Graves Disease

Graves’ disease affects 16.7% of India's adult population, making it one of the most common autoimmune disorders. The symptoms of Graves’ disease can vary from person to person, often including anxiety, tremors, weight loss, and changes in heart rate. Early diagnosis and proper treatment help most people manage their symptoms and lead normal, fulfilling lives.

What is Graves’ Disease?

Graves’ disease is an autoimmune condition where the body's immune system mistakenly attacks the normal thyroid gland, causing it to secrete excessive amounts of thyroid hormones. Irish physician Robert Graves first described the condition in the 1800s, and it represents the most common cause of hyperthyroidism.

The thyroid gland is a small butterfly-shaped organ located in the front of the neck that plays a key role in managing various bodily functions. Under normal circumstances, it produces hormones that control:

• Body temperature regulation
• Heart rate maintenance
• Metabolic rate management
• Energy conversion from food
• Muscle and bone function

In Graves’ disease, the immune system produces an antibody called thyrotropin receptor antibody (TRAb). This antibody interferes with normal thyroid function by mimicking the role of the pituitary hormone, leading to excessive production of thyroid hormones. The overproduction of these hormones creates a state of hyperthyroidism, which can affect multiple organs and body systems.

The condition differs from other thyroid disorders because it involves an autoimmune response in which the body's disease-fighting system malfunctions. 

Symptoms of Graves’ Disease

The following are some common graves' disease symptoms:

• Rapid or irregular heartbeat
• Anxiety and nervousness
• Unexplained weight loss despite increased appetite
• Frequent bowel movements
• Trembling hands
• Excessive sweating
• Difficulty sleeping
• Muscle weakness
• Changes in menstrual cycles in women
• Erectile dysfunction in men

A distinctive feature of Graves’ disease is its effect on the eyes, known as Graves’ ophthalmopathy. Less commonly, some patients develop Graves’ dermopathy, a skin condition characterised by reddish thickening of the skin, especially on the shins and tops of the feet. 

Causes and Risk Factors of Graves’ Disease

Medical researchers have identified that Graves’ disease develops when the body's immune system generates antibodies that target the thyroid gland. These antibodies, known as thyroid-stimulating immunoglobulins (TSI), trick the thyroid into producing excessive amounts of hormones.

Several factors increase the likelihood of developing Graves’ disease:

• Gender and Age: Women are 7-8 times more likely to develop the condition, particularly between ages 30-50
• Family History: People with relatives who have Graves’ disease face a higher risk
• Other Autoimmune Disorders: Conditions like type 1 diabetes or rheumatoid arthritis increase susceptibility
• Smoking: Cigarette smoking significantly raises the risk and can worsen eye problems
• Pregnancy: Pregnancy or recent childbirth can trigger the onset
• Emotional Stress: Severe emotional or physical stress may contribute to development
• Environmental Factors: Exposure to certain viruses or bacteria might trigger the condition

Complications of Graves’ disease

The most significant complications include:

• Heart Problems: The condition can cause irregular heartbeat (arrhythmia), increasing the risk of stroke and heart failure. The excessive thyroid hormone makes the heart work harder, potentially leading to serious cardiovascular issues.
• Bone Complications: The disease can cause osteoporosis, making bones abnormally thin and weak, increasing the risk of fractures.
• Thyroid Storm: This rare but life-threatening condition occurs when thyroid hormone levels become extremely high. It requires immediate medical intervention and can cause high fever, rapid heartbeat, and severe dehydration.
• Vision Problems: About 25% of patients develop Graves’ ophthalmopathy (graves’ disease of eyes), which can cause eye bulging, vision changes, and, in severe cases, vision loss if left untreated.
• Pregnancy Risks: Untreated Graves’ disease during pregnancy can result in serious complications, including miscarriage, premature birth, and pre-eclampsia.
• Goitre: The development of a goitre (enlarged thyroid gland) is another potential complication that can cause difficulty swallowing or breathing. 

Diagnosis

The diagnostic process generally involves a detailed medical history review and physical examination, paying special attention to thyroid gland characteristics and eye symptoms.

The primary diagnostic tools include several blood tests:

• Thyroid Function Tests: These measure TSH (thyroid-stimulating hormone) levels and thyroid hormones (Free T4 and Free T3)
• Thyroid Antibody Tests: These detect TSI (thyroid-stimulating antibodies) and TBII (thyrotropin binding inhibitory immunoglobulins)
• Radioactive Iodine Uptake: This test shows how much iodine the thyroid collects, helping distinguish Graves’ disease from other thyroid conditions
• Doppler Ultrasound: For patients who cannot undergo radioactive testing, such as pregnant women, doctors may use Doppler ultrasound to examine blood flow patterns in the thyroid gland. This non-invasive test can reveal the increased blood flow typical in Graves’ disease.

Treatment

Endocrinologists typically consider three main graves' disease treatment approaches:

• Antithyroid Medications: These drugs work by blocking the thyroid's ability to produce hormones. They are often the first choice for children and young adults.
• Radioactive Iodine Therapy: This treatment destroys overactive thyroid cells gradually. Doctors commonly recommend radioactive iodine therapy for adults over 40 and those who haven't responded well to medications.
• Thyroid Surgery: Surgical intervention, or thyroidectomy, removes part or all of the thyroid gland. Doctors typically recommend thyroidectomy for patients with large goitres or those who cannot tolerate other treatments.

When to See a Doctor

Patients should seek urgent care if they experience severe heart-related symptoms, such as rapid or irregular heartbeat or sudden vision changes. Pregnant women with Graves’ disease need special attention and should discuss safe treatment options with their healthcare team.

Prevention

Doctors recommend several lifestyle modifications that may help reduce the risk of developing or worsening Graves’ disease:

• Dietary Considerations: Limit foods high in iodine, such as kelp and seaweed. Avoid iodine supplements unless prescribed by a doctor
• Regular Exercise: Maintain an active lifestyle to improve thyroid function and overall health
• Stress Management: Practise stress-reduction techniques like meditation or regular physical activity
• Smoking Cessation: Quit smoking, as it increases disease risk and can worsen eye problems
• Vitamin D Management: Ensure adequate vitamin D levels through diet or supplements
• Gut Health: Focus on a balanced diet low in processed foods and sugar

Conclusion

People with Graves’ disease can lead normal, healthy lives through consistent medical supervision and lifestyle adjustments. Regular check-ups, medication adherence, and healthy habits like proper diet and stress management play vital roles in successful treatment outcomes.

FAQs

1. Who does Graves’ disease affect?

The condition predominantly affects women, with females being five times more likely to develop it than males. The typical age of onset falls between 30 and 60 years, though it can occur at any age. People with other autoimmune conditions, such as rheumatoid arthritis or type 1 diabetes, face an increased possibility of this condition.

2. How common is Graves’ disease?

Graves’ disease affects approximately 2–3% of the global population. It represents the most common cause of hyperthyroidism, accounting for 60-80% of all cases. 

3. Is Graves’ disease hereditary?

While not directly inherited, Graves’ disease has a genetic component. Having a family member with the condition or other autoimmune disorders increases the risk. The inheritance pattern is complex, involving multiple genetic and environmental factors.

4. How serious is Graves’ disease?

Graves’ disease requires careful management as it can lead to significant complications if untreated. The condition can affect multiple body systems, potentially causing:

• Heart problems and irregular heartbeat
• Bone weakness and osteoporosis
• Vision changes and eye problems
• Pregnancy complications

5. What is the difference between hyperthyroidism and Graves’ disease?

Graves’ disease is a distinct type of hyperthyroidism caused by an autoimmune response. While all patients with Graves’ disease have hyperthyroidism, not all cases of hyperthyroidism are due to Graves’ disease.

6. Can Graves’ disease be treated with diet?

Diet alone cannot treat Graves’ disease, but proper nutrition supports overall treatment. Patients should:

• Monitor iodine intake
• Maintain adequate calcium and vitamin D levels
• Avoid foods that trigger symptoms

Dr. Srinivas Kandula

MBBS, MD (General Medicine), DNB (Endocrinology)
CARE Multispeciality Clinic, Srinagar Colony, Hyderabad, Gurunanak CARE Hospitals, Musheerabad, Hyderabad, CARE Hospitals, Nampally, Hyderabad, CARE Hospitals Outpatient Centre, Banjara Hills, Hyderabad

To Book an Appointment, call:

+91 406 810 6585