Graves Disease

It is also termed as Exophthalmic goitre or toxic diffuse goitre.

What is Graves Disease?

Exophthalmic Goitre Definition: Graves disease is an immune system disorder characterised by excessive thyroid hormone production (hyperthyroidism). Graves' disease is a general cause of hyperthyroidism, but it may be caused by a variety of conditions.

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Exophthalmic Goitre Symptoms

Graves disease has a wide range of signs and symptoms because thyroid hormones affect many different body systems. Graves disease can affect anyone, but it is more prevalent in women and those under the age of 40. Following are the symptoms:

• Anxiety and irritability

• A fine tremor of the hands or fingers

• Heat sensitivity and an increase in perspiration or warm, moist skin

• Weight loss, despite normal eating habits

• Enlargement of the thyroid gland (goitre)

• Change in menstrual cycles

• Erectile dysfunction or reduced libido

• Frequent bowel movements

• Bulging eyes (Graves' ophthalmopathy)

• Fatigue

• Thick, red skin usually on the shins or tops of the feet (Graves' dermopathy)

• Rapid or irregular heartbeat (palpitations)

• Sleep disturbance

Graves' Ophthalmopathy

Graves' ophthalmopathy is present in about 30% of people with Graves' disease. Inflammation and other immune system events damage muscles and other tissues around the eyes in Graves' ophthalmopathy. 

The Following are Possible Signs and Symptoms:

• Bulging eyes

• Gritty sensation in the eyes

• Pressure or pain in the eyes

• Puffy or retracted eyelids

• Reddened or inflamed eyes

• Light sensitivity

• Double vision

• Vision loss

Graves' Dermopathy

Graves' dermopathy is a rare manifestation of Graves' disease that causes reddening and thickening of the skin, most often on the shins or tops of the feet.

Exophthalmic Goitre Cause

Researchers are uncertain as to why certain people develop autoimmune diseases like Graves' disease. These diseases are most likely caused by a combination of genes and an external trigger, such as a virus.

The immune system produces an antibody called thyroid-stimulating immunoglobulin (TSI) that binds to thyroid cells in Graves' disease. Thyroid-stimulating hormone (TSH) is a hormone produced by the pituitary gland that instructs the thyroid gland on how much thyroid hormone to produce. The thyroid produces too much thyroid hormone as a result of TSI.

How is Exophthalmic Goitre Diagnosed?

Based on your symptoms and results during a physical exam, your doctor may suspect Graves' disease. Hyperthyroidism may be confirmed by one or more blood tests, and Graves' disease can be the cause.

Other Clues That Hyperthyroidism is Caused by Graves’ Disease are:

• An Enlarged Thyroid

• Signs of Graves’ eye disease, present in about one out of three people with Graves’ disease4

• A history of other family members with thyroid or autoimmune problems

If your doctor is unsure about the diagnosis, he or she can order additional blood or imaging tests to confirm Graves' disease as the cause.

TSI can be detected by a blood test. In mild cases of Graves' disease, however, TSI may not be detected in the blood. One of two imaging tests that use small, safe doses of radioactive iodine may be the next step. Your thyroid absorbs iodine from your blood and uses it to produce thyroid hormones, and it can do the same for radioactive iodine.

Radioactive Iodine Uptake Test - This test determines how much iodine the thyroid absorbs from the blood. Graves' disease is a condition in which the thyroid accumulates a lot of iodine.

Thyroid Scan - The distribution of iodine in the thyroid is seen in this scan. Graves' disease affects the entire thyroid, so iodine accumulates in the gland. Some causes of hyperthyroidism, such as nodules (small lumps in the thyroid gland), produce a particular pattern of iodine.

How Can Exophthalmic Goitre be Treated?

Medicine, radioiodine therapy, and thyroid surgery are the three treatment choices. The most popular treatment for Graves' disease is radioiodine therapy, but physicians are starting to use the medicine more often than in the past. Your doctor can prescribe a particular treatment based on factors such as your age, whether you are pregnant, or whether you have other medical conditions, and may help you determine which one is best for you.

1. Radioiodine Therapy

Radioactive iodine-131 (I-131) is taken by mouth as a tablet or a liquid for radioiodine therapy. The thyroid gland's cells that contain thyroid hormone are steadily destroyed by I-131 at a higher dose than that used for imaging studies. Other body tissues are unaffected by the I-131 dose used in radioiodine therapy.

Since the thyroid hormone-producing cells are killed, almost everybody who receives radioactive iodine therapy develops hypothyroidism or an underactive thyroid. Hypothyroidism, on the other hand, is less difficult to manage and causes fewer long-term health issues than hyperthyroidism. With daily thyroid hormone, people with hypothyroidism can fully regulate their condition.

Doctors should not use radioiodine therapy to treat pregnant or breastfeeding mothers. The thyroid of a foetus may be harmed by radioactive iodine, which can be transmitted from mother to child by breast milk.

2. Medicines

• Beta-Blockers: Beta-blockers don't stop the thyroid from developing thyroid hormone, but they can help you feel better as you wait for other medications to kick in. Many of the signs of hyperthyroidism, such as shaking, rapid heartbeat, and nervousness, are relieved rapidly with these medications. The majority of people feel better after taking beta-blockers within a few hours.

• Antithyroid Medicines: The most straightforward treatment for hyperthyroidism is antithyroid therapy. Antithyroid medications reduce the amount of thyroid hormone produced by your thyroid gland. These drugs rarely have a lasting cure, but their effects can last for a long time in some people after they stop taking them. Methimazole, an antithyroid medication, is most often prescribed by doctors.

Antithyroid medication is often prescribed to pregnant and breastfeeding women because it is thought to be better for the baby than other medications. Since methimazole can damage the foetus, doctors prefer to use propylthiouracil NIH external connection over methimazole during the first three months of pregnancy.

Propylthiouracil may also damage the foetus in extreme cases, although any side effects are much less dangerous than getting untreated hyperthyroidism throughout pregnancy.

Your thyroid hormone levels may not return to normal for several weeks or months after you start taking antithyroid medication. The average recovery time is 12 to 18 months, but in people who don't want radioiodine or surgery to cure their Graves' disease, treatment can last for years.

Antithyroid Medicines Can Cause Side Effects in Some People, Including

• allergic reactions such as rashes and itching

• a decrease in the number of white blood cells in your body, which can lower resistance to infection

• liver failure, in rare cases

3. Thyroid Surgery

Surgery to suppress the thyroid gland is the least-used procedure for Graves' disease. Surgery is often used to treat massive goitres or pregnant women who are allergic to or experiencing side effects from antithyroid medications.

Your doctor will prescribe antithyroid medications to get the thyroid hormone levels back into the normal range before surgery. This procedure avoids a disorder known as thyroid storm, which occurs when people with hyperthyroidism undergo general anaesthesia and experience a sudden, extreme worsening of symptoms.

You will experience hypothyroidism after your thyroid is removed, and you will need to take thyroid hormone medication every day for the rest of your life. Your doctor will monitor your thyroid hormone levels after surgery and change your dosage as required.