Autoimmune Disease

1. GRAVES DISEASE

2. THYROID GLAND
The thyroid gland is a butterfly-shaped endocrine gland that is normally located
in the lower front of the neck.
The thyroid’s job is to make thyroid hormones, which are secreted into the blood
and then carried to every tissue in the body.
Thyroid hormone helps the body use energy, stay warm and keep the brain, heart,
muscles, and other organs working as they should.

3. GRAVES DISEASE
It is an autoimmune disease in which the patient's own immune system attacks the thyroid gland,
causing it to produce too much thyroxine.
Thyroxine (T4) is a hormone produced by the thyroid gland that has four iodine molecules
attached to its molecular structure.
T4, as well as other thyroid hormones help regulate growth and control metabolism in the body.
Although Graves' disease may develop at any age in both women and men, it more commonly
affects women aged 20 years or more.
Currently, there are no medications or treatment to stop the patient's immune system from
attacking their thyroid gland.
However, treatments do exist which can ease the symptoms and bring down the production of
thyroxine.

4. The syndrome typically includes two major categories of phenomena:.
Those specific to Graves’ disease, and caused by the autoimmunity include the exophthalmos,
thyroid enlargement and thyroid stimulation, and the dermal changes.
The second set of problems is caused by the excess thyroid hormone. This thyrotoxicosis, or
hyperthyroidism, does not differ from that induced by any other cause of excess thyroid hormone.
 It is an autoimmune condition that affects Thyroid function, causing enlargement and
overactivity (hyperthyroidism) of the Thyroid.

5. EPIDEMIOLOGY
100-200 cases per 100,000 every year, internationally.
Significantly higher incidence in women, 7:1 ratio.
Most common amongst young women, but can occur at any age. Most seen between the ages of
20-40
No definitive genetic linkage.

6. SIGNS AND SYMPTOMS
Most distinct signs, bulging eyes (Exophthalmos), pretibial myxoedema and thyroid acropachy
 Enlargement of the Thyroid (Goitre)
Increased appetite, coupled with weight loss
 Heat intolerance and diaphoresis
 Hyperactivity and fatigability

8. PATHOPHYSIOLOGY
Autoantibodies (TSI, TBII, TGI) target and bind to TSH Receptors.
Autoantibodies act like TSH (thyrotropin), causing excessive release of T3 and T4 into the blood.
This spike in Thyroid hormone release, causes TSH levels to decrease (negative feedback)
Pathophysiology
Exophthalmos is caused by antibodies attacking the eye muscle fibroblasts, forcing a change into
adipose tissue.
The resulting adipose tissue builds up, exerting a pressure behind the eyes. ● Pressure build up
constricts draining veins, resulting in oedema
The increases in appetite and weight loss, the heat intolerance and diaphoresis, are caused by the
Thyroid hormones increasing the Basal Metabolic Rate
Hyperactivity and Fatigability occurs as Thyroxine overstimulates the motor end plate of the
neuromuscular junction.

9. DIAGNOSIS
A blood test is carried out, checking for
increased free Thyroxine and
Triiodothyronine levels in the blood.
 Exophthalmos and non-pitting pretibial
myxoedema are unique features for Grave’s
Disease when coupled with hyperthyroidism.
Confirmatory.

10. Prognosis With treatment
the prognosis is normally very positive, without any major complications barring
any that may arise from thyroidectomy.
Without treatment there are long term health problems; excessively dry eyes,
blindness, continued muscle degradation etc.
Treatment
 ● Antithyroid drugs (methimazole) ● Radioiodine ● Thyroidectomy