Graves' disease is Thyroid gland An autoimmune pathology in which, for an unknown reason, the body's immune system produces autoantibodies, which cause the gland to produce more hormones than necessary, thus developing Hyperthyroidism.
Symptoms
Thyroid hormones have a significant impact on all cells in the body, so dysfunction is associated with a variety of symptoms. These include:
- Unexplained weight loss despite a normal or increased appetite
- General weakness, feeling tired
- Increased heat intolerance
- Increased heart rate (tachycardia >100 beats/minute); arrhythmia
- Increased stomach activity – diarrhea
- Menstrual cycle disorder
- Thinning of the skin, changes in hair structure
- Easily irritated, emotional lability
- Increased sweating
- Shaking hands (tremor)
- Thyroid enlargement – gout, which manifests itself as a swelling in the lower part of the neck.
Graves' ophthalmopathy
A particularly distinctive feature of Graves' disease is changes in the eyes, known as Graves' ophthalmopathy. These may include:
- Standing in front of the eyes
- Feeling of sand in the eyes
- Feeling of pressure or pain in the eyes
- Red, inflamed eyes
- Increased sensitivity to light
- Swollen or drooping eyelids
- Double vision
- loss of sight.
These symptoms, to varying degrees and in varying amounts, occur in up to 30% of people with Graves' disease. These changes are caused by the fact that autoantibodies to the thyroid gland also affect the muscles and other structures around the eye.
Ophthalmopathy most often occurs along with other characteristic symptoms of Graves' disease, but there are cases where eye changes begin several years before or after the manifestation of Graves' disease. It is also possible to develop Graves' ophthalmopathy without all the other characteristic changes.
Diagnosis
Once Graves' disease is suspected based on the listed symptoms and family history, the next step is to confirm the diagnosis with laboratory and instrumental examinations, which include:
Hormonal examination: TSH, fT4, fT3 tests confirm the presence of hyperthyroidism – pathologically increased activity of the thyroid gland. As a rule, TSH is very low at this time, and the level of fT4 is sharply high.
Immunological examination: If the symptomatic manifestation and hormonal analyses still raise suspicion and cannot firmly confirm the presence of Graves' disease, the amount of antibodies against the thyroid-stimulating hormone receptor (TSHr-ab) in the blood is determined. These antibodies are the main suspect in the development of the disease, as this substance forces the gland to work with increased load.
Instrumental examination: 1) Thyroid ultrasound, which in most cases will reveal the presence of an enlarged gland – a diffuse goiter.
2) Radionuclide scanning: reveals how much iodine the thyroid gland is able to absorb at a given moment (i.e. whether the activity of the gland is normal, increased or decreased) and, in case of a violation, whether all parts of the organ are involved in the process. The examination is painless, involves scanning, or taking an image, 4-6 hours after swallowing the capsule and 24 hours later. Based on the analysis of the resulting image, it is determined how functionally active the gland is.
3) CT or MRI testing may be necessary due to changes in the eye.
Treatment
The goal of treatment for Graves' disease is to stop/reduce the excessive production of thyroid hormones. There are three options to achieve this goal. The doctor and the patient will decide together on the most appropriate method:
1) Antithyroid drugs:
Their mechanism of action is based on blocking the secretion of hormones by the gland. Although these drugs successfully relieve symptoms within a few weeks of starting, their discontinuation is often followed by a relapse of the disease - a re-development. A rare but serious side effect of these drugs is agranulocytosis - a decrease in the number of leukocytes, which increases the body's sensitivity and susceptibility to infectious processes.
2) Treatment with radioactive iodine:
For most doctors and patients, this is the most acceptable method of treatment, as it does not involve the risks associated with surgery and, unlike drugs, the cure is achieved permanently. However, the effect will appear after several months, and sometimes repeated doses are required if the goiter is very large. After the procedure, hypothyroidism develops - functional failure of the thyroid gland, as its cells are completely destroyed, and the patient requires lifelong thyroxine replacement therapy, since the hormones of the gland are vital for the body. Nevertheless, a positive point is that the management of hypothyroidism is a much easier process than that of Graves' disease.
Radioactive iodine treatment is contraindicated in pregnant women or if pregnancy is planned within the next 6-9 months.
3) Surgical treatment:
If other methods cannot be used for one reason or another, surgery is the next option. It is performed under general anesthesia. Although surgery can successfully treat hyperthyroidism, even in this case, the patient will have to deal with hypothyroidism for the rest of his or her life.
Author: Elga Giorgadze (Endocrinologist)
Similar articles:
