Graves' Disease Diagnosis

  • Diagnosis

    Graves' disease is a condition in which the thyroid gland makes too much thyroid hormone (hyperthyroidism). It is usually easy to treat and the prognosis is good, although life-long observation by a physician will be required Figure 01. Graves' disease, named after the Irish doctor who first described the illness, is the most common type of hyperthyroidism. It is also referred to as “diffuse toxic goiter”.

    The thyroid is the butterfly-shaped organ situated at the base of the throat. It secretes two hormones (thyroxine and triiodothyronine, also called T4 and T3) that regulate the speed at which the body converts food and oxygen into energy (metabolism). In Graves' disease, the gland goes into overdrive and makes too much hormone, increasing the body's metabolic rate by as much as 60% to 80%. The consequences of a racing metabolism range from weight loss and lighter periods (in women) to serious health concerns such as heartbeat irregularities and osteoporosis.

    Click to enlarge: Glands of the endocrine system

    Figure 01. Glands of the endocrine system

    The thyroid is the butterfly-shaped organ situated at the base of the throat. In Graves' disease, the thyroid gland goes into overdrive and makes too much hormone, increasing the body's metabolic rate by as much as 60% to 80%.

    Graves' disease results when the body's immune system attacks the thyroid gland. The immune system normally guards the body against infections and cancer by making special proteins called antibodies. In Graves' disease, the blood cells that perform this task (lymphocytes) produce antibodies against proteins on the surface of thyroid cells. This stimulates the thyroid gland to secrete too much thyroid hormone, and the gland becomes enlarged.

    An overactive thyroid gland can produce a host of symptoms that can be mistaken for other things. In fact, it is easy for people to blame weight loss, fatigue, and insomnia on stress when Graves' disease is the true culprit. Nervousness, irritability, trembling, sweating, and muscle weakness are other common symptoms of an overactive thyroid gland. In some patients, skin becomes delicate and hair falls out. In premenopausal women, menstrual flow may lighten or stop altogether. More dangerous manifestations include heart palpitations and osteoporosis, which can lead to brittle bones that break easily.

    A painless bulge in the throat (goiter) is a telltale sign of a thyroid problem.

    People with Graves' disease often have bulging, watery eyes, and may experience vision problems such as double vision or blurry vision Figure 02.

    Click to enlarge: Bulging, watery eyes characteristic of Graves' disease

    Figure 02. Bulging, watery eyes characteristic of Graves' disease

    Though rare, Graves' disease can produce a thick, red rash on the front of the shins Table 01.

    Table 1.  Symptoms of Graves' Disease

    Nervousness, irritability, anxiety
    Muscle weakness, fatigue
    Increased appetite, weight loss despite normal eating
    Sweating, shaking, heart pounding
    Hair loss or thinning
    Light or no menstrual flow
    Goiter, bulging eyes
    Vision disturbances (blurred or double vision)
    Skin rash

    Having a family member with Graves' disease or another similar disease in which the body attacks itself (autoimmune disease) increases the risk for developing Graves' disease.

    Increased iodine intake in a person predisposed to Graves' disease seems to play a role in triggering the disease.

    Stress is thought to trigger Graves' disease in some people. Some patients report that symptoms began during or just after emotionally difficult times in their lives, such as caring for a sick family member, a divorce, losing a loved one, or severe financial problems. Research also reveals a link between elevations in stress hormones like cortisone and adrenaline and increased antibody production by the immune system.

    Women are more prone to developing all types of thyroid problems, including Graves' disease. About 2% of women in the U.S. have hyperthyroidism at some time, compared to 0.4% of men. The condition usually strikes during the middle age, but may occur earlier in life.

    If your doctor suspects that you have an overactive thyroid gland, he or she will take your medical history and perform a physical examination. Goiter and a fast pulse are signs of hyperthyroidism. If you have warm, velvety skin, bulging eyes, and trembling fingertips, this too will alert your doctor to the possibility of an overactive thyroid. He or she will ask you if anyone in your family has had a thyroid problem or another autoimmune disease such as diabetes to get a better idea if your hyperthyroidism is genetic.

    Blood tests can reveal a thyroid gland that is working too quickly. A simple blood test can confirm hyperthyroidism. If your thyroid gland is overactive, your blood test will show high levels thyroid hormones and low levels of another hormone, called thyroid-stimulating hormone (TSH). In an attempt to determine the nature of your hyperthyroidism, your doctor may wish to measure the level of thyroid-stimulating antibodies in your blood. High levels reveal immune system involvement, which is indicative of Graves' disease.

    A scan of your thyroid gland can show if your entire thyroid gland is involved, which is characteristic of Graves' disease.

    Because a thyroid problem is not always obvious, regular screening is advised. The American Thyroid Association recommends that all adults get their thyroids checked once every five years, starting at age 35. If you have a known thyroid problem, thyroid disease in your family, or other risk factors such as an autoimmune illness like diabetes, you should be screened more frequently. A simple blood test is all that is required.

  • Prevention and Screening

    Because a thyroid problem is not always obvious, regular screening is advised. The American Thyroid Association recommends that all adults get their thyroids checked once every five years, starting at age 35. If you have a known thyroid problem, thyroid disease in your family, or other risk factors such as an autoimmune illness like diabetes, you should be screened more frequently. A simple blood test is all that is required.

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