Graves’ DiseaseCherry Kristine Gomez Lavador

Biologist of Caraga State University

What is a thyroid gland?The thyroid gland is a butterfly-shaped

endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and thencarried to every tissue in the body. Thyroidhormone helps the body use energy, staywarm and keep the brain, heart, muscles,and other organs working as they should.

Graves' disease is an autoimmune disease in which the patient's own immune system attacks the thyroid gland, causing it to produce too much thyroxine. Thyroxine (T4) is a hormone produced by the thyroid gland that has four iodine molecules attached to its molecular structure. T4, as well as other thyroid hormones help regulate growth and control metabolism in the body. 

Although Graves' disease may develop at any age in both women and men, it more commonly affects women aged 20 years or more. Currently, there are no medications or treatment to stop the patient's immune system from attacking their thyroid gland. However, treatments do exist which can ease the symptoms and bring down the production of thyroxine.

The syndrome typically includes two major categories of phenomena:.

Those specificto Graves’ disease, and caused by the autoimmunity include the exophthalmos, thyroid enlargement and thyroid stimulation, and the dermal changes.

The second set of problems is caused by the excess thyroid hormone. This thyrotoxicosis, or hyperthyroidism, does not differ from that induced by any other cause of excess thyroid hormone.

What causes Graves’ disease?Graves’ disease is triggered by some process in the

body’s immune system, which normally protects us from foreign invaders such as bacteria and viruses.. In Graves’ disease, antibodies bind to the surface of thyroid cells and stimulate those cells to overproduce thyroid hormones.

The cause of Graves' disease is thought to be related to many factors including genes, gender, stress,  pregnancy and possibly infections.

If, for some reason, the thyroid gland secretes an overabundance of these hormones, 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 releases abnormal  antibodies that mimic TSH. Spurred by these false signals to produce, the thyroid's hormone factories work overtime and exceed their normal quota.

TSH Thyroid Stimulating Hormone; secreted by the pituitary gland. Stimulates the thyroid, causing it to release thyroid hormones.

T3 Triiodothyronine; a less abundant but more potent thyroid hormone. Aids in regulating metabolism and heart rate.

T4

Thyroxine; the most important thyroid hormone. Processes iodine in the thyroid, affects mitochondrial activity, regulates protein synthesis and breakdown and carbohydrate metabolism. This hormone stimulates the central nervous system and the endocrine system, and remains active in the body for up to a month. Too much thyroxine can cause over-stimulation of the nervous/endocrine systems as well as increased metabolism.

Iodine

An important element necessary for healthy thyroid functioning. Too much stored iodine in the thyroid is a sign of hyperthyroidism. Iodine deficiency or allergy can result in a goiter (swollen thyroid gland).

Table 1 - Important Thyroid-Related Hormones and Elements

Symptoms : Anxiety Breast enlargement in men (possible) Double visionEyeballs that stick out (exophthalmos) Eye irritation and tearingFatigue Goiter (possible) Heat intoleranceIncreased appetites Increased sweatingInsomnia Irregular menstrual periods in womenMuscle weakness NervousnessRapid or irregular heartbeat (palpitations or arrhythmia)Restlessness and difficulty sleeping Shortness of breath with activity Weight loss (rarely, weight gain)

Older patients may have these symptoms:

Rapid or irregular heartbeat Chest painMemory loss Weakness and fatigue

Tests to diagnose Graves' disease

Thyroid function tests -A blood sample is sent to a lab to see if your body has the right amount

of thyroid hormone (T4) and TSH. A high level of thyroid hormone in the blood plus a low level of TSH is a sign of overactive thyroid. Sometimes, routine screening of thyroid function reveals mild overactive thyroid in a person without symptoms. In such cases, doctors might suggest treatment or watchful waiting to see if levels return to normal.Radioactive iodine uptake (RAIU)

- An RAIU tells how much iodine the thyroid takes up. The thyroid takes up iodine and uses it to make thyroid hormone. A high uptake suggests Graves' disease. This test can be helpful in ruling out other possible causes of overactive thyroid.Antibody tests

-A blood sample is sent to a lab to look for antibodies that suggest Graves' disease.

TreatmentTreatment is aimed at controlling your overactive

thyroid. Medicines called beta-blockers are often used to treat symptoms of rapid heart rate, sweating, and anxiety until the hyperthyroidism is controlled. Hyperthyroidism is treated with one or more of the following: Antithyroid medications Radioactive iodine Surgery

If you have radiation or surgery, you will need to take replacement thyroid hormones for the rest of your life, because these treatments destroy or remove the gland.

Some of the eye problems related to Graves disease usually improve when hyperthyroidism is treated with medications, radiation, or surgery. Radioactive iodine can sometimes make eye problems worse. Eye problems are worse in people who smoke, even after the hyperthyroidism is cured.

Sometimes prednisone (a steroid medication that suppresses the immune system) is needed to reduce eye irritation and swelling.You may need to tape your eyes closed at night to prevent drying. Sunglasses and eye drops may reduce eye irritation. In rare cases,  surgery or radiation therapy (different from radioactive iodine) may be needed to prevent further damage to the eye and loss of vision.