Graves Disease

What is Graves disease?

Graves disease (also known as Graves' disease) is an autoimmune disease. This means your immune system, which normally protects your body and helps fight disease, produces antibodies that attack the thyroid gland. These antibodies act like TSH and cause the gland to make too much thyroid hormone. This condition is called hyperthyroidism. Although it can occur at any age in men or women, Graves disease is more common in women between age 20 and 50, those who have other autoimmune diseases, and those who often have a family history of thyroid disease.

What are the complications of Graves disease?

If left untreated, hyperthyroidism can lead to heart failure or brittle bones (osteoporosis). Pregnant women with uncontrolled Graves disease are at greater risk of miscarriage, premature birth, and having a baby with low birth weight. Graves disease can also cause swelling behind the eyes that sometimes makes them bulge outward. This condition is called Graves ophthalmopathy or Thyroid Eye Disease and is relatively rare.

How is Graves disease diagnosed?

Your doctor will do a physical exam and may use different types of tests to diagnose Graves disease.

Clinic Visit. 
Your doctor MAy:

• ask about your symptoms and your personal and family medical histories 
• look for enlargement of your thyroid gland and eye irritation
• check your pulse
• look for signs of trembling

Blood tests. When thyroid hormone levels are high, the pituitary doesn't need to make as much TSH. Very low levels of TSH and high levels of T4 and T3 in your blood suggest hyperthyroidism. An antibody test called thyrotropin receptor antibody test (TRAb) can detect the antibody in the blood which causes Graves Disease. 

Radioactive iodine uptake test. The thyroid absorbs iodine from your blood and uses it to make thyroid hormone. When the thyroid produces too much thyroid hormone, it absorbs more iodine. This test involves swallowing a capsule containing a small, harmless amount of radioactive iodine. The amount of iodine taken up by your thyroid is then measured. A high uptake of radioactive iodine suggests Graves disease.

How is Graves disease treated?

Graves is a treatable disease that can be well controlled. Some patients may go into remission, but many need long-term treatments for this condition. Several treatments are available, including:

• Antithyroid medications lower the amount of hormone the thyroid makes. The preferred drug is methimazole. For pregnant or breastfeeding women, propylthiouracil (PTU) may be preferred. These medications help control but may not cure the condition, and are generally not taken for a long period of time.
• Radioactive iodine (in amounts much higher than the amount used in the radioactive iodine uptake test) will cure the thyroid problem. However, it usually destroys the thyroid. You will probably need to take thyroid hormone pills for the rest of your life to have normal hormone levels. This treatment is generally tolerated well, but can worsen Graves eye disease if it is present.
• Surgery to remove the thyroid gland. Surgery is a permanent solution, but not usually preferred because of the risk of damaging the nearby parathyroid glands (which control calcium metabolism in the body) and the nerves to the larynx (voice box). Surgery is recommended when neither antithyroid medication nor radioactive iodine therapy is appropriate.
• Beta blockers can control many symptoms, especially rapid heart rate, trembling, and anxiety. But they do not cure the disease because the thyroid still produces too much thyroid hormone. 

Questions to ask your doctor

• Is my hyperthyroidism caused by my Graves Disease? 
• Which treatment is best for me - antithyroid medications, radioactive iodine, or surgery? 
• What sort of blood test monitoring would I need if I take antithyroid medications? Which side effects should I monitor for? 
• What sort of side effects are there for radioactive iodine? How quickly would it work? What sort of blood test monitoring would I need? 
• What are the complications seen with surgery? How frequently do they happen? 
• How likely is it that my Graves disease will go into remission on its own?
• Do I need evaluation for my heart of bones?
• How often should I see my doctor after treatment?