system normally produces antibodies designed to target a specific virus, bacterium or other foreign substance. In Graves' disease — for reasons that aren't well understood — the immune system produces an antibody to one part of the cells in the hormone-producing gland in the neck (thyroid gland).


Normally, thyroid function is regulated by a hormone released by a tiny gland at the base of the brain (pituitary gland). 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).


Cause of Graves' ophthalmopathy

Graves' ophthalmopathy results from a buildup of certain carbohydrates in the muscles and tissues behind the eyes — the cause of which also isn't known. It appears that the same antibody that can cause thyroid dysfunction may also have an "attraction" to tissues surrounding the eyes.


Graves' ophthalmopathy often appears at the same time as hyperthyroidism or several months later. But signs and symptoms of ophthalmopathy may appear years before or after the onset of hyperthyroidism. Graves' ophthalmopathy can also occur even if there's no hyperthyroidism.


Diagnosis


To diagnose Graves' disease, your doctor may conduct a physical exam and check for signs and symptoms of Graves' disease. He or she may also discuss your medical and family history. Your doctor may also order tests including:


Blood tests. Blood tests can help your doctor determine your levels of thyroid-stimulating hormone (TSH) — the pituitary hormone that normally stimulates the thyroid gland — and your levels of thyroid hormones. People with Graves' disease usually have lower than normal levels of TSH and higher levels of thyroid hormones.


Your doctor may order another lab test to measure the levels of the antibody known to cause Graves' disease. It's usually not needed to diagnose the disease, but results that don't show antibodies might suggest another cause of hyperthyroidism.


Radioactive iodine uptake. Your body needs iodine to make thyroid hormones. By giving you a small amount of radioactive iodine and later measuring the amount of it in your thyroid gland with a specialized scanning camera, your doctor can determine the rate at which your thyroid gland takes up iodine. The amount of radioactive iodine taken up by the thyroid gland helps determine if Graves' disease or another condition is the cause of the hyperthyroidism. This test may be combined with a radioactive iodine scan to show a visual image of the uptake pattern.


Ultrasound. Ultrasound uses high-frequency sound waves to produce images of structures inside the body. It can show if the thyroid gland is enlarged. It's most useful in people who can't undergo radioactive iodine uptake, such as pregnant women.


Imaging tests. If the diagnosis of Graves' disease isn't clear from a clinical assessment, your doctor may order special imaging tests, such as a CT scan or MRI.


Treatment 


The treatment goals for Graves' disease are to stop the production of thyroid hormones and to block the effect of the hormones on the body. Some treatments include:


Radioactive iodine therapy

With this therapy, you take radioactive iodine (radioiodine) by mouth. Because the thyroid needs iodine to produce hormones, the thyroid takes the radioiodine into the thyroid cells and the radiation destroys the overactive thyroid cells over time. This causes your thyroid gland to shrink, and symptoms lessen gradually, usually over several weeks to several months.


Radioiodine therapy may increase your risk of new or worsened symptoms of Graves' ophthalmopathy. This side effect is usually mild and temporary, but the therapy may not be recommended if you already have moderate to severe eye problems.


Other side effects may include tenderness in the neck and a temporary increase in thyroid hormones. Radioiodine therapy isn't used for treating pregnant women or women who are breast-feeding.


Because this treatment causes thyroid activity to decline, you'll likely need treatment later to supply your body with normal amounts of thyroid hormones.

TYPE OF DOCTOR DEPARTMENT :- :- specialist in disorders of hormone function and the endocrine system (endocrinologist). If you have Graves' ophthalmopathy, your doctor may also recommend that you see a doctor who has trained in eye disorders (ophthalmologist).

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