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Graves’ Disease

Graves’ disease is a condition in which the thyroid gland produces excessive hormones (hyperthyroidism). It is the most common cause of hyperthyroidism. It is an autoimmune disorder, meaning the body’s immune system acts against its own healthy cells and tissues. The disorder may occur at any age, but women over age 20 are most commonly affected.

The thyroid gland, located in front of your neck just below the voice box (larynx) produces two hormones thyroxine (T4) and triiodothyronine (T3) that regulate body metabolism. With Graves’ disease, the immune system makes antibodies that attack to the thyroid cells and stimulate the thyroid to make more amount of thyroid hormone than your body needs. This results in hyperthyroidism.

Patients with Graves’ disease may have some of the common symptoms such as anxiety, difficulty in sleeping, fatigue, muscle weakness, nervousness, hand tremors, frequent bowel movements, increased appetite, rapid and irregular heartbeat, weight loss, goiter (enlarged thyroid gland), and change in menstrual cycles, and breast enlargement in men. Graves’ disease can also cause eye changes such as inflammation, swelling of the tissues around the eyes, and bulging of one or both eyeballs. This condition is called Graves’ ophthalmopathy. Rarely, there may be thickening and reddening of the skin over the shins known as pretibial myxedema. This skin problem is not serious and is usually painless.

Your doctor will diagnose hyperthyroidism based on the findings of a physical examination of neck, medical history, and by laboratory tests. Laboratory tests include blood tests to measure levels of thyroxine, or T4, and triiodothyronine, or T3 and thyroid-stimulating hormone (TSH) in your blood. Your doctor may conduct a radioactive iodine uptake test, to measure the amount of iodine the thyroid collects from the bloodstream.

The goal of treatment is to control the excessive activity of the thyroid gland. Treatment options include:

  • Antithyroid drugs: Anti-thyroid medications may be prescribed to interfere with the production of hormones by the thyroid gland.
  • Beta blockers: Your doctor may prescribe beta blockers to relieve symptoms such as rapid heartbeat, sweating, and anxiety.
  • Sometimes a steroid drug that suppresses the immune system may be prescribed to reduce eye irritation and swelling.
  • Radioiodine therapy: The thyroid gland uses iodine to produce thyroid hormone. With this treatment, you swallow a pill that contains radioactive iodine that destroys thyroid cells so that less thyroid hormone is made. The thyroid gland shrinks and the symptoms reduce gradually over time. Radioiodine therapy is not used in pregnant women or women who are breastfeeding.
  • Thyroid surgery: You may need to have surgery to remove your thyroid (thyroidectomy).
    After removal of the gland, you will need treatment to provide normal amounts of thyroid hormone to your body for the rest of your life.
  • Royal Australian and New Zealand College of Ophthalmologists.
  • Royal Australasian College of Surgeons
  • UNSW Australia
  • The University of Sydney
  • Sydney & Sydney Eye Hospital
  • Westmead Hospital
  • Save Sight Institute