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Grave's Disease
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Grave's disease is a disease of the thyroid and is the most common cause of a high thyroid situation. It is an auto-immune disease in which the body attacks the thyroid cells, making them make more thyroid hormone than necessary. It causes an increase in metabolic rate, causing many different signs and symptoms.
The symptoms of Grave's disease include irritability, difficulty sleeping, anxiety, fatigue, rapid or irregular heartbeat, tremor of the hands, an increase in perspiration, weight loss, sensitivity to heat, goiter (enlargement of the thyroid gland), change in menstrual cycles, diarrhea and brittle hair.
One symptom of Grave's disease involves the eyes. Grave's disease causes a bulging of the eyes typical a high thyroid condition. It's called Grave's ophthalmopathy or exophthalmos. It can cause tearing or gritty feelings in the eyes, inflamed eyes, swelling of the eyelids, sensitivity to light and a widening of the space between the eyelids. Corneal ulcers and double vision can occur. Eye movements can be restricted and blurry vision can occur.
Doctors don't know what causes Grave's disease. Because it is an auto-immune disease, it is likely that a trigger causes antibodies to be made against thyroid cells. What the trigger is happens to be unknown. Doctors know that there are risk factors for the disease, including having a family history of having the disease, being a woman (who have seven times the risk over men), being older than 20 years, being pregnant, being a smoker and being under a great deal of stress.
Complications of Grave's disease include problems with the heart that lead to arrhythmias and congestive heart disease, brittle bones due to a leaching of calcium from the bones and a condition called thyrotoxic crisis, in which an individual gets a fever, high pulse or even delirium.
Doctors diagnose Grave's disease by examining the eyes for exophthalmos and examining the thyroid gland for enlargement. Pulse and blood pressure are increased in Grave's disease and the tremor is prevalent in some patients with the disease. The blood is checked as well for the levels of thyroxin and thyroid stimulating hormone or TSH. The thyroxin level will be increased in Grave's disease and the TSH level will be quite low. A radioactive iodine uptake test will show an increase in uptake of radioactive iodine. This will be true of most cases of Grave's disease but some cases will already have burned out the thyroid gland and will look like hypothyroidism.
The treatment of Grave's disease focuses on reducing the thyroid hormone levels and reducing symptoms. One treatment involves using beta-blockers to reduce the heart rate. These include propranolol, atenolol, or metoproprolol.
Medications like propylthiouracil or methimazole stop the thyroid gland from making excessive amounts of thyroxin and triiodothyronine or T3. It takes about one to two years of treatment in order to block the thyroid gland effectively and some people relapse after that.
Radioactive thyroid treatment is treatment in which the thyroid gland is given excessive amounts of radioactive iodine. The radioactive iodine is taken up by the thyroid gland and kills off the overactive thyroid gland, resulting in a low thyroid condition. After the thyroid gland becomes underactive, the doctor uses thyroid hormone replacement to replace the lost thyroxin. This kind of treatment can last indefinitely.
Surgery can be done to remove the thyroid gland in situations where the radioactive thyroid therapy doesn't work. The surgery is called a thyroidectomy. Patients need to take thyroid hormone replacement for the rest of their lives after having their enlarged thyroid gland removed.
There can be treatment for the eye disease seen in Grave's disease. Prednisone can reduce the swelling behind the eyes. There is surgery that decompresses the eye by removing the bone between the sinuses and the orbit itself. There can be eye surgery to the muscles around the eye and certain glasses can correct the double vision sometimes noted in exophthalmos.