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'
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
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
There's no way to stop your immune system from
attacking the thyroid gland, but treatments can
decrease the production of thyroxine.
There's no treatment to stop your immune system from producing the
antibodies that cause Graves' disease. Treatments to control the
symptoms of Graves' disease are designed to decrease the production of
thyroxine or to block its action. They include:
These medications, which include propranolol (Inderal), atenolol (Tenormin),
metoprolol (Lopressor) and nadolol (Corgard), often bring quick
relief of hyperthyroid signs and symptoms, such as a rapid heart
rate, nervousness and tremors. These medications aren't a cure for
Graves' because your body will still produce too much thyroxine, but
beta blockers block some of the action of the thyroid hormone. Beta
blockers are often used in conjunction with other forms of
These prescription medications include propylthiouracil and
methimazole (Tapazole) and prevent your thyroid from producing
excessive amounts of hormones. Typically, treatment with
anti-thyroid medications continues for at least a year. For 20
percent to 30 percent of people with Graves' disease, treatment with
anti-thyroid medications for 12 to 18 months causes a long-term
remission of the disease. However, relapse is fairly common. These
drugs are often used in combination with radioactive iodine
treatment or surgery to help control signs and symptoms. About 5
percent of people who take these medications have an adverse
reaction to them.
To make thyroid hormone, your body needs iodine and will use
whatever form of iodine is available in your blood. If you take
radioactive iodine, the iodine collects in your thyroid gland, and
over time the radioactivity destroys the overactive thyroid cells.
This causes the thyroid gland to shrink, and problems lessen
gradually, usually over several weeks to several months. Because
this treatment causes thyroid activity to decline, you likely will
later need thyroxine treatment to supply your body with normal
amounts of thyroid hormones. Treatment doesn't require a hospital
stay. Radioactive iodine treatment given in the small doses used to
treat Graves' disease has few side effects. After radioactive iodine
treatment, any iodine not taken up into the thyroid gland is
excreted in your urine and saliva. This treatment is used for more
than 70 percent of adults with hyperthyroidism.
If you can't tolerate an anti-thyroid drug and don't want to have
radioactive iodine therapy, surgery to remove your thyroid gland (thyroidectomy)
is an option. After the surgery, you'll likely need thyroxine
treatment to supply your body with normal amounts of thyroid
hormones after the surgery. Risks of this surgery include potential
damage to your vocal cords and your parathyroid glands, tiny glands
located on your thyroid gland. Your parathyroid glands produce a
hormone that controls the level of calcium in your blood.
Complications occur in less than 1 percent of people under the care
of a surgeon experienced in thyroid surgery.
If Graves' disease affects your eyes (Graves' ophthalmopathy), you can
manage mild symptoms by using artificial tears liberally during the day
and lubricating gels at night. If your symptoms are more severe, your
doctor may recommend:
Treatment with prescription corticosteroids may diminish swelling
behind your eyeball.
In this surgery, your doctor removes the bone between your eye
socket (orbit) and your sinuses — the air spaces next to the orbit.
This gives the eyes room to move back to their original position.
Possible complications include double vision and lip numbness.
The inflammation caused by Graves' disease can affect your eye
muscles, making them too short to allow the eyes to align properly.
In eye muscle surgery, your doctor cuts the muscle where it attaches
to your eyeball and then reattaches it farther back. Sometimes, more
than one operation is necessary.
You may have double vision either because of Graves' disease or as a
side effect of surgery for Graves' disease. Though they don't work
for everyone, prisms in your glasses may correct your double vision.
Orbital radiotherapy was once a common treatment for Graves'
ophthalmopathy. Orbital radiotherapy uses targeted X-rays over the
course of several days to destroy some of the tissue behind your eyes.
However, Mayo Clinic studies have suggested that this treatment provides
no benefit for people who have mild to moderately severe Graves'
ophthalmopathy. Researchers believe that because of the costs, risks and
ineffectiveness, orbital radiotherapy isn't for people who have mild to
moderately severe Graves' ophthalmopathy.
Graves' disease >
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