Graves Disease

Grave’s Disease 

Objectives:

1. To understand pathophysiology of Grave’s disease
2. Signs and symptoms of Grave’s disease
3. Risk Factors of Grave’s disease
4. Comorbidities and complications from Grave’s disease
5. Diagnostic tests and treatments for Grave’s disease

1. Pathophysiology-Grave’s disease is an autoimmune disease disorder characterized by

hyperthyroidism due to circulating antibodies that attack the thyroid. The antibody called thyrotropin receptor antibody or TRAb, the TRAb interferes with the normal function of the thyroid causing an overproduction of thyroid hormones.

1. Grave’s disease is also associated with pernicious anemia, DM type 1, autoimmune adrenal insufficiency, rheumatoid arthritis, myasthenia gravis, systemic lupus erythematosus,  systemic sclerosis, Sjogren’s syndrome

1. Signs and Symptoms—anxiety and irritability, fine tremors of hands and fingers, heat sensitivity, warm moist skin, weight loss, enlarged thyroid (goiter), change in menstrual cycles, erectile dysfunction or decreased libido, frequent bowel movements, bulging eyes (ophthalmopathy), thick, red skin on shins and tops of feet (dermopathy), rapid or irregular heartbeat
2. Symptoms specific to Grave’s disease—opthalmopathy and dermopathy with 30% of Grave’s patients experiencing other symptoms such as gritty sensation, pain and pressure in eyes, light sensitivity, double vision, vision loss, reddened or inflamed eyes, and puffy or retracted eyelids.
3. Risk factors- women under 40, family history, having other auto immune disorders (Diabetes 1 or rheumatoid arthritis), emotional or physical stress, pregnancy, and smoking
4. Complications of Grave’s disease—pregnancy during the disease can cause—miscarriage, preterm birth, fetal thyroid dysfunction, poor fetal growth, maternal heart failure and preeclampsia

Heart disorders—left untreated can cause heart rhythm disorders and congestive heart failure

Thyroid storm—if left untreated in severe hyperthyroidism—fever, profuse sweating, vomiting, diarrhea, delirium, weakness, seizures, markedly irregular heartbeat, jaundice, severe low blood pressure, and coma.

Brittle bones—too much thyroid hormone interferes with the body’s ability to incorporate calcium into the bones leading to osteoporosis

1.  Tests—TSH levels, If TSH levels are off then test T3 and T4 levels,  ultrasound of the thyroid to see if it is enlarged, radioactive iodine to determine the rate at which the thyroid takes in the iodine (rules out Grave’s disease)
2. Treatments---Goal is to inhibit the production of thyroid hormones and block the effects on the body

Radioactive iodine therapy—causes thyroid gland to shrink and symptoms decrease over several weeks to several months.  Side effects are new or worsened symptoms of Grave’s opthalmopathy which are mild and temporary, tenderness in the neck, and an increase in thyroid hormones. Not recommended for pregnant or nursing women.

Anti-thyroid medications—Tapazole (Methimazole) and propylthiouracil (PTU) Tapazole is also used prior to radioactive iodine treatment and prior to surgery to remove the thyroid gland.