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Graves' disease
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Graves' disease

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DIABETES AND ENDOCRINE SYSTEM

Endocrine System

Graves disease, named after Robert J. Graves, MD, circa 1830s, is an autoimmune disease characterized by hyperthyroidism due to circulating autoantibodies. Thyroid-stimulating immunoglobulins (TSIs) bind to and activate the thyroid stimulating hormone (TSH) receptors, causing the thyroid gland to grow and the thyroid follicles to increase synthesis of thyroid hormone. Graves disease, along with Hashimoto thyroiditis, is classified as an autoimmune thyroid disorder. Graves' disease is the most common form of hyperthyroidism. It occurs when your immune system, which normally protects your body from bacteria and viruses, mistakenly attacks your thyroid gland and causes it to overproduce the thyroid hormone, thyroxine. This autoimmune response can also affect the tissue behind your eyes (Graves' ophthalmopathy) and the skin on your lower legs and feet (Graves' dermopathy).

When you have too much thyroid hormone in your system, your body's metabolism rate can increase by 60 percent to 100 percent, because thyroxine regulates your cells' metabolism. A higher metabolism can lead to a number of health problems, such as an irregular heartbeat or anxiety.

Graves' disease is rarely life-threatening. Although it may develop at any age and in either men or women, Graves' disease is far more common in women and usually begins between 20 and 40 years of age.

There's no way to stop your immune system from attacking the thyroid gland, but treatments can decrease the production of thyroxine.

When to seek medical advice

If you have some of the signs and symptoms of Graves' disease, which may include an enlarged thyroid, protruding eyes, anxiety, intolerance to heat, rapid heartbeat, tremor and weight loss, see your doctor. Your doctor will try to determine the underlying cause of your signs and symptoms.

Screening and diagnosis

To diagnose Graves' disease, your doctor typically uses these procedures:

  • Physical exam. Your doctor examines your eyes to see if they're irritated or protruding and looks to see if your thyroid gland is enlarged. Because Graves' disease increases your metabolism, your doctor will check your pulse and blood pressure and look for signs of trembling. Your doctor will also ask you about your symptoms and your medical and family history.

  • Blood sample. A sample of your blood can tell your doctor your levels of thyroxine, thyroid-stimulating hormone (TSH) and TRAb. TSH, which the pituitary gland produces, is the normal thyroid stimulator. It's typically at a very low level in Graves' disease, while your level of thyroxine is usually elevated. That's because TRAb, an abnormal antibody that mimics TSH, stimulates the thyroid gland. Doctors often don't check for TRAb levels, except in cases in which the diagnosis isn't clear.

  • Radioactive iodine uptake. Your body needs iodine to make thyroxine. By giving you a small amount of radioactive iodine, then later measuring the amount of radioiodine in your thyroid gland, your doctor can determine the rate at which your thyroid gland absorbs iodine. A high uptake of radioactive iodine indicates your thyroid gland is producing too much thyroxine, as is the case in Graves' disease. Low uptake occurs in some of the other causes of hyperthyroidism.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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