Graves' disease is a disorder of the immune system that causes the thyroid gland to become overactive. Call your doctor if you have any of the symptoms of hyperthyroidism, including: Also call your doctor if you develop swelling or skin changes in your feet or lower legs, or if you notice a change in your eye appearance or eye function. If you have Graves' ophthalmopathy, your doctor may also recommend that you see a doctor who has trained in eye disorders (ophthalmologist). However, it is still used if other treatments are unsuccessful. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. The implications of this treatment option are very similar to that of surgery: patients need to take a synthetic T4 hormone for the rest of their life, and it doesn’t address the underlying immune system issue. Thyroid hormones affect many aspects of your body. The level of TSH may remain low for weeks to months after methimazole is initiated. Be prepared to answer the following: Mayo Clinic does not endorse companies or products. Graves' disease is the most common autoimmune condition in the U.S. For Graves' disease, some basic questions to ask your doctor include: Your doctor is likely to ask you a number of questions. Other side effects may include tenderness in the neck and a temporary increase in thyroid hormones. Radioactive iodine is concentrated in breast milk and women must stop breast feeding if they choose this therapy. It is not a disorder, but it is normally a sign of a problem related to the thyroid gland. What Is the Vertical Diet? In patients whose scan reveals a diffuse, patchy uptake with autonomous (“hot”) and photopenic areas, the presence of an elevated, circulating TSH receptor antibody level may be the only evidence for coexisting Graves' disease (in a pre-existing multinodular goitre) as opposed to a toxic multinodular goitre, especially in older patients. Your doctor will talk to you about any precautions you should take with this therapy. Thank you for your interest in spreading the word on CMAJ. Graves’ disease was originally known as “exophthalmic goiter” but is now named after Sir Robert Graves, an Irish doctor who first described the condition in 1835. In older people, particularly people with heart disease, the disease may cause heart failure or heart-related chest pain called angina. This treatment option is based on removing the thyroid surgically and replacing its function with a synthetic T4 hormone. Graves disease affects the thyroid gland, a butterfly-shaped organ at the base of the neck, just below the Adam’s apple. It takes several weeks for the action of anti-thyroid medications to lower thyroid blood levels toward normal. One to 2 percent of patients with ophthalmopathy will also have a localized dermopathy, commonly over the anterior shins (pretibial myxedema), consisting of nonpitting edema with occasional raised, hyperpigmented, violaceous papules. Treatment of patients with Graves' disease and the appropriate extent of thyroidectomy. These can include your nervous system function, brain development, body temperature, and other important elements. ISSN 1488-2329 (e) 0820-3946 (p). Available treatments for Graves' disease are contrasted in Table 4. In addition, using compression wraps on your legs may help. Proptosis and extraocular muscle fibrosis may produce disabling diplopia. Exposure to tobacco and other drugs has been shown to be a trigger for autoimmune disorders. These symptoms may include: A small percentage of people with Graves’ disease will experience reddened, thickened skin around the shin area. 2019; doi:10.1097/MED.0000000000000492. Accordingly, treatment of subclinical hyperthyroidism needs to be individualized and based on the patient's age, symptoms and comorbidities. Consuming foods that are rich in iodine or taking iodine supplements may make the symptoms of Graves’ disease worse. Although pretreatment with antithyroid drugs does not prevent the rise in thyroid indices following radioiodine, it allows them to rise from a lower baseline value42 and should be considered for patients with severe hyperthyroidism, elderly patients and those with pre- existing cardiovascular disease. Because all available treatments have serious drawbacks, extensive discussion with the patient about therapeutic options is key to disease control and persistent long-term health. Risks of this surgery include potential damage to the nerve that controls your vocal cords and the tiny glands located adjacent to your thyroid gland (parathyroid glands). Your immune system usually produces proteins known as antibodies in order to fight against foreign invaders like viruses and bacteria. Radioactive iodine therapy has been used to treat Graves’ disease since the 1940s. Antithyroid drugs, radioiodine and surgery all effectively restore euthyroidism but have potentially serious side effects. Removing the thyroid, whether by surgery or RAI, never made much sense to me. Thyroidectomy should only be considered in the following circumstances: when patients have large goitres, when patients are intolerant of antithyroid drugs and/or choose to refuse radioiodine therapy, during the second trimester of pregnancy after failure of antithyroid drugs, or when there is concern about worsening of thyroid ophthalmopathy following radioiodine. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Three treatment options are available for people with Graves’ disease: Your doctor may suggest you use one or more of these options to treat your disorder. Cross-sensitivity between antithyroid drugs may occur in up to 50% of cases.22 Potentially fatal agranulocytosis (absolute neutrophil count < 0.25 х 109/L) occurs in 0.2%–0.5% of subjects. If you have Graves' disease, make your mental and physical well-being a priority: These steps may make your eyes feel better if you have Graves' ophthalmopathy: If the disease affects your skin (Graves' dermopathy), use over-the-counter creams or ointments containing hydrocortisone to relieve swelling and reddening. However, people with very large goiters are less likely to respond well to anti-thyroid medication or radioactive iodine, and may have a better outcome if most of the thyroid gland is removed surgically (called subtotal thyroidectomy). Is It Safe to Take Pepcid While Pregnant? Graves’ disease is one of the most common forms of hyperthyroidism. Rarely, findings may predominate in a single organ system (i.e., altered bowel habit, emotional lability, gynecomastia) and distract from the correct diagnosis. In Graves’ disease, your immune system mistakenly produces antibodies called thyroid-stimulating immunoglobulins that target your own healthy thyroid cells. Your doctor may request laboratory tests if they suspect you have Graves’ disease. Although TSH receptor antibodies are present in the sera of almost all patients with Graves' disease, their measurement is available only in some areas currently. Photo: 123rf. ATDs are generally very effective at reducing T3 and T4 levels and controlling the symptoms of Graves disease. Such concerns can be avoided by definitive radioiodine therapy before conception, and this should be discussed with all female patients of reproductive age. Graves’ disease is an autoimmune disorder. Because Graves' disease increases your metabolism, your doctor will check your pulse and blood pressure and look for signs of tremor. This will still need to be confirmed by thyroid blood tests. These medications don't inhibit the production of thyroid hormones, but they do block the effect of hormones on the body. Anti-thyroid drugs can often be used in conjunction with other treatments such as radioactive iodine therapy or surgery. 2016; doi:10.1089/thy.2016.0229. Conventional Treatment of Graves’ Disease. The use of antithyroid drugs is shown in Fig. 2. This review focuses on issues related to the diagnosis and treatment of Graves' disease that will best help the nonendocrinologist meet these objectives. Best Practice & Research Clinical Endocrinology & Metabolism. What Are the Symptoms of Graves’ Disease? 3: The use of antithyroid drugs. Graves’ disease is the only type of hyperthyroidism that is associated with swelling and inflammation of the eye tissue. Davies TF, et al. The hyperthyroidism and goitre of Graves' disease are caused by stimulation of the thyroid by TSH receptor antibodies.1 Production of these antibodies is primarily within the thyroid gland itself,2 and the immunology underlying this process has been ably described in detail elsewhere.3 It has been suggested that a genetic clonal lack of suppressor T cells may be responsible for the unregulated production of TSH receptor antibody.4 Identified predisposing factors for Graves' disease are outlined in Box 1.