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Frequently Asked Questions



What is Graves' disease?

The leading cause of hyperthyroidism (over active thyroid), Graves' disease (Graves'), represents a basic defect in the immune system (autoimmune disease), causing production of immunoglobulins (antibodies) which stimulate and attack the thyroid gland, causing growth of the gland and overproduction of thyroid hormone. Similar antibodies may also attack the healthy tissues in the eye muscles and the pretibial skin (the frontal skin on the lower leg).

A Quick Overview

ABBREVIATIONS & DEFINITIONS

Hyperthyroidism: a condition where the thyroid gland is overactive and produces too much thyroid hormone. Hyperthyroidism may be treated with antithyroid meds (Methimazole, Propylthiouracil), radioactive iodine or surgery.

Graves' disease: the most common cause of hyperthyroidism in the United States.

Thyroxine (T4): the major hormone secreted by the thyroid gland. Thyroxine is broken down to produce Triiodothyronine which causes most of the effects of the thyroid hormones.

Radioactive iodine (RAI): this plays a valuable role in diagnosing and treating thyroid problems since it is taken up only by the thyroid gland. I-131 is the destructive form used to destroy thyroid tissue in the treatment of thyroid cancer and with an overactive thyroid.

Methimazole: an antithyroid medication that blocks the thyroid from making thyroid hormone. Methimazole is used to treat hyperthyroidism, especially when it is caused by Graves' disease.

Propylthiouracil (PTU): an antithyroid medication that blocks the thyroid from making thyroid hormone. Propylthiouracil is used to treat hyperthyroidism, especially in women during pregnancy.

What are the signs and symptoms of Graves' disease?

The symptoms of Graves' thyroid disease tend to come on slowly, and they vary from person to person. It's not always obvious that something is wrong. Often people don't see a doctor until they experience palpitations or shortness of breath.

  • Fatigue
  • Weight Loss
  • Restlessness
  • Tachycardia (rapid heartbeat)
  • Heart palpitations
  • Heat intolerance
  • Increased sweating
  • Tremors
  • Muscle weakness
  • Hair, nail and skin changes
  • Change in libido (sex drive)
  • Enlarge thyroid gland
  • Restless sleep
  • Blurred or double vision
  • Eye complaints, i.e., redness & swelling
  • Nervousness and irritability
  • Erratic behavior
  • Increased appetite
  • Shortness of breath
  • Distracted attention span
  • Decrease in menstrual cycle
  • Increased frequency of stools

Who develops Graves' thyroid disease?

Although Graves' disease most frequently occurs in women in the middle decades (8:1 more than men), it also occurs in children and in the elderly. There are several elements contributing to the development of Graves' disease. There is a genetic predisposition to autoimmune disorders. Infections and stress play a part. Graves' disease may have its onset after an external stressor. In other instances, it may follow a viral infection or pregnancy. Many times the exact cause of Graves' disease is simply not known. It is not contagious, although it has been known to occur coincidentally between husbands and wives. Of research importance, the Graves' gene in DNA has not yet been identified.

How is Graves' thyroid disease treated?

Graves' disease is treated three ways. The choice of treatment varies to some degree from country to country, and among particular physicians as well. The decision should be made with the full knowledge and informed consent of the patient, who is the primary member of the treatment team. The selection of treatment will include factors such as age, degree of illness, and personal preferences. Generally speaking, from least invasive to most invasive, the treatments include:

  1. Anti-thyroid drugs which inhibit production or conversion of the active thyroid hormone
  2. Subtotal thyroidectomy, in which a surgeon removes most of the thyroid gland and renders it incapable of overproducing thyroid hormone
  3. Radioactive iodine (I-131), which destroys part or all of the thyroid gland and renders it incapable of overproducing thyroid hormone

The first treatment is about 20-30% effective, and the latter two treatments result in about a 90-95% resolution rate of the disease. In a few cases, the treatments must be repeated. In all cases, lifetime follow-up laboratory studies must be done, and in almost all cases, lifetime replacement thyroid hormone must be taken.

Are there any alternatives for treating Graves' thyroid disease?

There are a number of things that you can do to assist your body in healing. However, the state of science as we know it indicates there is no "natural" way to "cure" Graves' disease. For instance, although there are no specific foods that will change your thyroid function, the healthier, nutritionally dense foods you eat, the better your body will be able to fight against infection and further insult. Equally, many of the treatments like acupuncture, exercise, meditation, and various mind-body therapies may provide comfort measures and relief, but are not a substitute for standard medical treatment. Be sure to consult and collaborate with your physician when embarking on additional therapies. There are many studies of other auto-immune diseases that indicate that the more input and control a patient has in their care, the more rapid their recovery will be. It is of interest to all who are hopeful of more, effective additional treatment models in the future that the National Institutes of Health are trying to adequately research and evaluate the hard data of alternative therapies.

What are the complications with Graves' thyroid disease?

Graves' disease usually responds to treatment, and after the initial period of hyperthyroidism, is relatively easy to treat and manage. There are some exceptions to this, and for some, treatment and subsequent stabilization are much more challenging, both to the patient and the treating team of physicians. The more serious complications of prolonged, untreated, or improperly treated Graves' disease include weakened heart muscle leading to heart failure; osteoporosis, or possible severe emotional disorders.

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