June 16, 2024

Graves’ disease, named after the Irish doctor Robert James Graves, is an autoimmune condition impacting the thyroid gland—a small, butterfly-shaped gland situated below the Adam’s apple in the neck. This disorder triggers the overproduction of thyroid hormone, resulting in hyperthyroidism. While it is a persistent lifelong condition, there are treatment options that can effectively manage the disorder, and in certain cases, cause temporary remission.

In this article, we will explore the causes, symptoms, risk factors and treatment of Graves’ disease.

Causes Of Graves’ Disease:

Dr. Ankur Bambhania, (Consultant), MD (General medicine), DrNB ( Critical Care), at HCG Hospitals, Bhavnagar shares the causes of Graves’ Disease:

Genetic factors:

People with a family history of Graves’ disease are more likely to develop it themselves. Certain genes may increase the risk of developing Graves’ disease.

Environmental factors:

  • Stress: Severe emotional or physical stress can trigger Graves’ disease in some people.
  • Smoking: Smoking is a significant risk factor for Graves’ disease and can also worsen the severity of the disease.
  • Iodine consumption: Too much or too little iodine in the diet can increase the risk of Graves’ disease.
  • Viral infections: Some viral infections, such as the Epstein-Barr virus, may trigger Graves’ disease.
  • Pregnancy: Pregnancy can sometimes trigger Graves’ disease or worsen existing Graves’ disease.

Symptoms Of Graves’ Disease:

Graves’ disease is characterised by several key features. “Firstly, it leads to hyperthyroidism, where the thyroid gland is overstimulated, resulting in an excess production of thyroid hormones. This hormonal imbalance causes symptoms like weight loss, a rapid heart rate, and increased energy levels,” says Dr Sajid Mairaj, who is a Senior Consultant Physician at Prayag Hospitals Group.

“Additionally, individuals with Graves’ disease often develop a goiter, causing swelling in the neck, which can be associated with discomfort or difficulty swallowing. Graves’ ophthalmopathy is another hallmark, manifesting as eye-related issues such as bulging eyes (exophthalmos), double vision, and eye irritation. Lastly, skin changes, including redness and swelling of the legs and feet (Graves’ dermopathy or pretibial myxedema), further contribute to the distinctive clinical profile of Graves’ disease,” he adds.

Risk Factos Of Graves’ Disease:

Dr Aman Priya Khanna, Co-founder and Medical Director, HexaHealth, General, Laser, Bariatric and Minimal Access Surgeon lists the following risk factors of this autoimmune disorder:

  • Inheritance: The last two decades have encouraged researchers to evaluate the genetic contribution to GD. Extensive investigations have revealed a high number of 35-70% of familial heredity concerning Graves’ Disease. 

  • Females: Another interesting aspect observed to be related to the higher prevalence of the disease is the female gender. There is a slight dominance of GD in women, which is investigated to be due to oestrogen and X-chromosome functionality.

  • Diabetes mellitus and RA: Being an autoimmune disease, the chances of acquiring GD increase if an individual has DM and rheumatoid arthritis. The rate of prevalence of Graves’ is 17-30% with Type 1 diabetes and 1.2% with RA.

  • Age: A study conducted by Xie et al., 2021 showed that adolescents have a higher chance of suffering from Graves’ Disease. The results showed almost 64% of symptoms and GD prevalence among patients before adolescence. Meanwhile, the symptoms and diagnosis rate dropped to 35% during puberty. 

  • Smoking: Lifestyle choices contribute significantly to facilitating the progression of Graves’ disease and worsening the symptomatic complexities. Cigarette smoking is among the prominent factors which increase the chances along with fatality of the symptoms associated with GD.

Diagnosis Of Graves’ Disease Amd Treatment:

Diagnosis typically involves blood tests to measure thyroid hormone levels, as well as imaging studies like ultrasound and sometimes a radioactive iodine uptake test. Treatment options may include medications to regulate thyroid hormone levels, radioactive iodine therapy to reduce thyroid function, or in some cases, surgical removal of the thyroid gland.

Dr Farah Ingale, who is a Senior Consultant Physician & Diabetologist, and Director Internal Medicine, at Fortis Hiranandani Hospital Vashi says that there are three treatment options for Graves’ Disease: Antithyroid drugs (Thionamides), Radio-Iodine, or surgery. She further went on to explain the following:

  • For patients with mild disease and small goiters, who are more likely to achieve remission after one year of treatment, primary antithyroid drug therapy may be preferred. The antithyroid drugs will control hyperthyroidism.
  • Radioiodine has a lower complication rate than surgery and may be the preferred definitive therapy of hyperthyroidism in non-pregnant patients; except in patients with moderate or severethyroid eye disease.
  • Surgery – For patients with Graves’ Disease who undergo near-total or total thyroidectomy,thyroid hormone should be initiated before discharge in a euthyroid patient and serum TSH should be measured six to eight weeks later to adjust the dose to maintain the TSH in the normal reference range.

[Disclaimer: The information provided in the article, including treatment suggestions shared by doctors, is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]

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