Graves Disease Causes - Graves disease is a condition that results when the body produces too much thyroid hormone. Common hyperthyroidism causes include Grave's disease. Graves disease is treated with medications to reduce thyroid hormone production or surgery to remove the thyroid gland. Graves' disease and hyperthyroidism symptoms are often very similar or the same.
Symptoms of Graves Disease
Symptoms of graves disease can vary from person to person but often include weight loss, anxiety, heat intolerance, and a rapid or irregular heartbeat.
Some people with Graves disease also develop Graves' ophthalmopathy, a condition that affects the eyes and can cause double vision, irritation, and swelling around the eyes.
Symptoms of Graves disease often mimic hyperthyroidism symptoms:
- Irritability and Anxiety
- Tremor of the hands and fingers
- Heat sensitivity and an increase in perspiration or warm, moist skin
- Unintentional weight loss
- Enlargement of the thyroid gland (goiter)
- Change in menstrual cycles
- Erectile dysfunction or reduced libido
- Frequent bowel movements
- Bulging eyes (Graves' ophthalmopathy)
- Thick, red skin commonly found on the shins or tops of the feet (Graves' dermopathy)
- Rapid or irregular heartbeat (palpitations)
- Interrupted sleep
Graves Disease Causes, Hyperthyroidism Risk Factors, and Complications
Graves Disease Causes. The thyroid is a small, butterfly-shaped gland located in the front of the neck. The thyroid gland produces two main hormones: thyroxine (T4) and triiodothyronine (T3). These hormones help control the body's metabolism. They affect how quickly the body uses energy, how warm a person feels, and how much they weigh.
Hyperthyroidism is a condition in which the thyroid gland produces too much thyroid hormone.
The thyroid normally releases the correct amount of hormones, but sometimes it may produce too much T4. This may occur for several reasons, including:
- Graves' disease. Graves' disease is an autoimmune disorder in which the immune system stimulates the thyroid into producing more T4 than necessary. Graves disease causes hyperthyroidism.
- Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular goiter, or Plummer's disease). This type of hyperthyroidism occurs when one or more adenomas of a person's thyroid produce more T4 than necessary. An adenoma refers to a part of the gland that has separated itself from the rest of the gland, forming noncancerous or benign lumps that may cause an enlargement of the thyroid.
- Thyroiditis. Sometimes an individual's thyroid gland may become inflamed after pregnancy. This may be due to an autoimmune condition or for unknown reasons. The inflammation causes excess thyroid hormone stored in the gland to leak into the bloodstream. Some types of thyroiditis may cause pain, while others are painless.
Other hyperthyroidism and graves disease causes include:
- Thyroid cancer
- Iodine overload (excessive intake of iodine)
- Taking too much thyroid hormone medication
Some factors may increase a person's risk for hyperthyroidism. These include:
- Having a family history of Graves' disease or hyperthyroidism
- Being female
- Being over the age of 60
- Exposure to radiation
- Having an autoimmune disorder, such as rheumatoid arthritis, lupus, or type 1 diabetes
- Taking certain medications, including lithium and amiodarone.
Hyperthyroidism may cause several complications, including:
Heart Problems: The most common heart problem associated with hyperthyroidism is an enlarged heart (cardiomegaly). Other problems include an irregular heartbeat (arrhythmia), high blood pressure (hypertension), and congestive heart failure.
Eye Problems: Graves' ophthalmopathy is a condition that affects the eyes. It occurs in up to half of people who have Graves' disease and is caused by the production of antibodies that attack the muscles and tissues around the eyes. The condition can cause vision problems, such as double vision, and may require treatment with eye drops or surgery.
Thyroid Storm: A thyroid storm is a life-threatening complication of hyperthyroidism. It occurs when the thyroid gland becomes extremely overactive and produces large amounts of thyroid hormone. The hormone enters the bloodstream in large amounts and causes the body's systems to go out of balance. This can lead to fever, rapid heartbeat, chest pain, confusion, and seizures. A thyroid storm requires emergency treatment.
Brittle Bones: Untreated hyperthyroidism can also lead to weak, brittle bones (osteoporosis). The strength of the bones depends, in part, on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with the body's ability to incorporate calcium into the bones.
Red, swollen skin: In rare cases, people with Graves' disease develop Graves' dermopathy which affects the skin, causing redness and swelling. This usually happens in areas such as the shins or feet.
Thyrotoxic crisis: Hyperthyroidism increases a person's risk of thyrotoxic crisis. A thyrotoxic crisis is a sudden intensification of symptoms, leading to a fever, a rapid pulse, and possibly delirium.
Other complications that may occur:
- Loss of menstrual periods
- Weight loss
- Poor appetite
- Nausea and vomiting
Graves Disease Diagnosis and Treatment
There are a number of ways to diagnose hyperthyroidism. A doctor will likely begin by asking about an individual's symptoms and medical history. He or she will also do a physical exam, which may reveal an enlarged thyroid gland (goiter) or other signs of the condition.
The doctor may order blood tests to measure the level of thyroid hormone in the body. This can help determine whether a person has hyperthyroidism and how severe it is. Other tests that may be done include:
- Ultrasound: This test uses sound waves to create images of the inside of the body. It can help the doctor see if a person has an enlarged thyroid gland or any other abnormalities.
- Thyroid scan: This test uses a radioactive substance to help the doctor see how well the thyroid is functioning.
- CT scan: This test uses X-rays to create images of the body. It can be used to help diagnose thyroid cancer and other conditions that may cause hyperthyroidism.
- MRI: This test uses powerful magnets and radio waves to create images of the body. It can be used to help diagnose thyroid cancer and other conditions that may cause hyperthyroidism.
The doctor may also recommend a thyroid biopsy. This is a procedure in which a small piece of tissue is removed from the thyroid gland and examined under a microscope.
Treatment for hyperthyroidism and graves disease usually involves taking medications to lower the level of thyroid hormone in the body. There are a number of different medications that can be used, including:
- Radioactive iodine: Radioactive iodine is taken by mouth and absorbed by the thyroid gland. This causes the gland to shrink, and symptoms usually lessen within several months. However, this treatment may cause thyroid activity to slow enough to cause hypothyroidism, an underactive thyroid, and an individual may eventually need to take medication every day to replace thyroxine.
- Anti-thyroid medications: These medications slowly lessen symptoms of hyperthyroidism by preventing the thyroid gland from producing excess hormones. Medications include methimazole (Tapazole) and propylthiouracil. Symptoms typically lessen within several weeks to months. For some individuals, taking this medication clears up the problem permanently, but other people can experience a relapse. Both drugs may cause serious liver damage, sometimes leading to death. Some people allergic to these drugs may develop skin rashes, hives, fever, or joint pain. They may also increase the risk of infection.
- Beta-blockers: These drugs are commonly used to treat high blood pressure, but they can ease symptoms of hyperthyroidism, such as tremors, rapid heart rate, and palpitations. A doctor may prescribe them to help a patient lessen their symptoms until their thyroid levels are closer to normal. These medications usually are not recommended for people who have asthma, and side effects may include fatigue and sexual dysfunction.
- Surgery (thyroidectomy). If a patient is pregnant or otherwise cannot tolerate anti-thyroid drugs and does not want to or cannot have radioactive iodine therapy, they could be a candidate for thyroid surgery, although this is an option in only a few cases. In a thyroidectomy, the doctor removes most of the thyroid gland. Risks of this surgery include damage to a person's vocal cords and parathyroid glands — four small glands found on the back of the thyroid gland that help control the level of calcium in the blood. Additionally, a patient will need lifelong treatment with levothyroxine (Levoxyl, Synthroid, others) to supply their body with normal amounts of thyroid hormone. If their parathyroid glands are removed, they will require medication to keep their blood-calcium levels normal.
There are also several lifestyle changes a person can make to help control hyperthyroidism. These include:
- Resting often and avoiding strenuous activity
- Eating a healthy diet
- Avoiding caffeine, nicotine, and alcohol
- Managing stress
- Getting regular exercise
Graves Disease Treatment
Graves disease treatment is much the same as treating a patient for hyperthyroidism. However, treating Graves' ophthalmopathy may look different. Treatments for this disease include:
- Corticosteroids. Treatment with corticosteroids may help reduce swelling behind the eyeballs.
- Teprotumumab (Tepezza). This medication is given through an IV in the arm every three weeks, up to eight times.
- Prisms. A person may have double vision either because of Graves' disease or as a side effect of surgery for Graves' disease. Prisms in a person's glasses may correct their double vision.
- Orbital decompression surgery. A doctor removes the bone between the eye socket (orbit) and the sinuses, which are the air spaces next to the orbit. This gives the eyes room to move back to their original position.
- Orbital radiotherapy. This treatment uses targeted X-rays over the course of various days to destroy some of the tissue behind the eyes. A doctor may recommend this if a person's eye problems are worsening and corticosteroids alone aren't effective or well tolerated.