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Graves' Disease (Hyperthyroidism)

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Have you been feeling irritable lately? Do you tremble, lose weight for no apparent reason or feel hot all the time? If so, you could be one of the millions of people who have a condition known as Graves' disease, an autoimmune disorder that can cause myriad of health problems throughout the body, while being the most common cause of hyperthyroidism. Graves' disease is a rare disorder (only one fourth of one percent of the United States' population have Graves' disease - roughly 4.5 million people1), however most patients find that with education and continuing medical care, this is an easily treatable and manageable condition.

The History of Graves' Hyperthyroidism

The condition that would come to be known as Graves' disease was first, and briefly, documented by the English physician Caleb Hillier Parry in the late 1700s when he made the connection between an enlarged thyroid gland (goiter), rapid heartbeat and cardiovascular complications. Other physicians also noted this connection between thyroid enlargement and cardiac involvement, including the Italian physicians Giuseppe Flajani (1741-1808) and Antonio Giuseppe Testa (1756-1814).

However, the real breakthrough in studying this disorder took place when Robert James Graves, an Irish physician, discovered in the 1830s that several of his patients not only displayed an enlarged thyroid gland with a rapid or irregular heartbeat, but also enlarged and protruding eyes. Graves later went on to theorise that a disturbance of the thyroid gland could be the cause of these medical conditions, as well as documenting that women seemed to be suffering from this condition much more frequently than men. The theory that the thyroid could be at the heart of this medical issue, involving eye and heart problems, was later shown to be valid by the German physician Karl Adolph von Basedow. Basedow went on to show that this condition causes many other symptoms, including weight loss and nervousness, as well as the probability that excessive iodine could be a contributing factor to the illness.

Thanks to the studies of these physicians, we now know much of what they speculated about this illness is true; although it would not be effectively treated for several more decades. The elusive thyroid condition which was scrutinised by physicians of the 18th and 19th Centuries is now referred to as Basedow's Syndrome in some parts of Europe while being more commonly known as Graves' disease in most of the United States and the United Kingdom.

Physicians now know that Graves' disease is a very complex disorder that affects both the body's endocrine and immune systems, as well as many of the body's vital functions, so in order to better understand this condition, it's important to study both sides of the Graves' disease coin: autoimmunity and thyroid disease.

Graves' disease - Thyroid Disease or Autoimmune Disorder?

While Graves' disease presents itself as a type of thyroid Disease, it is actually an autoimmune disorder. An autoimmune disorder occurs when a person's immune system (the same system that protects the body from illness by fighting off bacteria and viruses) begins to attack the body's healthy tissues, such as glands, organs and skin. When the immune system attacks these otherwise healthy tissues, illness can develop. Approximately 50 million Americans suffer from some form of autoimmune disorder2, including Lupus, Multiple Sclerosis (MS), Guillain-Barré Syndrome, Crohn's Disease, Type 1 Diabetes Mellitus, Rheumatoid Arthritis, Hashimoto's Thyroiditis, Vitilago and premature grey hair.

There are around 80 forms of immune system disorders, affecting every tissue and organ in the body. Some forms of autoimmunity can be relatively harmless with few symptoms, while others can be persistent and life threatening. Autoimmune disorders are thought to be hereditary (around 10 to 15 percent of all people can inherit an immune system that can cause a problem3), thus one's chance of developing a disorder increases if there is a presence of autoimmunity in their family's medical history. Curiously, the type of autoimmunity can differ within a family, for example, a person may have Hashimoto's Thyroiditis while the father has diabetes and a grandparent lupus. One's chance of developing an immune system disorder also increases if a person has been diagnosed with autoimmunity in the past (eg, the chance that a person will develop diabetes or Crohn's Disease increases if they have already developed Rheumatoid Arthritis). Anyone can develop an immune system disorder and at any age, but women develop these disorders most frequently - around 75 percent of all people diagnosed with autoimmune disorders are women between the ages of 20-454.

Researchers are still discovering the triggers for and hereditary factors involved in immune system disorders, but the exact reasons why some people develop these disorders in the first place are not readily understood. Many researchers are also investigating the connections between smoking tobacco, viral infections, physical and emotional trauma, stress, exposure to chemical agents5 and possibly the role of some immunisation vaccines6 and the development of autoimmunity. Generally, scientists suspect that something in the environment can make the immune system go haywire, but as of yet no one knows why.

There is not yet a cure for any autoimmune disorder. However, many autoimmune disorders can be treated and controlled with medications, surgical procedures, physical therapy, proper nutrition and preventative measures (such as stopping smoking, which is believed to aggravate some immune system disorders, including Graves' disease).

Thyroid Disease - a 'Whole-Body' Effect

The thyroid, a small butterfly-shaped gland positioned underneath the Adam's apple, has been called the 'Body's Furnace' as it is responsible for many bodily functions, most importantly metabolism. The four lobes of the thyroid gland excrete hormones7 into the body, regulating the body's energy level as it metabolises food as well as helping to regulate heart rate, cholesterol levels, muscle strength and skin condition, visual and mental acuity and menstrual/reproductive functions, making the thyroid one of the most important glands in the endocrine system. The thyroid is in turn regulated by the pituitary gland, located at the base of the brain. The pituitary gland secretes a hormone called TSH (Thyroid Stimulating Hormone) which, as the name denotes, stimulates the thyroid, causing it to release hormones of its own. The thyroid gland also stores and metabolises iodine, an important element in the diet, necessary for maintaining proper thyroid functioning.

There are several instances that can cause the thyroid to malfunction, ranging from thyroiditis (an inflammation of the thyroid gland, usually treated with antibiotics) to thyroid cancer (a very rare form of tumour which may be either benign or malignant). When the thyroid malfunctions, whether it is because of disease or cancer, it typically goes in one of two directions:

  • Hypothyroidism - the most common form of thyroid malfunction, occurring when the thyroid releases too little thyroid hormone; or

  • Hyperthyroidism - a rarer form of thyroid malfunction, occurring when the thyroid releases too much thyroid hormone.

Table 1 - Important Thyroid-Related Hormones and Elements
TSHThyroid Stimulating Hormone; secreted by the pituitary gland. Stimulates the thyroid, causing it to release thyroid hormones.
T3 Triiodothyronine; a less abundant but more potent thyroid hormone. Aids in regulating metabolism and heart rate.
T4 Thyroxine; the most important thyroid hormone. Processes iodine in the thyroid, affects mitochondrial activity, regulates protein synthesis and breakdown and carbohydrate metabolism. This hormone stimulates the central nervous system and the endocrine system, and remains active in the body for up to a month. Too much thyroxine can cause over-stimulation of the nervous/endocrine systems as well as increased metabolism.
IodineAn important element necessary for healthy thyroid functioning. Too much stored iodine in the thyroid is a sign of hyperthyroidism. Iodine deficiency or allergy can result in a goiter (swollen thyroid gland).

Since the thyroid gland controls and regulates so many of the body's vital functions it is easy to understand why any malfunction of the gland, causing either too little or too much thyroid hormone to be released, can cause physical complaints throughout the body of an individual. Most commonly low or too much energy, weight gain or loss, slow or fast heart rate, depression or nervousness, etc. And while thyroid disease can be caused by any number of illnesses or conditions, it's interesting to note that the two major causes of thyroid malfunction are both autoimmune disorders: Hashimoto's Thyroiditis (the most common cause of hypothyroidism) and Graves' disease (the most common form of hyperthyroidism).

Bringing It All Together - Graves' disease, Hyperthyroidism and the Body

When an individual's immune system attacks the thyroid gland, damaging the cells of the thyroid and causing the gland to release too much thyroid hormone, that person typically suffers from Graves' disease. The antibodies created by Graves' disease may also attack the tissues and muscles of the eyes, causing a host of visual complications, and rarely the skin of the lower legs. It is not contagious, one must be born with the antibodies in the blood stream in order to develop the condition later in life. It is also seven times more likely to affect women than men 8, and has been linked to other autoimmune disorders.

Most Graves' disease patients have the feeling that something is wrong with their bodies 9, especially considering the host of symptoms it causes. However it is oftentimes difficult to get an accurate medical diagnosis as Graves' disease can present itself as generalised anxiety disorder (GAD) or some other nervous/emotional condition, causing some doctors to take a wrong turn when diagnosing. Lack of education on the subject of autoimmune/thyroid disorders can also play a factor in how effectively patients are diagnosed, approximately 13 million Americans have a thyroid disorder, but more than half of them aren't aware of it.10 Although Graves' disease is the most common cause of hyperthyroidism, not all patients suffering from hyperthyroidism have Graves' disease and not all patients with Graves' disease suffer from hyperthyroidism.

Table 2 - Common Graves' Disease Associated Symptoms
Swelling of the thyroid gland (goiter)
Tachycardia (rapid heart rate: 100-120 beats per minute, or higher)
Arrhythmia (irregular heart beat)
Elevated blood pressure
Shortness of breath
Unexplained weight loss/inability to gain weight
Intolerance to heat
Increased sweating
Increased appetite
Frequent bowel movements
Chronic sinus infections
Increased energy
Erratic behaviour
Mood swings/'rages'
Memory loss
Difficulty concentrating/short attention span
Trembling in the hands or fingers
Smooth, velvety skin
Lumpy, reddish skin of the lower legs (pretibial myxedema)
Fine or brittle hair/hair loss/weak or brittle nails
Sweaty palms
Muscle weakness (especially in the large muscles of the arms and legs) and degeneration
Irregular/abnormally light menstrual periods
Difficulty conceiving/infertility/recurrent miscarriage
Changes in sex drive
Eye pain, irritation, or the feeling of grit or sand in the eyes
Swelling or redness of eyes or eyelids/eyelid retraction
Sensitivity to light
Protrusion of one or both eyes past the protective orbit (exophthalmos)
Blurred/double vision

A patient suffering from one or more of the major symptoms can determine whether or not they have Graves' disease through the aid of a few simple blood and laboratory tests11 and a doctor's final diagnosis. A doctor can test the level of TSH in the blood, the blood levels vary from doctor to doctor in regard to what determines thyroid disease12, but typically a TSH level above 3.0 indicates hypothyroidism, while a level below 0.3 indicates the hyperthyroidism associated with Graves' disease. The TSH level of a Graves' disease patient is lower than normal because their pituitary gland does not need to stimulate the release of thyroid hormone. The malfunctioning antibodies of a Graves' disease patient's immune system, while attacking the thyroid gland, are in turn doing the 'job' of the pituitary gland.

High levels of thyroid hormone in the blood can also be discovered through blood tests, checking for high levels of T4 (thyroxine), T3 (triiodothyronine), Free T4 and Free T3 are further ways of indicating hyperthyroidism. And once a doctor finds evidence of hyperthyroidism through the abovementioned blood tests, he or she may also wish to test for the presence of antibodies in the bloodstream, the same antibodies that are produced by a person with an autoimmune disorder. If antibodies, high levels of thyroid hormones and low levels of TSH are discovered through these tests, the likelihood of a patent having Graves' disease is very high.

Some physicians may diagnose a patient with Graves' disease based on these blood tests alone, or with the test results in conjunction with specific physical symptoms (eg, goiter, fast heart rate, high blood pressure, protruding eyes and weight loss),but other physicians take the diagnosing process a step further and suggest that patients undergo an iodine uptake test and thyroid scan.

These simple and painless procedures give some patients a taste of what one Graves' disease treatment option is like. Patients are given a small dose of radioactive iodine (commonly referred to as RAI, or for those nuclear science fans out there, an isotope of iodine with an atomic weight of 131: 131I) and several hours later have their lower neck scanned by what appears to be a Geiger counter. This allows a doctor of nuclear medicine to determine how much iodine is being stored in the thyroid (uptake). The thyroid naturally stores iodine to help it function properly, however, a greater amount of iodine has to be stored in order to keep up with the increased demand of a thyroid that is over-functioning. And because this is a radioactive form of iodine, it can be easily and accurately scanned by a doctor with the proper medical equipment. If a doctor detects a high level of iodine stored in the thyroid, the patient typically has hyperthyroidism.

Table 3 - Testing For Graves' disease
TSH Blood TestPhysician tests for levels of TSH in the blood. Higher than normal levels of TSH indicate hypothyroidism; lower than normal levels of TSH indicates hyperthyroidism or Graves' disease.
T4 and T3 Blood TestsPhysician tests for levels of thyroid hormone in the blood, namely thyroxine and triiodothyronine. High or low levels of these hormones may indicate hyper- or hypothyroidism, respectively.
Graves' Antibody TestPhysician tests for the presence of antibodies in the blood stream that are associated with the Graves' disease immune system disorder.
Iodine Uptake TestDoctor of nuclear medicine tests the possible Graves' disease patient by giving them a small amount of radioactive iodine (131I), then scanning the neck a few hours later to measure the level of iodine stored in the thyroid. High levels of iodine stored in the thyroid are indicative of Graves' disease/hyperthyroidism.
Thyroid ScanA procedure in which a physician uses an x-ray or fluoroscope to take a picture of the thyroid gland. An enlarged thyroid with tumours or nodules would explain a patient's hyperthyroidism. An enlarged thyroid free of nodules or tumours is a sign of Graves' disease.

If this is the case, a doctor may then proceed with the thyroid scan: an x-ray or fluoroscope of the patient's lower neck. If nodules or tumours are shown to be present on the thyroid gland, that will most likely be the cause of the hyperthyroidism and can be treated through surgery or radiation. However, if the patient is shown to have what is called a toxic diffuse goiter (swelling of the thyroid gland, but free of nodules or tumours), the patient will most likely be diagnosed as having Graves' disease.

Living With Graves' Disease

While Graves' disease is rarely ever debilitating, many patients still have to make some adjustments to their lifestyle as well as undergo regular testing and treatment in relation to the condition. Because Graves' disease affects so many bodily functions and tissues, patients will often have to undergo several treatments13 at the same time in order to approach them all.

The Heart

Doctors will often stabilise the patient's heart-related symptoms straight away with beta-blockers, prescribed in order to lower and stabilise the heart rate and blood pressure as well as to prevent further wear and tear on the patient's cardiovascular tissues due to hyperthyroidism. Beta-blockers also have a sedating effect that can ease the symptoms of shaking and tremors associated with Graves' disease. Many patients may continue to take beta-blockers well into their treatment for hyperthyroidism, until the affects of hyperthyroidism on the cardiovascular system are diminished or are treated completely. However patients with asthma are typically restricted from this form of treatment due to possible negative side-effects.

Physicians may sometimes discourage patients from taking part in strenuous activities in order to avoid heart and circulatory complications until cardiovascular issues are brought under control.

Graves' Eye Disease

Some Graves' disease patients also suffer from Graves' Ophthalmopathy, sometimes called Thyroid Eye Disease or TED. These patients must see a TED-trained and surgically capable ophthalmologist on a regular basis in order to monitor and treat eye changes as they occur. Usually if a patient has any eye changes, such as lid retraction, eye irritation, inability to wear contact lenses or the swelling of tissues in and around the eyes, they are mild and can be treated; cold compresses, elevating the head to relieve swelling and wrap-around sunglasses to help protect light-sensitive eyes from glare. More so than any other treatment, eye drops, ointments and humidifiers quickly become the TED sufferer's best friends. Thyroid eye disease often causes the corneas of the eyes to dry out as they are increasingly exposed to air as the eye tissues retract or swell. The 'get-the-red-out' varieties of eye drops may actually make the irritation of this condition worse. Therefore, lubricating, preservative-free eye drops and ointments are the best bet for eyes in these circumstances. The drops, free of chemicals and preservatives, will help rehydrate the cornea thus eliminating much of the pain and irritation associated with TED. Humidifiers act in much the same way by keeping the atmosphere moist around the TED sufferer, helping to ease some of the dry-eye symptoms.

In some cases, Graves' disease patients will undergo corrective eyelid surgery, a procedure that loosens and corrects the position of the eyelids in patients suffering from lid retraction. Most often to cosmetically correct the 'staring' and bulging-eyes appearance associated with Graves' eye disease. While this procedure will not 'cure' the cause of eye muscle degeneration, it can often boost the self-esteem of patients affected by this change in their appearance.

Table 4 - Treating Graves' Eye Disease
Dry eyes, irritation, blurrinessPhysician may prescribe lubricating, preservative-free eye drops or ointments. Humidifier, avoid smoking or being around smoke.
Swelling of the eyelids or surrounding tissues.Cold compresses, elevating the head to drain fluids.
Eyelid retractionMay go away with time, or remit and reoccur in the future. Doctors may treat the symptoms of dry-eye that often accompany eyelid retraction. In some cases perform corrective surgery to loosen the eyelids, improving appearance and sometimes the symptoms of corneal drying.
ExophthalmosIn mild cases, may be monitored while treating the accompanying symptoms, in hope that that remission will occur. In more severe cases, decompression surgery, radiotherapy, steroids and prisms (to correct double vision) may be administered.

Rarely, however, some patients may experience a condition known as exophthalmos, the forward protrusion, or bulging, of one or both eyes out of the protective orbital sockets, caused by inflammation and scarring of the tissues behind the eyes. Even more rarely, this condition necessitates corrective surgery. Orbital decompression surgery is typically the surgical method of choice, in which the bones behind the eyes and leading into the respective sinus cavities are removed, relieving pressure from behind the eyes and allowing the eyes to settle back into a more normal position and with more room to move, equalling a greater field of vision. Often, patients with severe exophthalmos will experience double vision (sometimes corrected with the addition of prisms to prescription glasses) or problems with their field of vision due to the immune system attacking the directional muscles of the eyes. Vision loss due to Grave's Ophthalmopathy and exophthalmos is extremely rare, but can occur when the inflamed muscles and tissues behind the eye cut off blood supply to the optic nerve or cause it to be stretched out of place.

The treatment of a patient's hyperthyroidism will have little or no effect on the patient's eyes, as they are two separate conditions of Graves' disease although they are caused by the same disruption of the immune system. In fact, some hyperthyroid treatments, such as RAI, have been shown to actually aggravate the patient's eye problems. Occasionally physicians may use steroids such as Prednisone, in conjunction with treatments that may adversely affect the eyes, in order to reduce swelling. Once a steroid is discontinued, however, the swelling often returns.

Ongoing treatment and closely monitoring any eye changes are very important to patients with Graves' disease, as Graves' eye disease can flare up or go into remission at any time throughout the course of one's illness. The connection between smoking and Graves' eye disease is becoming more evident. Scientists are discovering that patients who smoke also have the greatest chance of developing severe cases of TED as well as having an increased chance of loosing their sight14 compared to the occurrence of TED in non-smokers. And it is also important to note that not every Graves' disease patient will experience eye problems, while other patients may only experience eye-related problems with their Graves' disease (without the corresponding hyperthyroidism). This is one of the mysteries of Graves' disease, one into which researchers are still looking. While there is no cure for Graves' eye disease, many doctors are hopeful that individual cases can be treated successfully or even go into remission, never to occur again.

The Skin

Very rarely, some patients will develop a condition known as pretibial myxedema. In this instance a patient's immune system attacks the skin of the lower legs, resulting in lumpy, reddish skin. This condition is usually not painful nor is it serious, and it can sometimes flare up and go into remission. A dermatologist can be seen if there is any discomfort, but there is little that can be done to control this condition.

Treating Hyperthyroidism

Hyperthyroidism is possibly the most serious consequence of Graves' disease, as high levels of thyroid hormone can be damaging to many of the body's functions. Luckily, patients have several options at their disposal for treating hyperthyroidism: namely anti-thyroid medications, surgical thyroidectomy or RAI.

Anti-thyroid medications, such as Propylthiouracil (PTU) and Tapazole, work to suppress the overproduction of thyroid hormone. Therefore a patient must continue taking the medications as long as the symptoms of hyperthyroidism are present. Anti-thyroid medications have become increasingly popular as a form of treating Graves' Hyperthyroidism due to the simplicity and non-surgical or procedural aspects of the treatment, especially with young children, the elderly and pregnant women. However there are some risks, including (rarely) possibly serious suppression of the patient's immune system, rendering the patient susceptible to potentially life-threatening complications from otherwise harmless bugs, like the common cold or flu. Also, patients who choose anti-thyroid medications as their treatment option must continually have their thyroid and medication levels checked throughout the duration of their illness. Most patients are entirely happy with this option, however, and in some cases (about 30% of those who take anti-thyroid medication for a period of one to two years15) the patient's hyperthyroidism goes into complete, and permanent, remission. Anti-thyroid medications are sometimes also given to patients who have elected to undergo surgical thyroidectomy or RAI in order to better control the symptoms while waiting for another treatment to gain effectiveness. This also depletes the high levels of stored thyroid hormone within the thyroid itself, thus avoiding a toxic release of thyroid hormones that sometimes takes place after a patient undergoes RAI or thyroidectomy.

Surgical thyroidectomy is simply the surgical removal of all or part of the thyroid gland, which immediately reduces the levels of thyroid hormone in the body. Surgical thyroidectomy is also used to treat thyroid cancer and to remove large goiters or nodules that obstruct breathing or for cosmetic reasons. Thyroidectomy is typically considered a safe form of treatment, however up to seven percent of all thyroid surgeries result in some form of facial nerve damage, while up to three percent of patients are left with paralysis of both vocal cords 16. Another possible side-effect is damage to the parathyroids, four tiny glands located to the thyroid. The parathyroids control calcium levels in the body, and accidental damage to them could result in temporary or permanent calcium deficiency and possibly osteoporosis. There is also the risk that too much or not enough thyroid tissue will be removed during the procedure, but the chance of needing a second corrective treatment is much greater with RAI than with thyroidectomy. Most of the patients who undergo surgical thyroidectomy will require hormone replacement due to thyroid failure and the resulting hypothyroidism. However, surgical thyroidectomy remains a relatively safe and effective method of treating hyperthyroidism for those who are looking for a permanent, and non-irradiative, option.

RAI, the aforementioned radioactive iodine used in diagnosing Graves' disease, is the most popular option in treating hyperthyroidism. A patient would take a dose of RAI high enough to disable or 'shrink' the thyroid gland itself, in order to have a normally-functioning thyroid gland - become euthyroid. This typically causes the hyperthyroidism to go into remission as there isn't enough viable thyroid tissue to continue releasing the high levels of thyroid hormone. This is a 'one hit wonder', so to speak, patients appreciate the fact that they do not have to take a regimen of medications in order to counteract thyroid hormone, nor do they have to undergo a surgical procedure, but merely take one dose of RAI in a tasteless, odourless pill or liquid form. The ease and cost-effectiveness of this option often makes RAI the treatment du jour of medical professionals. However it is not without risk. Although this form of radiation has not been proven to cause cancer 17 throughout its 50 odd years of use in treating hyperthyroidism, it can cause harm to a foetus (namely, the thyroid of the foetus) of any woman who might take RAI during pregnancy or to children who are breastfed by an RAI patient. Therefore, medical professionals may order a pregnancy test before RAI is given and urge women not to become pregnant within a certain period of time after taking RAI, or to wean their children before undergoing treatment. In fact, some physicians discourage all female patients in their childbearing years from taking RAI, as the link between taking RAI and birth defects in future children is not concretely known. Those who choose this option are also asked not to come into contact with others, especially small children, the elderly and pets, for three to five days after ingesting the RAI. Radioactive iodine is secreted through sweat, saliva, urine and other bodily fluids and there is a possibility of exposing others to RAI (and subsequently affecting their thyroids) in this period of time before the radioactive iodine is flushed out of the patient's system or is rendered harmless (roughly one week). Doctors will usually give patients a list of post-treatment instructions, involving quarantine and preventative measures regarding exposing others to RAI, including eating, sleeping and restroom hygiene - instructions that should be followed to the letter by RAI patients.

It typically takes six weeks for the overproduction of thyroid hormone to be noticeably reduced, and six months before the RAI patient becomes euthyroid or, in many cases, hypothyroid 18. This is the greatest risk of RAI. Although physicians are getting better at pinpointing the exact dosage needed to render a patient euthyroid, more often than not the dosage is too high, resulting in the destruction of too much thyroid tissue and thus, thyroid failure. Patients must then take replacement thyroid hormones throughout their lifetime, but some feel this is a small price to pay to be free from the potentially life-threatening effects of hyperthyroidism. In some cases of RAI (roughly ten percent of all RAI patients 19), the dose is not high enough and patients must undergo a second treatment, which is usually effective. No matter what the outcome, all patients must undergo periodic testing of thyroid levels in order to screen from possible thyroid failure and hypothyroidism.

RAI patients also have the greatest risk of undergoing a condition known as thyroid storm (the most dangerous complication of Graves' disease). Thyroid storm occurs when a toxic level of stored-up thyroid hormones are suddenly and life-threateningly dumped into the body, resulting in rapid heart rate, confusion, dizziness, coma or heart attack.

Thyroid storm is a serious, life-threatening condition. Any person suffering from hyperthyroidism who experiences sudden dizziness, nausea, extremely rapid or low heart rate, high or low blood pressure or fainting should seek emergency medical help immediately.

Table 5 - Treating Graves' Hyperthyroidism
Anti-thyroid medicationBlocks the excessive production of thyroid hormones. A good alternative to surgery or radiation, but carries the risk of lowering white blood cell counts.
Surgical thyroidectomySurgical removal of all or part of the thyroid. A safe and permanent solution to hyperthyroidism, but carries the risks of damage to facial nerves, vocal cords and parathyroids as well as that of thyroid failure after the procedure and hypothyroidism.
RAIIngestion of radioactive iodine shrinks or destroys a portion of the thyroid, minimising or eliminating the effects of hyperthyroidism. A permanent and non-evasive form of treatment, but carries the risks of multiple treatments, foetal harm, the worsening of Graves' eye disease, thyroid storm, and thyroid failure and hypothyroidism.

Each one of these treatment options, as noted, comes with its own benefits and risks; for instance, RAI is the least evasive and typically the safest method of treatment, yet it has been shown to bring on and exacerbate Graves' Ophthalmopathy, in some cases rather severely. Therefore, choosing a treatment that is best for a patient can often be a very personal, and sometimes difficult, decision. The positive side to having so many options, however, is that patients can find a choice that's right for them without feeling as though they were 'rushed', or 'pushed' into deciding a treatment. After undergoing treatment most patients are able to go back to a normal lifestyle, and usually start to feel better right away. Developing hypothyroidism is a risk for anyone with Graves' hyperthyroidism, and thyroid levels will need to be monitored regularly. And when thyroid storm is no longer a threat, patients may go back to maintaining the active lifestyle they had to abandon for fear of heart and endocrine-related complications. But most importantly, regardless of which treatment or lifestyle choice a person makes, if they have been diagnosed with or suspect that they might have Graves' disease, they must get treated right away!

Emotional and Behavioural Effects

Emotional changes are common for patients with Graves' disease. Increased thyroid function can place stress on the adrenal glands, causing patients to feel tired and depressed, or hyper and anxious. The longer someone goes untreated for their hyperthyroidism, the more damage is inflicted upon the adrenal glands. Some patients may even experience adrenal failure after long-term hyperthyroidism, necessitating further treatment in order for them to feel 'normal' again.

Many Graves' disease patients experience emotional and behavioural disorders throughout the course of their illness. Mood swings, bouts of crying and sometimes overwhelming anger are common and, when combined with the low self-esteem developed by patients who are dealing with changes in their appearance, can be devastating. It is very important for patients with Graves' disease to have a close, supportive network of friends, family, co-workers or fellow patients. Both to help with the emotional trauma associated with Graves' disease, and to help the patient rebuild interpersonal relationships that may have been affected negatively due to the disease.

Alternative Treatments

There are many individuals who encourage holistic or alternative methods for treating Graves' disease and other illnesses, such as acupuncture, nutritional supplements or yoga. These treatments are great for helping to relieve stress and other symptoms of this condition; important, as stress has been shown to aggravate immune system disorders.

However, no alternative method has been shown to cure or adequately treat any aspect of Graves' disease, especially hyperthyroidism. In fact, not receiving appropriate medical care can place the life of a person with this condition at risk. It may not seem so to many patients, but Graves' disease is a serious and life-threatening condition if not promptly stabilised, monitored and treated through conventional methods.

The Future of Graves' Disease

As one can see, Graves' disease is a complex condition that can affect nearly every major function of the body while destroying the tissues of the thyroid and eyes, and rarely the skin of the lower legs. It is both unfortunate and lucky that, for such a serious condition, Graves' disease did not receive world wide recognition until it was reported that the former American President George Bush and his wife Barbara had both been diagnosed with Graves' disease (which is extremely rare, men developing Graves' disease alone is unusual, while a couple being diagnosed with the condition after they are married is almost unheard of). It is unfortunate that so little attention was paid to the condition up to that point, but lucky that such a prominent figure and his wife brought awareness of the condition to millions of people. The Olympic gold medallist Gail Devers and Ann Marie Mitchell, Mrs Missouri 2000, have also brought attention to this condition through publicly sharing their experiences as Graves' disease patients and educating others about detection and treatment options.

Since the earliest mention of Graves' disease in the medical community back in the 18th Century, physicians have progressed in the diagnosis and treatment of this disorder by leaps and bounds. What was once a condition that killed half of the people who suffered from it, Graves' disease, while remaining a life-threatening illness, is today completely treatable if not curable. Those who suffer from Graves' disease come in all shapes, sizes, ages, races and nationalities, but all have one thing in common: the continuing desire to manage, treat and hopefully one day, cure, this condition.

With each passing day, scientists and physicians are uncovering the secrets behind autoimmune disorders and their related illnesses. With continued education and research, it is hopeful that some day all sufferers of autoimmune disorders, including Graves' disease, can be cured of their conditions and that autoimmunity can be prevented in future generations.

1According to the Thyroid Foundation of America.2Statistic provided by the American Autoimmune Related Diseases Association.3According to the American Thyroid Association.4According to The National Women's Health Information Centre.5The International Programme on Chemical Safety studies find that some pesticides and metals (especially gold) can trigger autoimmune responses in some persons.6The World Health Organisation studies on the relationship between certain vaccinations and the development of Type 1 Diabetes and Multiple Sclerosis.7See Table 1: Important Thyroid-Related Hormones and Elements.8According to the American Autoimmune Related Diseases Association.9See Table 2 - Common Graves' disease Associated Symptoms.10According to the National Graves' disease Foundation.11See Table 3: Testing For Graves' disease.12See's guide to Thyroid Disease, and available testing methods.13See Table 4 - Treating Graves' Eye Disease and Table 5 - Treating Graves' Hyperthyroidism.14According to The Thyroid Society.15According to The Thyroid Society.16Statistics provided by The Association of Thyroid Surgeons.17According to the Journal of the American Medical Association.18According to The Thyroid Society.19Statistics provided by The Thyroid Society.

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