Graves Disease is a rare autoimmune disorder that affects only 2% of our population. The causes of Graves are as little understood as the rest of the autoimmune diseases. It is a disorder of the thyroid gland that causes an increase in the uptake of thyroid hormones, called hyperthyroidism. Also known as toxic goiter, this disease can cause some very serious symptoms to occur, some of them life threatening if not treated. The symptoms are:
Tremors and shaking of the hands
Diarrhea or frequent bowel movements
Sensitivity to heat
Inability or great difficulty in getting pregnant
Changes in vision
Muscle weakness-often severe
According to the findings as of today, Graves Disease is the only one of the hyperthyroid disorders that cause a thickening around the eye, and the bulging eyeballs of goiter. Another rare manifestation of Graves Disease is a thickening of the skin on the shins, accompanied by a reddish scaly coarsening, known as pretibial myexedema.
How is Graves disease diagnosed? Specialized thyroid tests including the thyroid stimulating free hormone, in addition to the traditional Free T3 and T4 screening tests, alert your physician that you have hyperthyroidism. Another thyroid assay used to nail the diagnosis down is the TSI-Thyroid Stimulating Hormone test. Scans can also be used to gauge the amount of enlargement and to check for the speckled patterns seen in other autoimmune diseases.
The causes of Graves Disease are unknown. There does tend to be a familial history of some form of hyperthyroidism in families, but that only raises the possibility of Graves Disease developing. Stress plays a factor in some cases, caused either by illness or major life events. Stress as a trigger both for developing autoimmune diseases or having flares is a well documented aspect of autoimmune disruption. There has been some indication as with SLE, that a woman’s hormones play a part in the development of this illness.
How is this disease treated? If the disease is in the mild to moderate stages, an anti-thyroid medication can be prescribed, which modulates how much free thyroid is in your system. Often this is enough to put the patient into remission.
Radioactive iodine is used for moderately severe Graves Disease. The uptake of the substance kills off excess thyroid cells, and ultimately destroys the thyroid gland, without resorting to surgery. You will need to be treated for hypothyroidism for the rest of your life.
Removal of the thyroid gland surgically often effectively eliminates the risks associated with the worst of this disease. Thyroid hormone replacement therapy, using oral medication is a lifetime necessity for patients who have had their thyroid glands removed. This is a small price to pay, as left untreated Graves Disease can be a life threatening illness. One of the most dangerous crisis’ is thyrotoxic storm : “Thyrotoxic storm is a rare life-threatening condition that develops in cases of untreated hyperthyroidism. It is usually brought on by an acute stress, such as trauma surgery or infection. Symptoms are severe, with a pounding heart, sweating, restlessness, shaking, diarrhea, change in consciousness, agitation and confusion. Congestive heart failure can develop rapidly and lead to death.” ibid: womenshealth.gov
Cardiac symptoms and tremors can be relieved by the use of beta blockers such as Lopressor or Inderal. Eye symptoms and discomfort can be eased with lubricating gels and drops. Though if eye inflammation, bulging and visual disturbances are severe, an opthamologist can perform surgery to remove supraorbital bone between the eye socket and sinuses to relieve pressure by decompressing the area and give the eyeball room to ease back in.
Graves can cause badly shortened eye muscles. If this is a problem, a surgeon can detach the muscle, then reattach it further back in the socket. It often requires more than one surgery to correct the issue. Double vision, another frequent side effect of Graves Disease can in some cases be alleviated by the use of prisms in glasses.
Frequently the use of corticosteroids to tamp down hyperimmunity can be helpful in alleviating many of the symptoms of inflammation to the eyes.
To make your life more comfortable it is suggested that you try the following things:
Sleep with the head of your bed elevated to relieve the pressure to your eyes.
Use compression bandages on your affected shin(s) along with cortisone creams to ease swelling, itching and burning.
Always wear sunglasses with specially filtered lenses when outdoors to protect your vulnerable eye area.
Use drops and gels to soothe and cool irritated eyes frequently.
Because you are at higher risk for osteoporosis, make certain to take enough calcium, and get a bone density scan yearly. If you show signs of osteoporosis there are medications you can take to increase bone density over time.
Recognize that symptoms of emotional instability such as excessive worry, irritability and fatigue will improve over time with treatment. People with autoimmune disorders during flare ups frequently evince such signs, which do go away once the flare is brought under control.
Finally get support from others who have Graves Disease. You can find a group online through the links I’ve posted below. That support is a critical component in helping you get needed support during flares, and provides you with a “safe” outlet for those often rocky moments. The best part of support groups is the giving back. It is surprising how just as small few words of encouragement for someone else can improve both your lives.