Graves Disease


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Graves' disease, also known as toxic diffuse goiter, is the most common cause of hyperthyroidism in the United States. 

Hyperthyroidism is a disorder that occurs when the thyroid gland makes more thyroid hormone than the body needs.

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Graves Disease

  1. 1. Fitango Education Health Topics Graves Disease
  2. 2. OverviewGraves disease, also known as toxic diffuse goiter,is the most common cause of hyperthyroidism inthe United States.Hyperthyroidism is a disorder that occurs when thethyroid gland makes more thyroid hormone thanthe body needs. 1
  3. 3. SymptomsPeople with Graves disease may have some of thecommon symptoms of hyperthyroidism such as:-- nervousness or irritability-- fatigue or muscle weakness-- heat intolerance 2
  4. 4. Symptoms-- trouble sleeping-- hand tremors-- rapid and irregular heartbeat-- frequent bowel movements or diarrhea-- weight loss 3
  5. 5. Symptoms-- goiter, which is an enlarged thyroid that maycause the neck to look swollenIn addition, the eyes of people with Gravesdisease may appear enlarged because their eyelidsare retracted and their eyes bulge out from the eyesockets. This condition is called Gravesophthalmopathy. 4
  6. 6. SymptomsGraves ophthalmopathy (GO) occurs when cellsfrom the immune system attack the muscles andother tissues around the eyes. The result isinflammation and a buildup in tissue and fatbehind the eye socket, causing the eyeballs tobulge. In rare cases, inflammation is severe enoughto compress the optic nerve that leads to the eye,causing vision loss.Other symptoms of GO include: 5
  7. 7. Symptoms-- dry, irritated eyes-- puffy eyelids-- double vision-- light sensitivity-- pressure or pain in the eyes 6
  8. 8. Symptoms-- trouble moving the eyesA small number of people with Graves diseasealso experience thickening and reddening of theskin on their shins. This usually painless problem iscalled pretibial myxedema or Graves dermopathy.National Institute of Diabetes and Digestive andKidney Diseases: 7
  9. 9. Symptoms 8
  10. 10. DiagnosisDoctors can sometimes diagnose Graves diseasebased only on a physical examination and amedical history. Laboratory tests confirm thediagnosis. 9
  11. 11. DiagnosisThe ultra-sensitive TSH test is usually the first test adoctor performs. This test detects even tinyamounts of TSH in the blood and is the mostaccurate measure of thyroid activity available.Another blood test used to diagnose Gravesdisease measures T3 and T4. In making a diagnosis,doctors look for below-normal levels of TSH,normal to elevated levels of T4, and elevated levelsof T3. 10
  12. 12. DiagnosisBecause the combination of low TSH and high T3and T4 can occur with other thyroid problems,doctors may order other tests to finalize thediagnosis. Two of these tests are based on the factthat the thyroid gland uses iodine to make thyroidhormone. Both tests use small, safe doses ofradioactive iodine. 11
  13. 13. DiagnosisThe radioactive iodine uptake test measures theamount of iodine the thyroid collects from thebloodstream. High levels of iodine uptake canindicate Graves disease. 12
  14. 14. DiagnosisA thyroid scan shows how and where iodine isdistributed in the thyroid. In Graves disease, theentire thyroid gland is involved so the iodine showsup throughout the gland. Other causes ofhyperthyroidism such as nodules - small lumps inthe gland - will show a different pattern of iodinedistribution. 13
  15. 15. DiagnosisDoctors may also consider the thyroid-stimulatingimmunoglobulin test, although this test usuallyisnt necessary to diagnose Graves disease. Thistest, also called a TSH antibody test, measures thelevel of TSI in the blood. Most people with Gravesdisease have this antibody, but people whosehyperthyroidism is caused by other conditions donot.National Institute of Diabetes and Digestive andKidney Diseases: 14
  16. 16. Diagnosis 15
  17. 17. Diagnosis 16
  18. 18. TreatmentDoctors may prescribe one or more of the threetreatment options: radioiodine therapy, antithyroiddrugs, or thyroid surgery. 17
  19. 19. Treatment **Radioiodine therapy** is the most commonly used treatment for Gravesdisease in the United States. In radioiodinetherapy, the patient takes radioactive iodine-131by mouth. Because the thyroid gland collectsiodine to make thyroid hormone, it will collect theradioactive iodine from the bloodstream in thesame way. Iodine-131-stronger than theradioactive iodine used in diagnostic tests-willgradually destroy the cells that make up thethyroid gland but will not affect other tissues in thebody. 18
  20. 20. Treatment **Radioiodine therapy**Many doctors use a large enough dose of iodine-131 to shut down the thyroid completely, butsome prefer smaller doses to try to bring hormoneproduction into the normal range. More than oneround of radioiodine therapy may be needed.Results take time and a person undergoing thistreatment may not notice improvement insymptoms for several weeks or months. 19
  21. 21. Treatment **Radioiodine therapy**People with Graves ophthalmopathy should talkwith their doctor about any risks associated withradioactive iodine treatments. Several studiessuggest that radioiodine therapy can worsenophthalmopathy in some people. Othertreatments such as steroids may prevent thiscomplication. 20
  22. 22. Treatment **Radioiodine therapy**Although iodine-131 is not known to cause birthdefects or infertility, radioiodine therapy is notused in pregnant women or women who arebreastfeeding. Radioactive iodine can be harmfulto the fetus thyroid, and it can be passed frommother to child in breast milk. 21
  23. 23. Treatment **Radioiodine therapy**Almost everyone who receives radioactive iodinetreatment eventually develops hypothyroidism,which occurs when the thyroid does not makeenough thyroid hormone. People withhypothyroidism must take synthetic thyroidhormone.**Medications** 22
  24. 24. Treatment **Radioiodine therapy**Doctors may prescribe a drug called a beta blockerto reduce symptoms until other treatments takeeffect. Beta blockers act quickly to relievesymptoms such as hand tremors, rapid heart beat,and nervousness. These drugs act by blocking theeffects of thyroid hormone on the body, but theydo not stop thyroid hormone production. 23
  25. 25. Treatment **Radioiodine therapy**Two antithyroid drugs, methimazole andpropylthiouracil (PTU), interfere with the way thethyroid gland uses iodine to make thyroidhormones. Doctors sometimes use antithyroiddrugs as the only treatment for Graves disease,but these drugs usually do not produce permanentresults and their use requires frequent monitoringby a health care provider. More often, antithyroiddrugs are used to pretreat patients older than 60or those who have other health problems beforebeginning radioiodine thera 24
  26. 26. Treatment **Radioiodine therapy**Because pregnant and breastfeeding womencannot receive radioiodine therapy, they areusually treated with an antithyroid drug instead.Pregnant women should not take methimazole andshould be monitored if they take PTU. Women whoare breastfeeding should take the smallest dosenecessary of either drug. 25
  27. 27. Treatment **Radioiodine therapy**Antithyroid drugs can cause side effects in somepeople. Allergic reactions such as rashes anditching are the most common side effects. Rarely,antithyroid drugs cause liver failure or a decreasein the number of white blood cells, which canlower resistance to infection.**Thyroid Surgery** 26
  28. 28. Treatment **Radioiodine therapy**Surgery is the least-used option in treating Gravesdisease. However, doctors sometimes choosesurgery to treat pregnant women who cannottolerate antithyroid drugs, people in whom thyroidcancer is suspected, or those who fail other formsof treatment. Graves disease itself does not causecancer. 27
  29. 29. Treatment **Radioiodine therapy**When surgery is used, many doctors recommendthe entire thyroid be removed, thus eliminatingthe chance that hyperthyroidism will return. If theentire thyroid is removed, lifelong thyroidhormone replacement is necessary. 28
  30. 30. Treatment **Radioiodine therapy**Although uncommon, certain problems can occurin thyroid surgery. The parathyroid glands could bedamaged because they are located very close tothe thyroid gland. These glands help controlcalcium levels in the body. Damage to the laryngealnerve, also located close to the thyroid gland,could lead to voice changes or breathing problems.When surgery is performed by an experiencedsurgeon, less than 1 percent of patients havepermanent complications. 29
  31. 31. Treatment **Eye Care**The eye problems associated with Graves diseasemay not improve following thyroid treatment, sothe two problems are often treated separately. 30
  32. 32. Treatment **Eye Care**Eye drops can relieve dry, gritty, irritated eyes—themost common of the milder symptoms. If pain andswelling occur, doctors may prescribe a steroiddrug such as prednisone. Other drugs thatsuppress the immune response may also providerelief. Special lenses for glasses can help with lightsensitivity and double vision. Patients may beadvised to sleep with the head elevated to reduceeyelid swelling. For people who are unable to fullyclose their eyelids, taping the eyelids shut at nightca 31
  33. 33. Treatment **Eye Care**In more severe cases, external radiation applied tothe eyes may be used to reduce inflammation. Likeother types of radiation treatment, the beneficialeffects are not immediate, but most people feelrelief from symptoms as soon as 1 to 2 monthsafter treatment. 32
  34. 34. Treatment **Eye Care**Surgery may be used to improve the protrusion ofthe eyes and correct the vision changes caused bypressure on the optic nerve. A procedure calledorbital decompression makes the eye socketbigger, giving the eye room to sink back to a morenormal position. Eyelid surgery can returnretracted eyelids to their normal position.National Institute of Diabetes and Digestive andKidney Diseases: 33
  35. 35. Treatment **Eye Care** 34
  36. 36. CausesScientists dont know exactly why some peopledevelop Graves disease, but they believe factorssuch as age, sex, heredity, and emotional andenvironmental stress are involved.An individuals chance of developing Gravesdisease increases if other family members have it. 35
  37. 37. CausesResearchers have not been able to find a specificgene that causes the disease to be passed fromone generation to the next. Scientists know thatsome people inherit an immune system that canmake antibodies against healthy cells, butpredicting who will be affected is difficult. 36
  38. 38. Facts-- Graves disease is the most common cause ofhyperthyroidism in the United States and mainlyaffects young women.-- In Graves disease, the immune systemstimulates the thyroid gland to make too muchthyroid hormone. 37
  39. 39. Facts-- Common symptoms of hyperthyroidism includenervousness or irritability, heat intolerance, rapidand irregular heartbeat, frequent bowelmovements or diarrhea, weight loss, and goiter.-- People with Graves disease may also havebulging eyes, a condition called Gravesophthalmopathy. 38
  40. 40. Facts-- Graves disease is most often treated withradioiodine therapy, which gradually destroys thecells of the thyroid gland. Antithyroid drugs andsurgery to remove the thyroid are sometimesused.-- The eye problems associated with Gravesdisease may require additional treatment. 39