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Graves’ disease is a lifelong condition, but appropriate medical care can control the symptoms and reduce the risk of complications.
Graves’ disease is one of the causes of thyrotoxicosis or metabolic derangement due to excessive thyroid hormone levels in the body.
The thyroid is a butterfly-shaped gland (two lobes connected by a bridge of tissue called isthmus) located at the base of the neck and below Adam’s apple that produces and releases two hormones: triiodothyronine (T3) and thyroxine (T4).
These hormones play a crucial role in several important bodily functions such as maintaining:
- Body temperature.
- Heart rate.
- Metabolism.
- Protein synthesis.
For adjusting the level of thyroid hormones, the body has a complex mechanism.
- The hypothalamus, located above the pituitary gland in the brain, secretes the thyrotropin-releasing hormone.
- This causes the pituitary gland to produce thyroid-stimulating hormone (TSH).
- TSH stimulates the thyroid gland to produce thyroid hormones (T3 and T4).
- Depending on the levels of thyroid hormones circulating in the blood (too high or too low), the pituitary gland slows or speeds the release of TSH.
What is Graves’ disease and thyrotoxicosis?
Graves’ disease
A type of autoimmune disease that damages the thyroid gland resulting in the overproduction of thyroid hormones (hyperthyroidism).
- The most common cause of hyperthyroidism.
- The condition got its name from Robert Graves, an Irish doctor, who first described the condition in the 1800s.
- People affected with Graves’ disease produce excess thyroid hormone, sufficient enough to damage the heart and other organs.
Thyrotoxicosis
Thyrotoxicosis is a rare treatable condition that occurs due to excess thyroid hormone in the body that could be due to hyperthyroidism (production and release of excess thyroid hormones) and excess consumption of thyroid medications.
- The likelihood of thyrotoxicosis increases as age progresses.
- Women are more commonly affected by thyrotoxicosis than men.
What are the symptoms of Graves’ disease and thyrotoxicosis?
Graves’ disease
Symptoms of Graves’ disease include:
- Insomnia (difficulty sleeping)
- Goiter (enlarged thyroid)
- Eye inflammation that causes eyeballs to protrude from the sockets
- Arrhythmia (fast and irregular heartbeats)
- Fatigue (excessive tiredness)
- Hand tremors
- Heat intolerance
- Irritability
- Muscle weakness
- Unexplained weight loss
- Changes in menstrual cycles
- Erectile dysfunction or reduced libido
Thyrotoxicosis
Common symptoms of mild and moderate thyrotoxicosis include:
- Unexplained weight loss
- Tachycardia (rapid heartbeat)
- Arrhythmia (an irregular heartbeat)
- Muscle weakness
- Nervous, anxious/irritable
- Shakiness
- Increased sensitivity to heat
- Changes in menstruation
How are Graves’ disease and thyrotoxicosis treated?
Graves’ disease
Graves’ disease is a lifelong condition, but appropriate medical care can control the symptoms and reduce the risk of complications.
- Beta-blockers such as propranolol and metoprolol regulate the heart rate.
- Antithyroid medications such as methimazole (Tapazole) and propylthiouracil block the gland’s production of thyroid hormone.
- Radiation or radioiodine therapy involves one dose of radioactive iodine; over time, radiation slowly destroys thyroid gland cells.
- Surgery: complete or partial removal of the thyroid gland (thyroidectomy or subtotal thyroidectomy).
Thyrotoxicosis
Treatment for thyrotoxicosis depends on the cause and the options may include:
- Anti-thyroid drugs such as methimazole (Tapazole) and propylthiouracil (PTU).
- Radioactive iodine: oral intake of radioactive iodine makes the overactive thyroid cells absorb the iodine, which damages the cells causing the shrinkage of the thyroid gland.
- Surgery: removal of the thyroid gland (thyroidectomy).
- Beta-blockers help regulate the heartbeat.
- Glucocorticoids are a type of corticosteroid prescribed to treat thyroiditis.
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Key differences between Graves’ disease and thyrotoxicosis
- The exact cause is unknown (autoimmune).
- The trigger factors may be a combination of genes and exposure to a virus.
- Emotional or physical stress.
- Hyperthyroidism
- Graves’ disease
- Thyroiditis (thyroid inflammation)
- Excess thyroid medications
- Hamburger thyrotoxicosis
A predominant cause of hyperthyroidism (affects 1 out of every 200 Americans)
A complication of hyperthyroidism
- Being a woman
- Family history of thyroid disease
- Other autoimmune diseases, such as rheumatoid arthritis, lupus, or type I diabetes
- Celiac disease
- A hormone disorder such as Addison’s disease
- Pernicious anemia (anemia caused by lack of vitamin B12)
- Vitiligo (a skin disorder)
- Smoking
- A family history of thyroid disease, especially Graves’ disease
- Female gender
- Age above 60 years
- Certain autoimmune diseases include type I diabetes, pernicious anemia, and Addison’s disease
- Blood tests for thyroid hormone levels
- Radioactive iodine uptake (RAIU) test
- Thyroid scan
- Antibody test:
- TSI (thyroid-stimulating immunoglobulins)
- TBII (thyrotropin binding inhibitory immunoglobulins)
- Blood test
- Physical examination
- Thyroid hormone levels (T3, T4, and TSH)
- Imaging tests (thyroid scan, ultrasound, and radioactive iodine uptake test)
- A lifelong condition
- Treatable but with side effects
- Generally good but depends on the underlying cause
- Treatable
- Thyroid eye disease or Graves’ ophthalmopathy
- Heart problems (increased risk of stroke, heart failure, and other heart issues)
- Graves’ dermopathy or pretibial myxedema (red, thickened skin on shins and feet)
- Thyroid storm (dangerously high thyroid activity)
- Osteoporosis (weak and brittle bones)
- Heart issues atrial fibrillation, stroke, and congestive heart failure)
- Osteoporosis
- Graves' eye disease
- Thyroid storm (thyrotoxic crisis)