What is Graves’ disease and what do you need to know about it? Who is at risk? Today we will go through this issue.
What is Graves disease?
Graves’ and Basedov’s disease is an autoimmune disease in which the autoantigen is the TSH receptor (TSHR). Its stimulation by anti-TSHR antibodies causes increased thyroid hormone secretion and symptoms of hyperthyroidism, stimulates thyroid growth and development of its vascularization. Activation of cellular response mechanisms against the same antigen found in the connective tissue cells of the orbit and skin leads to the remaining symptoms of the disease.
To date, the etiopathogenesis of the disease has not been established, it is only known that it is an autoimmune disease. It occurs more often in women (about 10 times more often), which in turn may suggest the effect of estrogens on the development of the disease. In addition, it has been observed that the disease more often begins after severe stressful situations, while smoking increases the risk of developing hyperthyroidism and changes in the eye sockets during the course of the disease.
Graves’ disease – symptoms
A typical feature of Graves’ disease is its recurrent course with periods of exacerbation and remission. The thyroid gland is enlarged.
Common symptoms of hyperthyroidism dominate:
- increased sweating
- heat intolerance
- weight loss
- muscle twitching
- increased pulse voltage.
They are accompanied by ChGB-specific signs of autoimmune inflammation of the orbital soft tissues (exophthalmos) or skin (mucosal edema) and thyroid acropathy (EMO syndrome). Sometimes other autoimmune diseases such as pernicious anemia, myasthenia gravis, rheumatoid arthritis and autoimmune cirrhosis are also found.
How is Graves disease diagnosed?
Graves’ disease is diagnosed based on the results of hormonal tests (decrease in TSH, increase in FT4, rarely increase in FT3), thyroid imaging (ultrasound, scintigraphy), fine needle aspiration and after ophthalmological examination.
First of all, after diagnosing the disease, you should aim to achieve a state of euthyroid disease, i.e. a condition in which the thyroid gland works properly (it is neither overactive or underactive). To obtain this condition, drugs used to treat hyperthyroidism are used, first of all it is thiamazole, sometimes also propylthiouracil. If the goal of treatment is to achieve immune remission, then the optimal duration of treatment is 18 months.
In more than 75% of cases, it is sufficient to give the patient a single dose of radioactive iodine. Sometimes surgery is needed, usually when the patient is suffering from severe orbitopathy. Usually a radical or almost complete thyroidectomy is performed. Thyroid orbitopathy should also be treated during the course of the disease.
Anti-inflammatory drugs are used for treatment, usually glucocorticoids are the first-line drugs. Sometimes, surgery is necessary to treat the lasting consequences of orbitopathy.