Graves Disease: Etiology, Diagnosis and Treatment - Research Paper Example

 Graves Disease: Etiology, Diagnosis and Treatment Graves’ disease, also known as Basedow-Graves’ disease, is an autoimmune disease affecting the thyroid. In fact, the thyroid is responsible for producing hormones like T3 and T4 which maintain the use of energy in body. The hormone production in thyroid is controlled by the thyroid stimulating hormone (TSH) produced by the pituitary gland. When a person has Graves’ disease, their immune system produces antibodies which are similar to TSH. These antibodies stimulate the thyroid to produce more hormones than the body actually needs. This situation is called hyperthyroidism (Amanda, 2002). With hyperthyroidism, many important body functions speed up, including heart rate and the conversion of food into energy. Graves’ disease is a rare disorder, and according to Office on Women’s Health statistics, the number of people with Graves’ disease in the U.S is 4.5 million, that is roughly 0.25% of the population. Though this disease can affect both men and women, the latter is 10 times more vulnerable than the former (“Graves’ Disease Fact Sheet,” 2013). The History of the Disease The earliest records of Graves’ disease are found in the documents of the English physician Caleb Hillier Parry (1700s). Though the name was not given at that time, he noted that there is a connection between enlarged thyroid gland, rapid heartbeat and cardiovascular complications. Similarly, physicians like Giuseppe Flajani and Antonio Giuseppe Testa, both in 1700s, noted the connection between enlarged thyroid and cardiac complications. However, it was Robert James Graves’ (1930s) who first theorized that a thyroid gland disturbance could be the reason behind the complications like enlarged thyroid, increased and irregular heartbeat, and protruded eyes. Moreover, the scholar noted that females are much more vulnerable to this condition than men are. Later on, Karl Adolph von Basedow further elaborated on this finding and pointed out that there are many other conditions associated with this, including nervousness and weight loss (Weetman, 2003). Signs and Symptoms The list of symptoms is rather long. They include swelling of the thyroid gland (goiter), rapid heart rate (tachycardia), irregular heart beat (arrhythmia), higher blood pressure, shortness of breath, sudden weight loss, poor weight gain despite high appetite, intolerance to heat, restlessness, frequent bowel movements, increased energy, fatigue, insomnia, erratic behavior, chronic sinus infections, rages, blurred vision, double vision, protruded eyes beyond the protective orbit (exophthalmos), intolerance to light, eyelid retraction, eye pain and irritation, change in sex drive, sweat in palms, hair loss, light hair, weak nails, muscle weakness and degeneration, pretibial myxedema, smooth skin, tremor in the hands, difficulty concentrating and so on. Normally the TSH level of a patient with Graves’ is below 0.3 because the pituitary gland does not stimulate the thyroid. The reason is that the work is done by the immune system (Moore, 2001). Factors Leading to Graves’ Disease There are various factors which lead to the onset of Graves’ disease. The first factor is gene. Studies have shown that some people are predisposed to Graves’ because of their genes (Rapoport & McLachlan, 2000). In addition, people with Graves’ disease often have other family members with some form of autoimmune diseases like rheumatoid arthritis, Type I diabetes, Vitiligo, Addison’s disease, Lupus, Pernicious anemia and so on. The second important cause is gender. It is claimed by researchers that sex hormones have a role in this predisposition as more women than men are affected by this disease. Moreover, pregnancy is found playing an important role because one-third of the women who get Graves’ disease are found to be pregnant within 12 months prior to the beginning of the symptoms. Moreover, there are studies showing that severe emotional stress can trigger the disease in people who are predisposed to getting it (Girgis, Champion, & Wall, 2011). Diagnosis There are various tests for the disease. The first one is TSH Blood Test which involves checking the TSH levels in blood. If the TSH levels are found below normal, it indicates hyperthyroidism or Graves’ disease. The second important test is T4 and T3 Blood Tests. These tests check the levels of the thyroid hormones thyroxine and triiodothyronine. Higher levels of these hormones indicate hyperthyroidism or Graves’ disease. The third test is Graves’ Antibody Test in which the presence of antibodies which are often linked with Graves’ disease immune system disorder is identified. Another test is Iodine Uptake Test. This test involves giving the patient a small quantity of radioactive iodine and later measuring the level of iodine stored in the thyroid. A higher than normal storage indicates hyperthyroidism or Graves’ disease. The next test is thyroid scan. In this test, either x-ray or fluoroscope picture of the thyroid is taken. If the thyroid is enlarged and free of nodules or tumors, the possibility is of Graves’ disease (Shomon, 2009). Dealing with Graves’ Disease Though Graves’ disease is not fatal, it becomes necessary for patients to make many changes in their lifestyle and undergo regular treatment in order to deal with the condition as the disease affects so many bodily functions at the same time. Thus, the management involves a number of treatments at the same time. An important aspect of the treatment is protecting the heart tissues from further damage and controlling and stabilizing heart rate and blood pressure. For this, doctors usually prescribe beta-blockers. These beta-blockers are useful in controlling the trembling of hands and fingers because of their sedating effect. Doctors often encourage patients to avoid strenuous physical activities as they can result in further heart and circulatory complications (Yeung, 2013). Another part is dealing with the eye disease called Graves’ Ophthalmopathy. Preservative-free eye drops, ointments, humidifiers and wrap-around sunglasses are useful in dealing with the eye disease. They will help reduce eye irritation, drying out of cornea, and blurriness. In addition, it is necessary for patients to avoid exposure to smoke. In order to deal with swelling of the eyelids, it is possible to use cold compressors. Moreover, the patient’s head can be elevated to drain fluids. Sometimes, eyelid retraction requires a corrective surgery. This will normalize the appearance by loosening the eyelids. Finally, severe cases of exophthalmos are dealt with decompression surgery, radiotherapy, steroids, and prisms. In fact, it is very necessary to monitor and continue treatment in Graves’ disease because Graves’ eye disease can show variation at any time. Another problem is the skin condition known as pretibial myxedema. This affects the skin of the lower leg, causing lumpy, reddish skin. This is not painful and is not serious. Sometimes, this situation can go into remission and never appear again (Yeung, 2013). However, the most important consequence to be managed is hyperthyroidism. In order to treat hyperthyroidism, there are three possible ways: anti-thyroid medications, surgical thyroidectomy and RAI (Yeung, 2013). Ant-thyroid medications include Propylthiouracil, Tapazole and such other medicines which are helpful in suppressing the overproduction of thyroid hormone. It is seen that these medications are highly effective and cure hyperthyroidism without any surgical intervention. However, the negative aspect is that this can lead to a serious suppression of the patient’s immune system, leading to life threatening complications even from harmless bugs like the common cold. The next important strategy is surgical thyroidectomy. This involves removing the thyroid fully or partially. In either case, there is a sudden fall in thyroid hormone in the body. However, at least in very few cases, the surgery results in facial nerve damage and paralysis of vocal cords. In addition, there is the possibility of damage to parathyroids (Rapoport & McLachlan, 2000). Another method is RAI which involves ingesting radioactive iodine. This results in the shrinkage or destruction of a portion of the thyroid, reducing or eliminating hyperthyroidism. However, there are possible dangers including thyroid storm and hypothyroidism. Thyroid storm is a condition in which stored-up thyroid hormones are dumped into the body in huge quantities. This is a life-threatening emergency. In addition, it is necessary to see that the fluids from the patient’s body do not reach others as radioactive iodine can enter their body and affect their thyroid. This necessitates quarantine and preventative measures (Rapoport & McLachlan, 2000). In total, Graves’ disease is a complex condition, though not fatal. It affects almost all important body functions. It requires regular monitoring and treatments for each symptom. Anyway, it is possible for Greaves patients to lead a nearly normal life with proper monitoring and medication. References Amanda. (2002). Graves’ disease (hyperthyroidism). Retrieved from http://www.bbc.co.uk/dna/place-london/plain/A688241 Girgis, C. M., Champion B. L., & Wall, J. R. (2011). Current concepts in graves’ disease. Therapeutic Advances in Endocrinology and Metabolism, 2. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23148179 Graves’ disease fact sheet. (2013). Retrieved April 26, 2014, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/Graves’-disease.html Moore, E. A. (2001). Graves’ disease: A practical guide. New York, NY: McFarland & Company. Rapoport, B., & McLachlan, S. M. (2000). Graves’ disease: Pathogenesis and treatment. Massachusetts: Kluwer Academic Publishers. Shomon, M. J. (2009). Living well with Graves’ disease and hyperthyroidism. New York, NY: HarperCollins. Weetman, A. P. (2003). Graves’ disease 1835-2002. Hormone Research, 59. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12638522 Yeung, S. J. (2013). Graves’ disease treatment & management. Retrieved from http://emedicine.medscape.com/article/120619-treatment Read More