WHAT IS GRAVES’ DISEASE AND HOW IS IT TREATED?

WHAT IS GRAVES’ DISEASE?

Graves’ disease is an autoimmune disorder characterized by the excessive activity of the thyroid gland, leading to hyperthyroidism. Itis named after Robert Graves, who identified this form of hyperthyroidism > 100 years ago. It is the most common cause of hyperthyroidism, particularly affecting women 7-8 times more frequently than men.

WHAT CAUSES GRAVES’ DISEASE?

Graves’ disease results from an autoimmune process within the body's immune system, typically responsible for protecting against foreign invaders like bacteria and viruses. In Graves’ disease, the immune system produces antibodies, specifically TSH receptor antibodies or thyroid-stimulating immunoglobulins (TSI), which stimulate thyroid cells to overproduce thyroid hormones. This overactivity leads to hyperthyroidism.

WHAT ARE THE SYMPTOMS OF GRAVES’ DISEASE?

Hyperthyroidism is a condition that occurs due to excessive production of thyroid hormones. The symptoms of hyperthyroidism include a racing heartbeat, hand tremors, trouble sleeping, weight loss, muscle weakness, neuropsychiatric symptoms, and heat intolerance. It is important to note that these symptoms are not specific to Graves' disease, but can occur in any form of hyperthyroidism.

Eye Involvement: Graves’ disease is uniquely associated with eye inflammation, swelling around the eyes, and eye bulging, known as Graves’ ophthalmopathy or orbitopathy. Approximately one-third of patients exhibit signs, with only 5% experiencing moderate-to-severe inflammation leading to potential vision issues.

Skin Involvement: Some individuals may develop pretibial myxoedema, a rare condition causing a lumpy, reddish skin thickening in front of the shins.

HOW IS THE DIAGNOSIS OF GRAVES’ DISEASE MADE?

Diagnosis involves evaluating symptoms, physical examinations, and laboratory tests measuring thyroid hormones (T4, T3) and thyroid-stimulating hormone (TSH). The presence of Graves’ eye disease, a symmetrically enlarged thyroid gland with a bruit, and a family history of autoimmune disorders further indicate Graves’ disease. Measuring TSH receptor antibody, a thyroid uptake scan ± thyroid ultrasound may be needed.

HOW IS GRAVES’ DISEASE TREATED?

Antithyroid Medication (Carbimazole Neomercazole®): Suitable for patients with a high likelihood of remission, these medications control hyperthyroidism effectively and is the only antithyroid medication available in South Africa.

Radioactive Iodine (RAI) or Surgery: If hyperthyroidism persists after six months, definitive treatments may include RAI or surgery. RAI is administered after achieving euthyroidism with antithyroid drugs.

OUTCOME OF TREATMENT:

Definitive treatments may lead to hypothyroidism (underactive thyroid). Regular thyroid function tests monitor this condition, and if hypothyroidism occurs, daily thyroid hormone tablets are prescribed. The effectiveness of medical treatment in achieving disease remission can vary greatly.

OTHER FAMILY MEMBERS AT RISK:

Graves’ disease has a genetic predisposition as an autoimmune disorder. Although no specific screening gene has been identified, there is a potential familial risk.

Note: Detailed instructions for managing radiation exposure after RAI treatment must be followed to limit exposure to others