What is Graves’ Disease?
Graves' disease is a disorder related to the immune system characterized by excessive thyroid hormone production (hyperthyroidism). Graves' disease is a common cause of hyperthyroidism, though it can be caused by a variety of conditions.¹
The immune system targets the thyroid, causing it to produce more thyroid hormone than the body needs. The thyroid gland is located in the front of the neck and is shaped like a butterfly. Thyroid hormones regulate the use of energy by our body, which means they have an impact on practically every organ in our body, including the rate at which the heart beats.⁸
Hyperthyroidism, if left untreated, can have major consequences on the heart, bones, muscles, menstrual cycle, and fertility. An untreated hyperthyroidism during pregnancy can cause health complications for both the mother and the baby. Graves' illness can also impact your skin and eyes. ⁷
Graves' illness is more common in women than in males, and it mostly affects young women. Thyroid disease can affect other family members, whether it's Graves' disease, a thyroid enlargement (goitre), or an underactive gland.¹
Signs and Symptoms
Graves' disease is characterized by the following signs and symptoms: ²
Figure: Signs and Symptoms of Graves Disease
Created by Aastha Malik
Graves' ophthalmopathy (GO) affects more than one-third of people who have Graves' illness. It occurs when the immune system affects the muscles and other tissues surrounding your eyes. Bulging eyes, gritty, itchy and puffy eyes are some of the
symptoms. The individual may have blurred or double vision light sensitivity pressure or pain in the eyes. These symptoms might appear before or at the same time as hyperthyroidism symptoms. GO can arise after Graves' illness has been treated in some cases. Even if your thyroid function is normal, you can get GO. The majority of people experience quite minor symptoms.³
Problems with the skin
Graves' disease patients occasionally acquire a condition that causes their skin to grow reddish, thick, and rough. Graves' dermopathy, also known as pretibial myxedema, affects your shins, but can also affect the tops of your feet and other portions of your body. The majority of occurrences are minor and harmless.³
Causes and Risk Factors
A failure in the body's disease-fighting immune system causes Graves' illness. It's unclear why this occurs. Antibodies are produced by the immune system to fight a specific virus, bacteria, or other foreign entity. Graves' disease occurs when the immune system creates an antibody against one component of the cells in the hormone-producing gland in the neck for unknown reasons (thyroid gland).
Thyroid function is normally regulated by a hormone produced by a small gland at the base of the brain (pituitary gland). The Graves' disease antibody, thyrotropin receptor antibody (TRAb), functions similarly to the regulating pituitary hormone. This suggests that TRAb interferes with the thyroid's normal regulation, resulting in excessive thyroid hormone production (hyperthyroidism). ³
Cause of Graves' ophthalmopathy
Graves' ophthalmopathy is caused by an accumulation of specific carbohydrates in the muscles and tissues behind the eyes; there is no known cause for this. The same antibody that can cause thyroid disease appears to have an "attraction" to the tissues around the eyes. ³
Graves' ophthalmopathy can occur simultaneously with hyperthyroidism or months afterwards. However, ophthalmopathy symptoms might emerge years before or after the onset of hyperthyroidism. Even if there is no hyperthyroidism, Graves' ophthalmopathy can develop.
Although anyone can get Graves' disease, there are a number of variables that can make it worse, including ³
- Genetics - A family history of Graves' disease is an established risk factor where a gene or genes that make a person more sensitive to the disorder are almost certainly present.
- Sex - Graves' disease is substantially more common in women than in men.
- Age - Graves' disease typically affects patients before they reach the age of 40.
- Other autoimmune conditions. People who have other immune system illnesses, such as type 1 diabetes or rheumatoid arthritis, are at a higher risk.
- Stress - either emotional or physical. In people with genes that increase their risk of Graves' disease, stressful life events or illness may act as a trigger for the disease's start.
- Pregnancy. Pregnancy or recent childbirth may raise the likelihood of developing the disease, especially in women who carry risk genes. Thyroid hormone levels that are slightly elevated are rarely a concern during pregnancy. However, hyperthyroidism can harm both the mother and the baby. Before getting pregnant, if you have Graves' disease, make sure your hyperthyroidism is under control.
- Smoking - Graves' illness is made worse by cigarette smoking, which weakens the immune system. Graves' ophthalmopathy is more likely to develop in smokers who have Graves' disease.
Figure: Risk Factors for Graves Disease
Created by Aastha Malik
In order to screen for the sign and symptoms of Graves' disease, the physician will assess your medical history and perform a physical examination of the patient. The doctor may conduct one or more of the following thyroid tests to confirm a Graves' disease diagnosis. ²
- Blood tests. These tests can check for TSI as well as assess thyroid hormone levels.
- Test for radioactive iodine uptake. This test determines how much iodine the thyroid absorbs from the bloodstream to produce thyroid hormones. Graves' disease is a condition in which your thyroid absorbs a lot of iodine.
- A thyroid scan is performed. This test, which is frequently performed in conjunction with the radioactive iodine absorption test, determines how and where iodine is dispersed throughout the thyroid. Iodine accumulates throughout the gland in Graves' disease.
- Doppler blood flow measurement. Sound waves are used in this test to identify increased blood flow in the thyroid owing to Graves' disease. It is also known as Doppler ultrasound. If radioactive iodine uptake is not an option for you, such as during pregnancy or breastfeeding, your doctor may order this test.
Graves Disease at Different Stages of Life
Graves' disease is a hyperthyroidism-causing autoimmune condition. It is the most frequent cause of hyperthyroidism in the United States, affecting around 1 in every 200 people. ⁴
The majority of people who have the disease are diagnosed when they are in their early to middle early adulthood. Graves' illness can, however, affect children and the elderly. Although most Graves' symptoms, such as a racing heart, insomnia, hand tremors, and weight loss, are consistent throughout life, a person's developmental stage and other medical issues might obscure the presence of Graves' disease or make it more likely to be misdiagnosed.
Graves' disease affects children at a far lower rate than it does adults, with a prevalence of 1 in 100,000. It is relatively uncommon before the age of three but becomes more common as children approach puberty, with the average age of onset for children being 12.5 years old. ⁴Graves' disease is four times more likely to affect girls than boys, and children with a family history of hyperthyroidism are more prone to develop the disease. Down syndrome, type 1 diabetes, asthma, and vitiligo are the most prevalent co-occurring disorders in children with Graves' disease. Girls with hyperthyroidism may have irregular periods during adolescence, and weight loss, lack of energy, hazy vision, attention issues in school, palpitations, mood swings, and trouble sleeping are common symptoms for both sexes.
Graves' disease is most commonly diagnosed between the ages of 30 and 50. Graves' disease can be triggered by pregnancy in certain women. Graves' disease affects about one in every 1,500 pregnant women, and up to 30% of young women with Graves' disease were pregnant in the year leading up to the commencement of their symptoms.⁴Graves' disease can develop in maturity as a result of severe stress or trauma. Additional stress can exacerbate symptoms in people who have already been diagnosed with Graves' disease. Hyperthyroidism affects approximately 0.5 to 4% of older people.
Tablets, radioiodine, or surgery are the three therapeutic choices.
Thionamides are a type of medication that is widely used to treat an overactive thyroid. They prevent your thyroid from over-producing hormones. Carbimazole and propylthiouracil are the two common types.
Before you see any results, you'll need to take the drug for 1 to 2 months. Meanwhile, you may be given another medication called a beta blocker to reduce some of your symptoms. While thyroid overactivity is being controlled, beta-blocking medications such as propranolol may be given to help manage some of the symptoms. The overproduction of thyroid hormone is not stopped by these tablets. ⁹
Your dose may be gradually reduced and eventually withdrawn once your thyroid hormone levels are under control. However, some patients will need to take medicine for several years, if not, their entire lives.
A modest dosage of radiation given in the form of an iodine tablet is known as radioiodine. It takes from weeks to months for the full effects to appear from the medication. It's frequently utilised to treat people who haven't been treated with pills. Many use it after their thyroid blood tests have stabilised, rather than initially trying a complete course of pills. In most cases, only one therapy is required, and the thyroid overactivity will not return. Because there is a chance that the thyroid will become underactive as a result of medication, all patients should undergo frequent thyroid examinations. Apart from pregnant or breastfeeding women, the treatment is completely safe. ¹
Another option is to have a portion of the thyroid gland removed. This is only used if the enlarged thyroid is pressing on the windpipe or gullet, or if pills or radioiodine have failed. Thyroid surgery is only conducted once the thyroid activity has been regulated with medication for a period of time. ¹
What is your Life Expectancy with Graves’ Disease?
Complications of Graves’ Disease
Graves' disease has the following complications:
- Pregnancy miscarriage, preterm birth, foetal thyroid malfunction, poor foetal growth, maternal heart failure, and preeclampsia are all possible consequences of Graves' disease during pregnancy. Preeclampsia is a disorder that causes high blood pressure and other severe signs and symptoms in pregnant women. ³
- Heart conditions - Graves' illness can cause heart rhythm problems, changes in the structure and function of the heart muscles, and can cause the inability of the heart to pump enough blood to the body if left untreated (heart failure).³
- Brittle bones - Untreated hyperthyroidism can also result in brittle, weak bones (osteoporosis). The amount of calcium and other minerals in bones determines their strength. The ability of your body to integrate calcium into bones is impeded by too much thyroid hormone.³
Thyroid storm, also known as rapid hyperthyroidism or thyrotoxic crisis, is an uncommon but life-threatening complication of Graves' disease. It's more likely if severe hyperthyroidism has not been treated properly.
Fever, sweating, vomiting, diarrhoea, delirium, severe weakness, seizures, irregular heartbeat, yellow skin and eyes (jaundice), very low blood pressure, and coma are all possible side effects of a sudden and abrupt surge in thyroid hormones. A thyroid storm necessitates rapid medical attention.³
How do diet and Lifestyle affect Graves’ Disease?
Nutrition and Grave’s disease
Although food cannot cure Graves' disease, it can supply antioxidants and nutrients that can help alleviate symptoms. In order to manage Graves' disease, it's important to eat a healthy diet. Some foods may aggravate the symptoms of Graves' condition. Food sensitivities or allergies can compromise the immune system, leading to disease flare-ups in some people. As a result, it's critical to try to figure out which foods you might be sensitive to. Keeping these foods out of your diet may help you feel better.
Iodine is used by your thyroid to produce thyroid hormones. If you have Graves' disease or another autoimmune thyroid ailment, too much iodine in your diet might cause serious side effects. Hyperthyroidism can be caused or worsened by eating foods high in iodine, such as kelp, dulse, or other types of seaweed. Supplementing with iodine can have the same effect. Therefore, it is important to avoid any supplements or multivitamins or food containing iodine.² Specific nutrients found in foods can help alleviate some of the symptoms of Graves' illness, such as
Foods high in calcium
Your body may have trouble absorbing calcium if you have hyperthyroidism, which may lead to brittle bones and osteoporosis as a result. A calcium-rich diet may be advantageous, though some dairy products are fortified with iodine and may not be as good for you as others.⁵ As you require some iodine in your diet, it is better to consult your doctor or nutritionist about which dairy products you should consume and which you should avoid. Almonds, broccoli, sardines, okra and almonds are examples of calcium-rich foods.
Vitamin D-rich foods
Vitamin D aids in the faster absorption of calcium from your diet. The majority of vitamin D is produced in the skin as a result of sunlight absorption. Among the dietary sources are sardines, cod liver oil, salmon, tuna and mushrooms. ⁵
Magnesium deficiency can interfere with your body's capacity to absorb calcium. A magnesium deficit can exacerbate the symptoms of Graves' disease. The following foods are high in this mineral: avocados, dark- chocolate, almonds and cashews.⁵
In individuals with Graves' disease, a selenium shortage is linked to thyroid eye disease. This can result in dilated pupils and double vision. Selenium is a mineral and an antioxidant. It can be found in mushrooms, brown rice, sardines and sunflower seeds.⁵
Yoga and meditation can increase relaxation and help with Graves' disease symptoms, including anxiety and insomnia. Going to counselling, writing, talking to a friend, changing sleep patterns, and limiting work stress are all effective stress management measures. ⁶
Exercise and Graves’ Disease
Exercise is an essential component of a healthy lifestyle. Aerobic exercise, resistance training, and weight-bearing activities are all good for your health, but weight-bearing activities are especially advantageous since they can help prevent osteoporosis, which is a common side effect of Graves' illness. However, exercising without first treating the illness is risky. Graves' disease patients already have a quicker metabolism and heart rate than the general population, and exercise can increase heart rate even more, potentially leading to heart failure.¹⁰
Graves' disease is overactivity of the thyroid gland named after Dr Graves. Antibodies encourage the thyroid gland to create too much thyroid hormone, resulting in an 'autoimmune' illness. Antibodies are created by the immune system to aid in the fight against infection. Antibodies react with the body's own tissues in people with autoimmune disorders.
The body mistakenly perceives the thyroid as a foreign tissue in Graves' disease and produces an antibody against it. This phenomenon is called 'autoimmunity'. The thyroid gland is stimulated by this antibody, causing it to overproduce the thyroid hormone. It is unknown why the antibody is formed. It's possible that thyroid disease exists in your family history. Stress appears to be a trigger of the condition at times. In the vast majority of cases, the cause is unknown.
You will be required to visit a GP in case you have observed symptoms of an overactive thyroid.
They'll inquire about your symptoms, and if they suspect you have a thyroid problem, they'll schedule a blood test to see how well your thyroid is functioning. If your blood test indicates that you have an overactive thyroid, you may be referred for more testing to determine the cause.
Grave’s disease is usually treatable. The following are the main treatments:
- Medication that prevents your thyroid from overproducing thyroid hormones
- Radioiodine treatment — a type of radiotherapy that destroys thyroid cells, limiting the thyroid's ability to generate thyroid hormones
- Thyroid surgery to remove part or all of your thyroid, preventing it from producing thyroid hormones
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- “Graves’ Disease Across the Life Span.” EverydayHealth.Com, https://www.everydayhealth.com/graves-disease/graves-disease-across-life-span/. Accessed 28 May 2022.
- “Graves’ Disease Diet: Foods to Eat and Foods to Avoid.” Healthline, 25 Jan. 2018, https://www.healthline.com/health/graves-disease-diet.
- “Healthy Living With Graves’ Disease.” EverydayHealth.Com, https://www.everydayhealth.com/graves-disease/healthy-living-with-graves-disease/. Accessed 26 May 2022.
- “Hyperthyroidism Symptoms and Treatment.” MedicineNet, https://www.medicinenet.com/hyperthyroidism_pictures_slideshow/article.htm. Accessed 26 May 2022.
- “Is Graves’ Disease Fatal? Symptoms, Treatment, Diet & Causes.” MedicineNet, https://www.medicinenet.com/graves_disease/article.htm. Accessed 26 May 2022.
- “Overactive Thyroid (Hyperthyroidism) - Treatment.” Nhs.Uk, 20 Oct. 2017, https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/treatment/.
- “Thyroid Problems: Diet and Exercise Risks.” Cleveland Clinic, 26 Nov. 2021, https://health.clevelandclinic.org/uncontrolled-thyroid-exercise-diet-risks/.