Grave's Disease / Hyperthyroidism
Other names: Thyrotoxic Myopathy, Toxic Diffuse Goiter
Grave's Disease is an autoimmune
disease that affects the thyroid and causes it to
become overactive and enlarged (called a goiter).
Ot is the most common form of Hyperthyroidism. Because
the thyroid is overactive, it produces too much of
the thyroid hormones T3 and T4, which are the hormones
that control the body's metabolism. The overproduction
of these hormones can cause fatigue, weight loss even
with a normal diet, rapid heart beat, muscular weakness,
non-pitted edema (when pressed the skin does not stay
indented where as pitted edema does indent). In some
cases the thyroid becomes quite enlarged and can even
be large enough to be visible to the naked eye. In
other cases, the goiter may be quite small and may
only be visible through imaging tests such as CT Scan
or MRI. Grave's most commonly develops in women over
the age of 20, however it can affect both men and
women at any age.
Grave's can also cause eye problems in which not
only do the soft tissues of the eye inflame, but the
eyeball can actually protrude causing a condition
called proptosis. Some more minor symptoms of the
eye might include lid retraction, or what is commonly
called lid lag.
There are different classifications of Grave's Disease
depending on the symptoms. The Classification of Grave's
Eye Disease (Wikipedia)
Class 0: No signs or symptoms
Class 1: Only signs limited to upper lid retraction
and stare, with or without lid lag
Class 2: Soft tissue involvement (edema of conjunctiva
and lids, conjunctival injection, etc)
Class 3: Proptosis (protrusion of the eye)
Class 4: Extraocular muscle involvement (usually with
diplopia or double vision)
Class 5: Corneal involvement (primarily due to ophthalmologist
or inability to close the eyelids fully)
Class 6: Sight loss (due to optic nerve involvement)
Symptoms:
Abnormal heart rhythm
Absence of period
Anxiety
Bulging eyes
Diarrhea
Difficulty falling asleep
Difficulty staying asleep
Double vision
Excessive irritability
Excessive sweating
Extremely hungry
Eyes sensitive to light
Fast heartbeat
Feeling hot
Fine, brittle hair
Gritty feeling in eyes
Hand tremors
High blood pressure
Increased heart rate
Increased reflexes
Infertility
Insomnia
Irritability
Light, infrequent periods
Loss of appetite
Muscle weakness
Overly dry skin
Panic attacks
Sensitivity to heat
Short attention span
Skin thickening on legs
Weakness in arm
Weakness in hand
Weakness in legs or thighs
Unintentional weight loss
Diagnosis:
Diagnosing Grave's Disease involves both a physical
examination that may show an increase heart rate and
enlarged goiter as well as blood tests. Imaging such
as and MRI or CT Scan might also be done to see if
the thyroid is enlarged if the physical examination
does can't determine whether or not the thyroid is
enlarged. Blood tests may also show:
Elevated Free Thyroxine (FT4)
Elevated Free Triiodothyronine (FT3)
Elevated Protein-Bound Iodine (PBI)
Low Thyroid Stimulating Hormone (TSH)
Elevated Total Thyroxine (T4)
Elevated Total Triiodothyronine (T3)
Other tests that may be used include Orbit CT scan
or ultrasound, Thyroid Stimulation Immunoglobulin
(TSI) and Thyroid Peroxidase (TPO) Antibody tests.
Treatment:
The goal of treatment is to control the output of
the thyroid hormones since there is no cure. Beta-blockers
are also used to treat symptoms such as the rapid
heart rate, anxiety, and excessive sweating until
the thyroid overproduction is under control. Iodine
is typically used to treat the overproduction, but
in more severe cases, removal or partial removal of
the thyroid may be required.
Eye problems usually improve on their own once the
output of the thyroid hormones are under control,
although steroids such as Prednisone is sometimes
used to reduce the inflammation and irritation in
the eyes. Sunglasses can help with the light sensitivity
and eye drops may be used to relieve eye irritation.
Prognosis:
Grave's Disease usually improves with treatment,
although there may be side effects from the treatments
depending on the body's ability to tolerate the medications
and therapy used. If the thyroid is removed or if
radiation is used for iodine therapy, then thyroid
replacement therapy will be a requirement for the
rest of the person's life. If the dosing of the thyroid
replacement isn't high enough, the lack of thyroid
hormones can cause depression, mental and physical
difficulties and weight gain so it is important to
monitor dosing closely. It is also important that
an Endocrinologist be active in the patient's recovery
and treatment processes.
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