Graves ‘ disease, also known as Graves’ disease, is an autoimmune disease of the thyroid gland that is usually associated with an overactive thyroid gland (hyperthyroidism). Women are four to five times more likely to be affected by Graves’ disease than men.
What is Graves’ disease?
Basedow ‘s disease (Basedow’s disease) is an autoimmune disease of the thyroid gland that is associated with an overactive thyroid gland (hyperthyroidism) and inflammation of the thyroid gland (thyroiditis). See lawfaqs for Definitions of Lyme Disease.
In Graves’ disease there is an excess of thyroid-stimulating hormone TSH (thyroid-stimulating hormone). As a result of a disruption in the immune system, the body’s own antibodies against the thyroid tissue, so-called TSH receptor antibodies (TRAK), are formed, which dock to the TSH receptors on the tissue surface of the thyroid gland, and gradually stimulate an overproduction of thyroid hormones that is uncoupled from the normal hormonal regulatory system cause an overactive thyroid.
Symptomatically, Graves’ disease usually manifests itself through a varying degree of goiter (enlarged thyroid gland), often in combination with endocrine orbitopathy (protruding eyeball) and tachycardia (tachycardia), with this mix of symptoms in Graves’ disease also being referred to as the Merseburg triad.
The causes of Graves’ disease have not yet been clarified. However, a genetic predisposition (predisposition) is assumed, since the disease occurs more frequently in certain families and in many cases manifests itself together in identical twins.
Furthermore, those affected by Graves’ disease share specific common genetic characteristics. It is also assumed that environmental factors, hormonal changes and stress factors influence the manifestation and course of Graves’ disease. Pregnancy, for example, is a proven trigger factor, although it has not yet been conclusively proven that this is caused by the hormonal change (changed estrogen and progesterone levels) during and after pregnancy.
In addition, infections caused by bacteria (including Yersinia enterocolitica) and viruses (including retroviruses) and excessive iodine intake are discussed as possible triggers of Graves’ disease.
Symptoms, Ailments & Signs
The overproduction of thyroid hormones in Graves’ disease affects many bodily functions and can therefore trigger a wide variety of symptoms. A disturbed metabolism becomes noticeable through constant weight loss despite sufficient food intake, sweating, hot flashes and frequent bowel movements are also typical. Difficulties falling asleep and sleeping through the night as well as increased irritability indicate involvement of the autonomic nervous system.
The heartbeat can speed up and does not slow down at night, high blood pressure and shortness of breath can also occur. Women often suffer from menstrual disorders, as a result of which there is no menstrual period – this reduces fertility. In men, erectile dysfunction often occurs as part of Basedow’s disease, and sexual desire can be restricted in both sexes.
A disruption in bone metabolism can trigger osteoporosis, which becomes noticeable through reduced bone density and an increased tendency to fractures. Muscle weakness often develops, and muscle pain also occurs at rest or under stress. Occasionally an increased trembling of the hands can be observed.
Protruding eyes (“Basedow’s goggle eyes”) are often noticed in those affected: In many cases, the eye changes are accompanied by a painful feeling of pressure, visual disturbances, irritation of the conjunctiva and increased sensitivity to light. Other typical signs include an enlarged thyroid gland (goiter), very warm, dry skin, and excessive hair loss.
Diagnosis & History
The doctor feels the thyroid enlargement in Graves’ disease
Graves ‘ disease can be felt on the basis of the goiter (enlarged thyroid gland). More than 50 percent of those affected by Graves’ disease have an endocrine orbitopathy, in which the eyes protrude as a result of inflammatory processes in the orbits and in the ocular fundus tissue.
In addition, sonography (ultrasound) of the thyroid shows hypoechoic (poor-echo) tissue structures. The increased production of thyroid hormones can be detected as part of a scintigraphy (nuclear medicine imaging method). In addition, an exact blood test to determine the hormone and antibody concentration serves to secure the diagnosis and is used for differential diagnosis in order to differentiate Graves’ disease from other autoimmune diseases of the thyroid gland (e.g. Hashimoto’s thyroiditis).
Thus, the TRAK concentration is usually increased in those affected by Graves’ disease. Graves’ disease has a chronic course, which can vary greatly from individual to individual and is characterized by spontaneous remissions (spontaneous healing) and recurrences (relapse).
Graves’ disease is a disease that can lead to complications. If the condition is not treated medically in the long term, there is a risk of heart problems such as cardiac arrhythmia or cardiac insufficiency (cardiac insufficiency). One of the feared effects of Basedow’s disease is the thyrotoxic crisis, which is a serious metabolic imbalance.
Although it occurs only rarely, it is a life-threatening emergency situation. The risk of a thyrotoxic crisis increases if the thyroid gland is severely overactive or if the prescribed medication is stopped. But incorrect treatment with iodine-containing agents is also a possible cause.
The thyrotoxic crisis is initially noticeable through heart palpitations, constant diarrhea, vomiting, anxiety and restlessness. High fever, impaired consciousness and disorientation can also set in. As the case progresses, there is a risk of a coma, circulatory failure and impairment of kidney function.
Complications from Graves’ disease are sometimes also possible during pregnancy and can occur even with sensible therapy. So it is conceivable that antibodies against the thyroid gland form within the mother’s blood and also penetrate the placenta.
In such cases, there is a risk that the unborn child’s hormone production will increase, leading to overproduction. This puts the child at risk of premature birth or too little weight at birth. In the first week of life, the mortality rate of the baby is increased.
When should you go to the doctor?
If an unplanned and unwanted continuous weight loss develops, a doctor should be consulted. Weight loss indicates metabolic disorders and is characteristic of Graves’ disease. Sweating, hot flashes or an inner turmoil are signs of an existing irregularity that should be presented to a doctor so that a diagnosis can be made. Disturbances in sleeping at night, problems falling asleep and severe tiredness are indications of a health imbalance. A doctor’s visit is necessary as soon as the symptoms persist for several days or weeks or increase in intensity. A doctor is needed for irritability, abnormal behavior or mood swings.
If the person concerned suffers from a cardiac arrhythmia, high blood pressure, muscle weakness or mobility problems, a doctor’s visit is necessary. Hair loss or changes in the complexion should also be examined and treated. Increasing fractures are considered to be particularly worrying and should be medically clarified by further tests. If you experience visual disturbances or shortness of breath, you should see a doctor as soon as possible. There is a risk of a further deterioration in the state of health. If sexually mature women experience disturbances or irregularities in their menstrual bleeding, they should consult a doctor. Decreased libido in both sexes is another indicator of impairment that should be investigated.
Treatment & Therapy
Since the causes of Graves ‘ disease have not been clarified, the therapeutic measures are symptomatic and aim at eliminating or reducing the hyperthyroidism with medication.
For this purpose, antithyroid drugs (thiamazole, carbimazole, propylthiouracil) are used, which have an inhibiting effect on hormone synthesis, secretion or iodine incorporation into the hormone precursors in the thyroid gland. Long-term drug therapy usually lasts 12 to 18 months, with the dosage decreasing with the duration of therapy.
In addition, β-blockers are often used in Graves ‘ disease to treat the accompanying symptoms (tachycardia, increased blood pressure). In some cases, this treatment results in a complete cure (40 to 70 percent). If further drug therapy is not successful after a relapse (about 80 percent of recurrence cases), definite therapeutic measures such as surgery or radioiodine therapy to remove or destroy the thyroid gland are an option.
In radioiodine therapy, radioactive iodine is administered, which causes temporary radiation that is localized to the thyroid gland and causes the thyroid tissue to die off. If the thyroid gland is greatly enlarged, it is surgically removed. As a result of the radioiodine therapy and the surgical intervention, there is a hypofunction that must be treated with hormones for life.
Outlook & Forecast
The prognosis of Graves’ disease is very different for each person affected. Remission can even occur in 50 percent of all cases. This means that the symptoms of the disease often subside permanently or temporarily. In such cases, however, the disease can recur even after many years. Conservative therapy in the form of a one to one and a half year treatment leads to a successful healing in about 50 percent of those affected. However, this also means that about every second person affected develops a so-called recurrence, this is the recurrence of the disease.
After radioiodine therapy or surgical removal of the entire thyroid gland, also known as thyroidectomy, definitive healing of the existing hyperthyroidism in those affected is possible. In both cases, however, the patients then have to take special thyroid hormones every day for the rest of their lives in order to achieve normal hormone concentrations in the body. Despite this, 50 percent of those affected have the possibility that Graves’ disease will heal on its own.
Nevertheless, treatment is necessary. Because even after healing, the disease can flare up again. A thyrotoxic crisis can also occur during the course of the disease. This is a dreaded complication because it leads to death in 20 to 30 percent of cases.
Since the causes of Graves ‘ disease have not been clarified, the disease cannot be prevented. However, all factors that negatively affect the immune system can contribute to the manifestation of Graves’ disease. These include stress and psychological strain, hormonal contraceptive methods and excessive intake of iodine (X-rays with iodine-based contrast media, iodized salt). Nicotine consumption can also trigger Graves’ disease and aggravate the course of Graves’ disease.
Graves’ disease can result in lifelong follow-up care. This is independent of the respective treatment method. It is also necessary to prevent ocular discomfort due to endocrine orbitopathy, which is possible in about 50 percent of all patients. In addition, the follow-up treatment of Graves’ disease requires a lot of effort and patience. The therapy strategies are designed for the medium to long term.
In the case of conservative drug therapy, the patient receives antithyroid drugs for one to two years. Depending on the initial situation, the risk of a recurrence is 30 to 90 percent. The follow-up examinations must take place every four to eight weeks.
The safest and fastest treatment methods for Graves’ disease are radioiodine therapy and surgery. However, following these procedures, it is necessary to take thyroid hormones for the rest of life. This is the only way to compensate for the resulting hypofunction of the thyroid gland, i.e. a lack of thyroid hormones. If regular check-ups are necessary at the beginning, these are then limited to one or two examinations a year.
Immediately after surgery on the thyroid gland, the patient receives thyroid hormones in a standard amount. How many hormones the patient ultimately needs is determined after the operation and individually adjusted accordingly. The target values vary and are determined by the general practitioner or an endocrinologist.
You can do that yourself
In the case of Graves’ disease, there are a number of measures that those affected can take to improve their quality of life. At the beginning there is the certainty after the diagnosis that you will be physically and emotionally stressed during the treatment period. Self-help groups for those affected by Basedow’s disease and other opportunities to talk are available here. These opportunities to talk can be particularly valuable if Graves’ disease has already led to visible physical symptoms.
Emotional strain and stress can be reduced by creating specific spaces and relaxation techniques. Since it is an autoimmune disease, the condition of the person affected has a not insignificant influence on the course of the disease. In order not to put additional strain on the thyroid, foods containing iodine should be avoided. The same applies to dietary supplements containing iodine. This can slow down the course of the disease and possibly have a favorable effect on therapy.
With regard to possible involvement of the eyes, they should be protected from strong stimuli. This means avoiding strong sunlight, cold wind, drafts and so on as much as possible. Since Graves’ disease can take very different courses and is quite common, it is also valuable to obtain comprehensive information about the condition. This often enables better management of the disease and its treatment.