Graves’ Disease is an immune system (autoimmune) disorder that is generally seen in women under the age of 40 and causes hyperthyroidism as a result of an overactive thyroid gland.
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It is an autoimmune disease (hypersensitivity in the immune system) characterized by an overactive thyroid gland. As a result of overactivity, it causes hyperthyroidism. It is commonly seen in women under the age of 40.
Although the exact cause of this disease is not known, the body’s defense cells are considered responsible. Symptoms emerge at the end of the inflammation process created by the elements of the body’s defense system. Since thyroid hormones affect many systems in the body, the symptoms and findings of Graves’ disease may present across a wide spectrum.
What Are the Symptoms and Findings in Graves’ Disease?
- Anxiety and irritability
- Heat sensitivity and moist skin
- Fine tremor in the hands and fingers (shaking)
- Enlargement of the thyroid gland (goiter)
- Weight loss despite normal eating
- Decreased libido and erectile dysfunction (difficulty maintaining an erection in men)
- Menstrual irregularity
- Unexplained diarrhea
- Usually, the skin on the shinbone and the top of the foot becomes swollen, red, and scaly (Graves dermopathy)
- Rapid or irregular heartbeat (palpitations)
- Fatigue
- Bulging eyes (Graves ophthalmopathy)
- Sleep irregularity
Diagnosis of Graves’ Disease
After listening to the patient’s history and performing a physical examination, if Graves’ disease is suspected, the diagnosis is confirmed with laboratory tests and imaging.
Medical History
Familial predispositions, other systemic complaints, medication use, and smoking are questioned.
Physical Examination
A general systemic examination is performed. Arterial blood pressure and pulse are checked. In addition, eye and skin findings and tremors in the hands are evaluated. The thyroid gland is examined by palpation to investigate its size, presence of nodules, whether there is increased warmth, and tenderness.
Laboratory Tests
First, TSH (thyroid-stimulating hormone), free T3, and free T4 tests, which show thyroid gland functions, are examined. In addition, autoantibodies such as anti-TPO and anti-TG, which tend to be elevated in Graves’ disease, should be evaluated. In the differential diagnosis, TRAb (thyrotropin receptor antibody) may also be helpful.
Thyroid Ultrasound
It should be performed to investigate the anatomical structure of the thyroid gland, its size, vascularity, and the presence of nodules. It provides the opportunity to take a sample when necessary.
Thyroid Scintigraphy
It is a method that helps distinguish Graves’ disease from other causes of hyperthyroidism. It can be used both for information about the gland’s anatomy and in differential diagnosis.
Treatment of Graves’ Disease
The treatment to be applied for Graves’ disease is determined by experienced endocrinology and general surgery physicians according to the patient’s age, the level of the disease, comorbidities and pregnancy status, and the response to previously applied medication therapies. The aim of treatment is to reduce thyroid hormone levels and eliminate the systemic effects of thyroid hormones.
Medication Therapy in Graves’ Disease
To eliminate palpitations, irritability, high blood pressure, and tremors in the hands that occur due to excessive secretion of thyroid hormones, (beta blocker medications) are used; and to reduce hormone secretion from the thyroid gland, (anti-thyroid medications) are used.
Radioactive Iodine Therapy in Graves’ Disease
It is based on destroying thyroid tissue with an radioactive substance given orally. It is not used in pregnant women, those planning pregnancy, and breastfeeding women.
Surgical Treatment Methods for Graves’ Disease
It is the procedure of removing all or part of the thyroid gland. It is applied in patients with thyroid nodules or suspicion of cancer, and in patients who are pregnant or planning pregnancy. It is also applied in those with moderate to advanced Graves ophthalmopathy and in patients for whom other treatment methods have not been successful. The most serious complication may be hoarseness. For this reason, it is recommended that the surgery be performed by surgeons who are especially experienced in thyroid surgery.
