About Graves' Disease

Doctors diagnose about a half million new cases of the disease annually in the United States. There are over 200,000,000 people worldwide with thyroid disease.

Graves' disease or diffuse toxic goiter is the most common form of hyperthyroidism. 90% of people who are hyperthyroid have Graves' disease. Diffuse means the entire gland is sick, not just part of it. Although the gland weighs in at only an ounce or so, it produces hormones that regulate your metabolism, digestion, heart beat, body temperature, and the smooth working of your muscles not to mention your energy levels. This little gland controls over 500 functions in the body. The energy use of virtually every cell and organ in the body is regulated by this small gland in the neck.

The brain's pituitary gland (the body's master gland) produces a thyroid stimulating hormone (TSH) which causes the thyroid gland to produce thyroxine (T4) and triiodothyronine (T3), the two vital hormones that regulate all of the afore-mentioned functions. The pituitary gland will secrete increased amounts of TSH only when the T4 and/or T3 levels are low.

The number after the T indicates the number of atoms of iodine, which that specific hormone contains. T4 has four iodine atoms, etc. T3 is the most potent thyroid hormone and is required through out the body for cell metabolism. T4 must be converted to T3 in order to interact in the cells metabolically. But T3 has an extremely short life span so the thyroid produces significantly more T4 than it does T3.

When you have Graves' disease, first the lymphocyte cells don't recognize the thyroid and therefore make TSA (thyroid stimulating antibodies), which attack the thyroid cells. They turn it on. The enzymes go faster and faster. You increase your iodine intake and your output of thyroid hormone. Your heart, brain and body temperature is up. The cell process is moving too fast. The thyroid now driven by antibodies doesn't listen to the pituitary, which is trying to shut down the TSH to get the thyroid to stop putting out excess thyroid hormone. The eye tissues are ignored too including the fat tissues, the lids which swell, the eyes which protrude and the tear ducts which fail. The skin too might change with the immune system attacking the skin (pretibial myxedema, thyroid acropachy). At the same time your nervous system is sped up. You become impatient, intolerant, and short tempered. Your liver is clogged, your heart is probably racing and you may be experiencing shortness of breath. You are already over sensitive to adrenaline and might now be misdiagnosed as having panic attacks, anxiety disorder, bowel diseases, liver disease or asthma.

The disease is named after nineteenth century Irish physician Robert J. Graves and/or European physician Dr. Basedow who both gave accurate, early accounts of the hyperthyroid condition.

Figure 2.1thyroid, parathyroids, pituitary, and hypothalamus

>We normally have 4 parathyroid glands, which are attached to the thyroid. They regulate the calcium in the body and aid the body in converting vitamin D into calcium, except when damaged or removed, then extra calcium and vitamin D must be taken for life and a person must be closely monitored.

A relatively common symptom of thyroid disease is a swelling of the thyroid gland. This might lead to a goiter, often slight, which in most patients is found to be benign. While Graves' disease is the most common cause of hyperthyroidism, the second most common cause is a toxic multi-nodular goiter, characterized by a rather large, lumpy thyroid. The treatment in these cases would be similar to those for Graves' disease. Sometimes a viral infection can cause an inflammation of the thyroid; this is called subacute thyroiditis. You will experience some sign of having an infection such as a fever, soreness, and/or elevated white cell count. This is a mild and time-limited (lasting about one month) experience. You might have a "cold" nodule which is a lump of thyroid tissue that is made up of primitive cells which lack the ability to identify and thereby take up and use iodine. "Cold" nodules don't produce thyroid hormone, but over time, sometimes years, they uncontrollably reproduce throughout the body for usually unknown reasons. Sometimes exposure to radiation is a cause, however, this is thyroid cancer. There are times when excessive iodine intake, thyroid tumors, or benign "hot" nodules, which Tipper Gore had in late 1999, can cause hyperthyroidism. The "hot" nodule or tumor is completely unresponsive to the pituitary's attempts to lower thyroid hormone output. Treatment would vary according to the cause. Antithyroid drugs will not bring about remission in the case of a "hot" nodule, however you could opt to go on them for a lifetime, although this would be unusual. Mrs. Gore had surgery. RAI (irradiation) can also be given which will target the "hot" nodule and leave any normal thyroid tissue undamaged.

A doctor can usually determine which kind of hyperthyroidism you have. If you have taken a radioactive iodine uptake test with Iodine 123 and found you have a diffuse enlargement of your thyroid, your doctor probably won't need the somewhat costly antibody tests to make the diagnosis. By the way, the uptake and scan tests both use a different isotope of radioiodine than the one given for I131 treatment. The most common antibody tests are for anti-TPO and anti-thyroglobulin antibodies. Not everyone with Graves' disease has these antibodies, but 90% do have Thyroid Stimulating Antibodies or Thyroid Binding Antibodies (TBII), which include subcategories of blocking and binding types.