Condition Overview
Graves' disease is an autoimmune disorder that causes hyperthyroidism, or an overactive thyroid. It is the most common cause of hyperthyroidism and occurs when the immune system mistakenly attacks the thyroid gland, leading to the overproduction of thyroid hormones (thyroxine or T4, and triiodothyronine or T3). These hormones regulate the body's metabolism, and their excess can affect many body systems.
Patients with Graves' disease may experience a variety of symptoms, including weight loss, increased appetite, nervousness, irritability, heat intolerance, increased sweating, palpitations, tremors, fatigue, muscle weakness, and changes in menstrual cycles. Additional distinctive features of Graves' disease include Graves' ophthalmopathy (eye symptoms like bulging eyes, redness, and swelling) and, less commonly, Graves' dermopathy (skin changes, usually on the shins). Over time, it can cause heart problems (arrhythmias) and shorten the life of those affected. Any treatment that rapidly normalizes thyroid hormone levels is acceptable, and all have risks and benefits for different people. Finally, Graves' disease can be associated with thyroid cancer.
Diagnosis involves a combination of clinical evaluation and laboratory tests. Blood tests typically show elevated levels of thyroid hormones (T3 and T4) and suppressed levels of thyroid-stimulating hormone (TSH). The presence of thyroid-stimulating immunoglobulins (TSIs) confirms the autoimmune nature of the disease. Imaging studies like radioactive iodine uptake (RAIU) tests and thyroid scans can help assess the activity of the thyroid gland.
Treatment Options
- Radioactive Iodine (RAI) Therapy
- Description: RAI therapy involves the oral administration of radioactive iodine, which is selectively taken up by the thyroid gland. The radiation destroys overactive thyroid cells, reducing hormone production. This treatment often leads to hypothyroidism, requiring lifelong thyroid hormone replacement therapy. Those who smoke should not be offered RAI.
- Indications: Patients seeking non-surgical treatment, those who do not respond to or cannot tolerate antithyroid medications, patients with contraindications to surgery such as thyroid eye disease (TED).
- Antithyroid Medications
- Description: Medications such as methimazole (Tapazole) and propylthiouracil (PTU) reduce thyroid hormone production by interfering with the thyroid gland's ability to use iodine. These drugs can be used as initial treatment, in preparation for RAI or surgery, or as long-term management in some cases. Women of child-bearing age should be extremely cautious and be well-informed, as both of these medications have been found to be teratogenic (associated with birth defects).
- Indications: Mild to moderate Graves' disease, initial treatment, patients preferring non-invasive management, patients preparing for surgery or RAI therapy.
- Thyroidectomy
- Description: Surgical removal of the thyroid gland, either partially (subtotal thyroidectomy) or completely (total thyroidectomy), is a definitive treatment for Graves' disease. It provides immediate control of hyperthyroidism, but requires thyroid hormone in the future. The Russell Center is one of the few center in the world that specializes in treating Graves' disease with "scarless" thyroid surgery.
- Indications: Severe Graves' disease, large goiters causing compressive symptoms, patients who cannot tolerate or do not respond to antithyroid medications or RAI, preference for surgical treatment, presence of suspicious thyroid nodules, those with thyroid eye disease, or those who prefer immediate treatment of their thyroid condition.
- Beta-Blockers
- Description: Beta-blockers, such as propranolol, are used to manage symptoms related to hyperthyroidism, such as rapid heart rate, palpitations, and tremors. These medications do not treat the underlying cause but provide symptomatic relief while other treatments take effect.
- Indications: Symptomatic management, preparation for definitive treatment, short-term relief of hyperthyroid symptoms.
Management of Graves' disease requires a multidisciplinary approach involving endocrinologists, ophthalmologists, and surgeons. The choice of treatment depends on the severity of the disease, patient preferences, and the presence of any complications. Regular monitoring and follow-up are essential to ensure effective management and to address any potential side effects or complications of treatment.
While non-surgical therapies can be considered for Graves' disease, removal of the entire thyroid gland has been found repeatedly to be associated with the longest lifespan after treatment. It is also the best option for patients who have thyroid eye disease (TED). Thyroid removal can usually be accomplished without a scar for patients who are interested. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for Graves' Disease.
