Graves' Disease
Graves' disease, also known as diffuse toxic goiter, is the most
common form of hyperthyroidism. More common in women than men, it
affects about 3.2% of women and 0.32% of men in the United States.
Not only can Graves' disease cause the rapid heartbeat, shaky hands,
weakness, and heat intolerance found in all forms of hyperthyroidism,
but it can also cause associated eye problems like exophthalmos
(a swelling of the tissue behind the eyes which pushes the eyes
forward).
The term "goiter" refers to the fact that your overworked gland
may grow bigger at the lower front of your neck, and "diffuse" means
that the whole gland is involved.
Diagnosis includes a test for thyroid-stimulating hormone (TSH)
from the pituitary, which will be low if the pituitary has detected
high levels of thyroid hormone in your blood. Measurement of thyroid
hormone itself (thyroxine or T4) helps your doctor know how sick
you are and serves as an initial guide for treatment. A radioactive
iodine scan shows that in Graves' disease the whole thyroid is involved
and not just one or more overactive lumps (nodules).
Treatment may be short or long term:
- To make your body less responsive to the stimulus given by the
thyroid hormone, you may be given beta-adrenergic blocking agents
like propranolol or atenolol to block the action of thyroid hormone
on your cells. This will tend to slow your pulse and calm you
down until other treatments have time to work.
- To cut down your thyroid's ability to make too much hormone,
there are antithyroid agents like methimazole (TapazoleŽ) or propylthiouracil
(PTU) which reduce the amount of iodine that can get into your
thyroid from the bloodstream. Since iodine is needed to make thyroid
hormone, levels fall, and you get slowly better.
- Permanent reduction of thyroid function can be obtained by treatment
with radioactive iodine.
- Alternatively, part or all of your thyroid can be removed surgically
to control your hyperthyroidism.
Once your hyperthyroidism is treated, what's left of your thyroid
may produce too little hormone, but that can be replaced by thyroid
hormone pills. You need to be checked regularly to be sure the dose
is correct. The rare eye problems can usually be helped by drugs,
or by radiation, or occasionally by surgery. They follow their own
schedule, usually coming early in your Graves' disease, but sometimes
late in the course of the condition. For the vast majority of patients,
eye problems will be on the mild side.
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