Causative & risk factors
The exact cause of Grave’s disease is not understood. In this disease body’s own immune system (autoimmune) produces antibodies that mimic the function of thyroid stimulating hormone, leading to production of excessive thyroid hormones (hyperthyroidism).
Having a family history of Grave’s disease or a history of any other autoimmune condition can increase your risk of Grave’s disease. Females have a higher incidence of developing Grave’s disease compared to males. Smokers and pregnant women are at a higher risk of developing Grave’s disease. Being under constant physical or emotional stress also puts you at risk of developing Grave’s disease.
Clinical presentation
Grave’s disease leads to a visible enlargement of the thyroid gland that looks like a lump on the neck (Goiter).
Grave’s disease gives rise to characteristic eye symptoms like redness, grittiness, excessive lacrymation, eyelid retraction and lid lag. Additional eye changes include exopthalmos, periorbital edema (swelling around the eyes) and ulceration of the cornea (Grave’s opthalmopathy).
The skin also undergoes various changes especially thickening and discoloration. The commonly affected locations include the shins and feet. These areas become red and thick, however without causing any pain to the patient (Grave’s dermopathy).
Females with Grave’s disease suffer from menstrual irregularities. Men may suffer from low libido or impotency.
Patients with Grave’s disease lose weight without any reason. They are usually hyper-irritable and lose weight in spite of having an increased appetite. They usually suffer from fine tremors in their hands. They sweat a lot and are very sensitive to high temperatures. They usually suffer from diarrhea and sometimes steatorrhoea (fat in stools).
Cardiovascular symptoms such as palpitations and dyspnoea on exertion may be present. Grave’s disease can lead to complications such as gynaecomastia, vitiligo, thyrotoxic crisis, congestive cardiac failure and osteoporosis. Females may develop additional complications like infertility, preeclampsia and miscarriages.
Investigations
The TSH (thyroid stimulating hormone) level of your blood will be measured. It is usually found to be low. At the same time, thyroid hormones like T3 and T4 are found to be raised. A thyroid scan is carried out to determine radioactive iodine uptake by thyroid gland.
Your doctor may also suggest an ultrasound, CT or MRI scan of the thyroid gland to visualize it.
Treatment
The main medications used for treatment are anti-thyroid drugs against hyperthyroidism. Beta blockers and other medications can be used for symptomatic relief.
Radioactive iodine ablation therapy is used to destroy overactive thyroid cells and shrink the thyroid gland, resulting in decreased thyroid hormone production.
When the patient does not respond to conservative measures, surgery is carried out to remove part of the thyroid gland (partial thyroidectomy).
The eye problems caused by Grave’s disease need additional treatment in the form of anti-inflammatory drugs and artificial tears. Orbital decompression surgery is done to help eyes to move back in by creating more space. Eye muscle surgery is done to improve eye alignment and movement. Orbital radiotherapy is useful when patient does not respond to other treatment options.
Alternative therapies like Yoga and Homoeopathy are also believed to be useful in patients with Grave’s disease.
Recent updates
Currently, a vaccine is being planned for prevention of Grave’s disease according to news-medical.net. Research is also underway to determine whether a total thyroidectomy or partial thyroidectomy should be recommended to patients of Grave’s disease.
