Grave's disease is a disease of the thyroid gland. The thyroid gland is an endocrine gland located in the very front of the neck below the larynx. It acts by releasing the hormones thyroxine or T4 and triiodothyronine or T3, which controls cellular metabolism. Besides metabolism, the thyroid gland controls weight, mood, energy levels and mental energy. Grave's disease is caused by an immune response that causes an overactive thyroid gland. In fact, it is the most common cause of an overactive thyroid gland, called hyperthyroidism.
Grave's Disease is more common in women over the age of twenty years. It can, however, occur at any age and is known to happen to men in rare cases. The symptoms can come on gradually or can occur suddenly. It is due to autoantibodies to thyroid tissue that turn on the thyroid gland and make it function in an overactive fashion.
The main symptoms of Grave's disease include possible breast enlargement in men, chronic anxiety, panic attacks, double vision, difficulty with concentration, exophthalmos (which are prominent eyeballs), irritation and tearing of the eyes, fatigue, frequent bowel movements, enlarged thyroid gland (called a goiter), intolerance to heat, increased sweating, increased appetite, trouble sleeping, irregular menstrual cycle, muscle weakness, rapid heartbeat (palpitations), irregular heart beat (arrhythmia), restlessness, tremor, shortness of breath, nervousness or weight loss.
The symptoms can be mild enough that you don't seek medical attention right away. After awhile, the symptoms worsen so you see a doctor and exams or tests can be done to show that you have hyperthyroidism from Grave's disease.
The doctor will perform a complete history and physical examination. The neck exam may show a diffusely enlarged thyroid gland. Doctors then do a blood level of T4, T3 and TSH. TSH is a pituitary gland hormone that turns on thyroid gland function. It tends to be quite low in Grave's disease, while the T4 and T3 levels are elevated. A radioactive iodine uptake test can be done which will show an increased uptake of radioactive iodine from an overactive thyroid gland.
Other tests that can be done include a CT scan of the neck or an ultrasound of the neck. Doctors can also test for a thyroid stimulating immunoglobulin, a thyroid peroxidase (TPO) antibody or an anti-TSH receptor antibody, which will be elevated.
The treatment of Grave's disease is directed at slowing the hyperactivity of the thyroid gland. Doctors use beta blockers like propranolol to regulate the heartbeat and to control the sweating and anxiety. This is usually a temporary measure until definitive treatment is done to control the thyroid gland hyperactivity. Hyperthyroidism is controlled by giving radioactive iodine that kills off overactive thyroid cells. Surgery can be done to remove all or part of the thyroid gland, and anti-thyroid gland medications.
After having thyroid gland surgery or radioactive thyroid treatments, you need to be on thyroid replacement medication for the rest of your life because you will be hypothyroid otherwise and will have symptoms because of that.
Prednisone can be given to suppress the thyroid gland function for a short while and it will help the eye irritation and perceived enlargement of the eyes. Radioactive iodine will sometimes make the eye condition worse for a while. Eye problems tend to be worse in those who are smokers and persist even after the thyroid condition is treated. It's possible that you might have to tape your eyes closed during the night so you don't scratch or dry out your eyes. If you have radiation therapy or surgery to treat the thyroid gland, the eyes can return to their normal appearance.
The prognosis of Grave's disease is often good after treatment. Thyroid surgery or radioactive surgery can lead to hypothyroidism, which can, in turn, lead to mental sluggishness, physical weakness, depression and weight gain.