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Graves’ disease is a form of hyperthyroidism. Hyperthyroidism means the thyroid gland is over active. The disease is one of the most common problems of the thyroid gland.
Graves' disease is also often known as thyrotoxicosis. This refers to the toxic condition resulting from thyroid overactivity.
Robert James Graves (1796-1853) was an Irish physician and teacher. His paper “Newly observed affection of the thyroid gland in females” was published in the London Medical and Surgical Journal in 1853. This paper described this condition and the disease was named after him.
The thyroid gland is a butterfly-shaped small organ situated over the front of the neck. It secretes hormones like thyroxine (T4) and triiodothyronine (T3) to regulate various metabolic processes of the body. (1-6)
The exact cause of Graves’ disease is unknown. It is speculated that this condition may have autoimmune origins. This means the body’s immune cells that help fight off infections turn back on some of the body’s own cells to cause disease. The immune cells make antibodies that attack the cells of the body’s own tissues.
In the case of Graves' disease, the body appears to be making antibodies that cause the thyroid gland to make more hormone than normal. The thyroid hormone regulates the body’s metabolism, heart rate, calories burnt at rest, energy level and other important body functions.
Graves' disease is the most common cause of hyperthyroidism. It makes up about 70% of cases of hyperthyroidism. In the UK incidence has been reported at between 100 and 200 cases per 100,000 population.
Women are more likely to get this condition. Graves is up to eight times more common in women than men.
People between the ages of 20 and 50 are most likely to be diagnosed with this condition.
Graves' disease is linked to insulin-dependent diabetes and pernicious anaemia. These are other autoimmune conditions. In addition, Graves’ disease may have a genetic association since it may run in some families.
An overactive thyroid gland can show symptoms such as weight loss, increased heart rate and palpitations, anxiety, sleeplessness, fatigue, tremors, sweaty and hot, breathless, diarrhoea etc.
The eyes may also be affected by this condition. This is termed Graves’ ophthalmopathy. There may be bulging eyes along with other eye problems. The eye lids do not close completely over the eyes leading to several complications. Dryness and irritation of the eyes are common.
Some people may notice a swelling in their neck because of an enlarged thyroid.
Diagnosis is made by a blood test measuring thyroid hormones. The antibodies against the thyroid gland may also be detected on blood tests.
A radioactive Iodine scan may also be prescribed. It is called RAI uptake and shows if there are areas of the thyroid gland making more or less hormone than normal.
A thyroid ultrasound helps detect cysts or tumours in the gland and can be used to measure the size of the gland.
Graves’ disease is treated using a combination of medication, radiation, and surgery. These treatments lower the amount of thyroid hormone in the body.
Medications commonly used are Carbimazole and Propylthiouracil. Medications that reduce the symptoms such as palpitations include beta blockers. This slows heart rate, lowers blood pressure, and reduces the anxiety. Prednisolone – a steroid preparation may also be prescribed in some patients.
Radioactive iodine is also prescribed as a pill in some individuals.
Surgery may be opted to remove part or all of the thyroid gland or a growth in the gland. This ensures a cure in many patients but comes with a set of risks.