What is this Condition?
Graves’ dse is a metabolic imbalance resulting from overproduction of thyroid hormones. This disorder causes increased production of the hormone thyroxine, enlarges the thyroid gland (goiter), and causes numerous changes in body systems. Graves disease occurs most often between ages 30 and 40, especially in people with a family history of thyroid abnormalities; only 5% of people with the disorder are younger than age 15.
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With treatment, most people can lead normal lives. However, thyroid storm – an acute exacerbation of Graves’ disease – is a medical emergency that may lead to life-threatening heart, liver, or kidney failure.
What Causes it?
Graves’ disease may result from both genetic and immunologic influences. For example, certain twins have a higher risk for Graves’ disease, suggesting a genetic link. This disease occasionally coexists with abnormal iodine metabolism and other endocrine disorders, such as diabetes, thyroiditis, and hyperparathyroidism.
In latent Graves’ disease, excessive dietary intake of iodine and, possibly, stress can precipitate clinical hyperthyroidism. Unless the disorder is properly treated, stress – including surgery, infection, toxemia of pregnancy, and diabetic ketoacidosis – can precipitate thyroid storm.
What are its Symptoms?
Classic of symptoms incl goiter (an enlarged thyroid), nervousness, heat intolerance, weight loss despite increased appetite, sweating, diarrhea, tremor, and palpitations.
Abnormally protruding eyeballs are a classic sign but don’t occur in all cases.
How is it Diagnosed?
Diagnosing Graves’ disease is usually uncomplicated. If your doctor suspects that you have it, he or she will carefully review your history, perform a physical exam, and order routine hormone tests. These tests confirm Graves’ disease by showing increased levels of the thyroid hormones thyroxine and triiodothyronine and other characteristic features of the illness. Ultrasound test may confirm eye problems caused by Graves’ disease.
How is it Treated?
Antithyroid drugs, radioactive iodine, and surgery are primary treatments for Graves’ disease. Which one is used depends on the size of the goiter, the causes, the person’s age and whether he or she plans to have children, and how long surgery will be delayed (if the person is a candidate).
Antithyroid drug therapy is used for children, young adults, pregnant women, and people who refuse surgery or radioactive iodine treatment. These drugs include propylthiouracil (PTU) and Tapazole, which block thyroid hormone synthesis. Although symptoms subside within 4 to 8 weeks after such therapy begins, the person must continue the medication for 6 months to 2 years. Many people must take the drug lnderal at the same time to prevent a rapid heart rate and other side effects of treatment.
Pregnant women should receive the lowest possible dosage of antiÂthyroid medication to minimize the risk of thyroid hormone insufficiency in the fetus. Because Graves’ disease sometimes worsens after childbirth, continuous control of the mother’s thyroid function is essential. The mother receiving low-dose antithyroid treatment may breast-feed as long as the infant’s thyroid function is checked periodically.
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Radioactive iodine treatment in the form of a single oral dose of iodine 131 is another major therapy for Graves’ disease and is the preferred treatment for people who don’t plan to have children. During treatment, the thyroid gland picks up the radioactive element as it does regular iodine. The radioactivity destroys some of the cells that normally concentrate iodine and produce thyroxine, thus decreasing thyroid hormone production and normalizing thyroid size and function. In most people, hypermetabolic symptoms diminish from 6 to 8 weeks after such treatment; others may require a second dose.
Thyroidectomy – surgery to remove part of the thyroid glandÂreduces its ability to produce hormone. Surgery is the preferred treatment for people with a large goiter who chronically relapse after drug therapy and for people who refuse or aren’t candidates for iodine 131 treatment.
After surgery or treatment with radioactive iodine, regular lifelong medical supervision is necessary because many people develop thyroid insufficiency, sometimes years after treatment.
Therapy for eye problems caused by Graves’ disease includes local applications of topical medications but may require high doses of corticosteroids. A person with severe eyeball bulging that causes pressure on the optic nerve may require external beam radiation therapy or surgical decompression to lessen pressure.
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Treatment of thyroid storm includes administration of an antithyÂroid drug, intravenous Inderal, a steroid, and an iodide drug. Supportive measures include administration of nutrients, vitamins, fluids, and sedatives.