Danger Level: Medium 

What is it?

Graves disease is an immune disorder of the thyroid gland in which the gland works overtime.

Who gets it?

About 2% of women, and 0.2% of men. Usually it begins between ages 20-50.

What causes it?

As explained in another disease of this kind (the auto-immune kind) – Lupus, although our body’s immune system creates molecules called antibodies to fight infections, sometimes, for reasons unknown, these antibodies can also attack the body itself.

To understand how these antibodies work, we first need to understand how the thyroid gland works.

In order for the thyroid gland to do its job, the brain sends it a command to work. It does so by sending a molecule called TSH to the gland. When it receives this molecule, through a receptor inside the gland, it starts producing the thyroid hormones, that are responsible for regulating different things in our body.

In graves disease the antibodies mentioned before attack the TSH receptor and cause it to work all the time, as if the brain is constantly sending TSH. This causes the thyroid gland to over-function, a condition called hyperthyroidism.

How does it feel?

There are many manifestations to the disease. They can be divided in two:

1. Symptoms that are related to the thyroid gland’s over function – they can also be seen in other conditions that cause the thyroid to over function:

• Hyperactivity and irritability
• Heat intolerance and sweating
• Heart palpitations
• Fatigue and weakness
• Weight loss with increased appetite
• Diarrhea
• Increased urination
• Tremor of the body
• Warm, moist skin
• Muscle weakness
• Goiter – this is an enlargement of the gland, as seen in this picture:

A woman with a goiter. You won’t see goiters these large today.

2. Symptoms that are related to Graves disease:

One of the main features in Graves is an eye problem, called an exophthalmus. What it means is simply “bulging of the eyes”, as can be seen in this picture:

How is it discovered?

By a blood test: It will show that the thyroid hormones are way up, and that TSH itself is low – the brain doesn’t send it anymore because it sees there are enough hormones already.

How is it treated?

There are 3 ways:

1. Antithyroid Drugs: These are drugs that cause the thyroid to produce less of its hormones. They are called Propylthiouracil and Methimazole.

2. Radioactive iodine: One of the materials needed to create thyroid hormones is iodine. The thyroid glands takes it from the blood and uses it to create its hormones. When it takes iodine that’s radioactive, the gland is destroyed and so can’t produce all those extra hormones.

3. Surgery: In which the gland is taken out, also stopping the over-releasing of hormones.

What happens after treatment?

In about 18-24 months, the antithyroid drugs are fully effective and the hormones return to normal. With radioactive treatment, it takes about 2-3 months for a full effect. In some cases the disease can return after treatment.

The cause of Graves disease, like other autoimmune diseases, isn’t known. There is nothing you can do to prevent it from coming.

What next?

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