By Dr. Ashwini Reddy, Endocrine Surgeon
The body has multiple chemicals called hormones, which regulate many of its functions. Increased or decreased levels of these hormones affect various functions including metabolism, growth and sexual functions. Thyroxin produced by the thyroid (situated in the front of the neck) is one such hormone, which has a significant role to play in metabolism.
Graves’ disease is one of the main causes of hyperthyroidism, where there is excessive production of thyroid hormones. Graves’ disease is an autoimmune disorder, wherein the body reacts against its own tissues. It is very common in women than men, especially after 20 years of age. Family history also has a strong correlation in developing Graves’ disease. The high levels of thyroid hormone increase the rate of metabolism, thereby altering weight, mental energy levels, physical stamina, and also mood.
Thyroid hormone is related to metabolism and more amount of it lead to higher metabolism. This causes the following symptoms.
- Intolerance to heat
- Excessive sweating
- Nervousness and anxiety
- Inability sleep, as the mind is always excited
- Increased appetite (sometimes despite weight loss) due to higher metabolism
- Irregular menstrual cycles
- Palpitations (rapid, loud heartbeat)
- Irregular heartbeats (tachyarrhythmia)
- Fine tremors of the extended arms
- Breast enlargement in men, known as gynecomastia
- Extreme moodiness, causing irritability and anger
- Inability to focus and concentrate
- General fatigue and shortness of breath with any exertion
- Increased frequency of bowel movements
In addition, the eye symptoms are quite diagnostic including:
- Protrusion of the eyes (exophthalmos), giving an impression that they are going to fall out
- Double vision
- Excessive tearing
- Increased irritation in the eyes
Diagnosis: The first symptom would be the presence of an enlarged thyroid gland (front of the neck above the collarbone), and the some of the above symptoms would be present.
In addition, tests to check for thyroid gland functioning including T3 and T4 levels would reveal increased amounts of hormone in the blood stream.
As a confirmatory test, the radioactive iodine uptake test also is done, which will indicate increased uptake by the thyroid gland. This indicates that the gland is functioning at an increased pace and requires additional iodine for the production of thyroid hormones.
Treatment: There are two approaches to it, one to control the symptoms and the other to control the thyroid gland per se.
- Beta blockers are very useful in controlling rapid heart rate and anxiety.
- Prednisone may be used to control eye irritation and swelling
- Antithyroid drugs are used to control the production of thyroid
- Radioactive iodine is given orally to control excessive thyroid production
- In severe cases, thyroid gland may be surgically removed partially or completely
Graves’ disease is not life-threatening and once symptoms are controlled, the patient’s quality of life improves drastically.