Graves’ Disease: Symptoms, Causes, and Treatment Overview

Graves’ Disease: Symptoms, Causes, and Treatment Overview

Question. Write a short note on Grave’s disease.

Answer. Grave’s disease is an autoimmune disease caused by the production of autoantibodies that stimulate thyroid-stimulating hormone receptors on the thyroid cell membrane, resulting in excessive synthesis and secretion of thyroid hormone.

Graves’ Disease: Symptoms, Causes, and Treatment Overview

Risk Factors Of Grave’s Disease

• Genetic susceptibility: The role of hereditary factors is evidenced by increased incidence of other autoimmune disorders in members of patient’s families.
• Emotional stress
• Gender: Females are more prone than men (7 to 10:1) ratio.
• Pregnancy: iodine­containing drugs
• Iodine and drugs: Amiodarone and iodine­containing contrast media may precipitate Graves’ disease.
• Irradiation, e.g. radioactive iodine for multinodular goiter.

Symptoms of Graves’ Disease and Diagnosis

Symptoms Of Grave’s Disease

• Weight loss with increased appetite
• Heat intolerance and sweating
• Fatigue and weakness
• Hyperactivity, irritability, dysphoria, insomnia
• Dyspnea
• Oligomenorrhea, loss of libido
• Diarrhea/Defecation hyper defecation
• Polyuria

Signs Of Grave’s Disease

• Tremor, hyper-reflxia
• Tachycarclia, atrial firillation in elderly
• Warm moist skin
• Lid retraction, lid lag (causing a stare)
• Thyroid ophthalmopathy is a specific feature of Grave’s disease for which signs and symptoms are as follows:

Investigations Of Grave’s Disease

• T3 and T4 both are elevated.
• Low TSH or become undetectable
• 131I uptake is increased, i.e. greater than 35% at 5 hours
• Serum cholesterol is low
• ECG shows tachycardia, arrhythmias, ST­T changes
• Ultrasonography of the thyroid shows different goiter

Treatment For Discomfort

• Artificial tears should be given for the day, i.e. methylcellulose is given.
• Simple eye ointment should be given for the night
• Patients should use dark glasses with side frames.
• No smoking

Medical Therapy of Grave’s Disease

• Reduction of morning lid edema by sleeping on the bed with its head slightly raised.
• Prednisolone 60 mg daily is given.
• Anti-thyroid drugs such as carbimazole i.e. 40–60 mg/day, methimazole, i.e. 100–150 mg 8 hourly, and propylthiouracil, i.e. 300–450 mg/day can be given depending on the severity of the disease.
  • Drugs should be gradually decreased for 4 to 8 weeks based on FT4 levels.
  • When FT4 levels are normal carbimazole 5–15 mg/day or propylthiouracil 50mg/day is given.
  • Drugs can be given for 1–2 years by regular checking of FT4 and TSH levels.
• For symptomatic relief beta-blockers such as propanolol 80–160 mg daily is given.
  • It is given for 2–3 weeks along with anti ­thyroid treatment.
  • It relieves symptoms such as anxiety, tremors, and tachycardia.
• Radioactive iodine, i.e. 131I leads to the destruction of thyroid cells and is given with anti­thyroid drugs.

Surgery Of Grave’s Disease

• Subtotal thyroidectomy is done in severely affcted cases.
• Before surgery patient should be made euthyroid by beta blockers and anti­thyroid drugs.
• Two weeks before the surgery drugs should be stopped and lugol iodine is given to reduce the vascularity.