Graves' Disease

First described by Sir Robert Graves in the early 19th century, Graves' disease is one of the most common of all thyroid problems. It is also the leading cause of hyperthyroidism, a condition marked by excessive production of thyroid hormones. Once the disorder has been correctly diagnosed, it is quite easy to treat. In some cases, Graves' disease goes into remission or disappears completely after several months or years. Left untreated, however, it can lead to serious complications-even death. Although the symptoms can cause discomfort, Graves' disease generally has no long-term adverse health consequences if the patient receives prompt and proper medical care.

Causes

Hormones secreted by the thyroid gland control metabolism, or the speed at which the body converts food into energy. The metabolic rate is directly linked to the amount of hormone "fuel" that circulates in the bloodstream. If, for some reason, the thyroid gland secretes an overabun-dance of this fuel, the body's metabolism goes into high gear, producing the pounding heart, sweating, trembling, and weight loss typically experienced by hyperthyroid people. Normally, the thyroid gets its production orders through another chemical, called thyroid-stimulating hormone (TSH), released by the pituitary gland in the brain. But in Graves' disease, a malfunction in the body's immune system results in the manufacture of abnormal antibodies, or defender proteins, that mimic the pituitary's messenger chemicals. Spurred by these false signals to produce, the thyroid's hormone factories work overtime and exceed their normal quota.

Exactly why the immune system begins to pro-duce these aberrant antibodies is unclear. Heredity and other characteristics seem to play a role in determining susceptibility. Studies show, for ex-ample, that if one identical twin contracts Graves' disease, there is a 50 percent likelihood that the other twin will get it too. Also, women are more likely than men to develop the disease. And smokers who develop Graves' are more prone to eye problems than nonsmokers with the disease.

Eye trouble-usually in the form of inflamed and swollen eye muscles and tissues that can cause the eyeballs to protrude from their sockets-is a distinguishing complication of Graves' disease. However, only a small percentage of all Graves' patients will experience this condition, known as exophthalmos. Even among those who do, the severity of their bout with Graves' has no bearing on the seriousness of the eye problem or how far the eyeballs protrude. In fact, it isn't clear whether such eye complications stem from Graves' disease itself or from a totally separate, yet closely linked, disorder. If you have developed exophthalmos, your eyes may ache and feel dry and irritated. Pro-truding eyeballs are prone to excessive tearing and redness, partly because the eyelids no longer can shelter them effectively from injury.

In severe cases of exophthalmos, which are rare, swollen eye muscles can put tremendous pressure on the optic nerve, possibly leading to partial color blindness or a decrease in visual acuity. Eye muscles weakened by long periods of inflammation can lose their ability to control movement, resulting in double vision.

Diagnostic and Test Procedures

Although Graves' disease can be diagnosed from the results of one or two tests, your doctor may use several methods to double-check the findings and rule out other disorders. An analysis of your blood will show if the levels of two hormones-thyroxine and triiodothyronine, which are produced or regulated by the thyroid-are higher than normal. If they are, and if levels of thyroid-stimulating hormone in your blood are abnormally low, you are hyperthyroid, and Graves' disease is the likely culprit. Blood analysis can also detect the presence of the abnormal antibody associated with Graves' disease, but this test is somewhat expensive and generally not necessary.

To confirm a diagnosis of Graves' disease, your doctor may conduct a radioactive iodide up-take test, which shows whether large quantities of iodide are collecting in the thyroid.

The gland needs iodide to make thyroid hormones, so if it is absorbing unusually large amounts of iodide, it obviously is producing too much hormone.

If exophthalmos is your only symptom, your physician will probably run blood tests to check for hyperthyroidism, since this eye disorder can occur apart from Graves' disease.

The doctor may also evaluate your eye muscles using ultra-sound, a CT scan, or magnetic resonance imaging (MRI). Signs of swelling in any one of these tests will confirm a diagnosis of Graves' disease.

Treatment

If you have Graves' disease, or even suspect that you have it, you should have a professional diagnosis and, if necessary, a treatment plan that suits your particular condition. Although the disorder is rooted in a malfunctioning immune system, the goal of both conventional and alternative approaches is to restore thyroid hormone levels to their correct balance and to relieve discomfort.

Conventional Medicine

If you have a mild case of Graves' disease, you and your practitioner may simply decide to see how the disease develops before initiating any treatment. Should medical intervention be necessary, the two most frequently used conventional treatments involve disabling the thyroid's ability to produce hormones.

One common approach uses a strong dose of radioactive iodide to destroy certain cells in the thyroid gland. This procedure attempts to halt excess hormone production by thinning the ranks of cells responsible for manufacturing the chemicals.

The amount of radioactive iodide you receive depends on the estimated size of your thyroid-determined either through a physical exam or by ultrasound-and on the gland's level of activity, as indicated by the results of an iodide up-take test. Despite its destructive effect on thyroid cells, the iodide used in this procedure will not harm surrounding tissues and organs.

At the beginning of the treatment, you will be given a capsule or liquid containing the radioactive iodide. Either way you take it, you should not feel any effects as the substance enters your sys-tem. Most of the iodide will gather and remain in your thyroid; excess amounts will be excreted in your urine.

It is a good idea to drink several extra glasses of water per day for about a week after the treatment to help flush the material out of your body as quickly as possible. To be on the safe side, you should also limit contact with infants, children, and pregnant women for at least seven days after you ingest the iodide.

You probably won't notice any changes in your body for several days after taking the radioactive iodide, but if your thyroid gland feels inflamed and sore, acetaminophen, ibuprofen, or aspirin can offer some relief. Over the next several months, the thyroid's hormone secretion should gradually begin to drop.

During this time you need to see your doctor for periodic check-ups to determine how well the treatment is progressing. Chances are good that a single dose of radioactive iodide will be sufficient to correct your hyperthyroidism.

However, if your condition hasn't improved three months or so after your initial treatment, your practitioner may give you a second dose of iodide. Once the doctor has decided that your Graves' disease is effectively under control, you will still need to have routine checkups to make sure that your thyroid levels remain within the normal range.

Although radioactive iodide treatments are generally safe, they cannot be given to pregnant women because the chemical may destroy the thyroid gland in the fetus. Therefore, you must make sure that you are not pregnant before you take radioactive iodide for Graves' disease. It is best to let several months pass after your last dose of radioactive iodide before you become pregnant; confirm the length of time you should wait with your practitioner. Except during these periods following the treatment, radioactive iodide poses no health risks for women who want to become pregnant, and it will not affect the fertility of either women or men.

Antithyroid drugs such as propylthiouracil and methimazole, which interfere with thyroid hormone production, can be used to treat Graves' disease. After you begin treatment, it may take several months for your hyperthyroid symptoms to subside.

This is because the thyroid has already generated and stored enough hormone to keep it circulating at elevated levels. Once the stores are drained, hormone production should drop to its normal level. Although your disease may seem to go away entirely, you might still need drug therapy to keep your thyroid operating properly.

Even if your case of Graves' disease does go into remission and your doctor says it's safe to stop taking your medication, you will need to be evaluated every year or so to make sure your hyper-thyroidism has not returned.

Beta-adrenergic blockers such as atenolol and propranolol, frequently prescribed to treat heart disease and hypertension, are also used by some patients to alleviate the heart palpitations and muscle tremors that characterize Graves' disease.

Before prescribing beta blockers for this condition, however, your doctor needs to know if you are asthmatic or have any kind of heart trouble.

Radioactive iodide treatments and antithyroid drugs are usually effective in slowing down thyroid hormone Output, but in some cases surgery is the best approach for Graves' disease.

If you develop the disorder before or during pregnancy, for example, or if you are reluctant or unable to undergo radioactive treatment or are allergic to antithyroid medication, your doctor may recommend subtotal thyroidectomy, a relatively safe and simple procedure in which most of the thyroid gland is removed.

Because many conventional remedies severely limit the thyroid's ability to manufacture thyroid hormone, they increase the chances that you will develop hypothyroidism, a potentially serious condition marked by insufficient thyroid hormone production (see Thyroid Problems). Therefore, if you have undergone any of the aforementioned treatments for Graves' disease, you must continue to see your doctor for periodic checkups to make sure the problem has not been overcorrected, causing your thyroid hormone levels to drop too low.

Only about 5 percent of people with Graves' disease will develop eye problems severe enough to warrant professional treatment. And almost half of those who develop exophthalmos, the condition that causes the eyeballs to protrude, will have mild cases that can be helped with simple treatments (see At-Home Remedies, right).

Graves' disease patients with eye problems can find temporary relief from the redness, swelling, and pain through a number of drugs, in cluding prednisone, methylprednisolone, and dexamethasone. However, these medications should not be used for long periods of time, as they can lead to bone loss, muscle weakness, and weight gain.

Vision problems and severe cases of eye pro-trusion can often be corrected through radiation therapy and surgery. Make sure to ask your doctor about any possible complications before undergo-ing surgery.

Alternative Choices

Alternative treatments generally serve to complement conventional medicine's more direct goal of thyroid hormone suppression. Some of these therapies help alleviate the unpleasant symptoms or Graves' disease, while others seek to improve general thyroid function.

Herbal Therapies

For relief from the symptoms of Graves' disease, try a combination of 4 parts bugleweed (Lucopus spp.), 2 parts motherwort (Leonurus cardiaca), 2 parts skullcap (Scutellaria lateriflora), and 1 part hawthorn (Crataegus laevigata) in a tincture, three times a day.

Lifestyle

After the heart rate has stabilized, aerobic exercise for 15 to 20 minutes a day is thought to be very good for maintaining good thyroid function.

Nutrition and Diet

If you are hyperthyroid, eating foods that inhibit the manufacture of thyroid hormones might help lower hormone secretion. These include cabbage, peaches, radishes, peanuts, rutabagas, soybeans, and spinach. Vitamin B complex injections may also prove useful.

Yoga

The Shoulder Stand position, practiced at least once daily for 20 minutes, can help some people with Graves' disease improve overall thyroid function. Lie on your back and lift your legs up so that your hips come off the floor. Supporting your hips with your hands, extend your legs into a vertical position. Slide your hands farther toward your shoulders, with your thumbs at the front of your body and your fingers at the back, making sure that the weight of your body is supported by your shoulders, not your head and neck.

At-Home Remedies

Symptoms

Call Your Doctor If :

you are feverish, agitated, or delirious, and have a rapid pulse. You could be having a thyrotoxic crisis, in which the effects of too much thyroid hormone suddenly become life-threatening.

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