Cwynar Article Archives

January 2011 | Newsletter archives

Is Graves' Disease a grave diagnosis?
By Eva Cwynar, M.D.

While any disease is cause for concern, Graves' disease, a common form of hyperthyroidism, is rarely life-threatening but can affect a patient's mood swings and sometimes alter physical appearance.

When people are hoarse, they often say they have a 'frog in their throat.' What we all actually have in the lower part of our necks is a butterfly, or at least a gland in the shape of one. It's the thyroid and its function is to secrete hormones such as thyroxine that deliver energy to our body's cells. When it becomes hyper, or over-active, it can cause a number of disorders, one of which is Graves' disease.

Named after the Irish physician Robert Graves who first recognized the disease in 1835, Graves' disease is characterized by over-activity of the thyroid gland and can cause an increased pulse rate, nervousness and sweating, heat intolerance and hair loss. Its most common symptoms also include increased irritability, fatigue, difficulty sleeping, a fine tremor in your hands or fingers, weight loss, frequent bowel movements and for women, a change in your menstrual cycle. It's also fairly common for the eyes to show a change. Known as Graves' ophthalmopathy, the tissues and muscles behind the eyes swell, causing the eyeballs to bulge slightly.

This hyperthyroid disease is four times more common in women than in men, and affects approximately 136,000 women and men in the United States each year.
In a normal immune system, antibodies protect you against infection and abnormal body cells. But in Graves' disease, the antibodies produced actually attack, causing the thyroid to overproduce thyroid hormones. While 10 to 15 percent of the population has the type of immune system that can lead to Graves' disease, a relatively small percentage actually develops the disease.

In my practice, I've seen patients who trigger hyperthyroidism when under severe emotional stress such as the death of a family member or a divorce. I've seen people who develop a goiter, or a swelling in their neck due to an enlarged thyroid, a key indication of hyperthyroidism and possibly Graves' disease. Nearly half of all people with Graves' develop eye symptoms as well. Diagnosis is actually very straight forward and includes a thorough medical history and physical examination as well as a blood test to measure thyroid hormone levels.

The good news is that you now have a diagnosis for your symptoms: Graves' disease. The bad news is that there are no treatments to stop production of the attacking antibodies.

Anti-thyroid drugs may be used to decrease production of thyroxine, the thyroid hormone. Beta-blockers help regulate your heart rate and even calm feelings of anxiety. In more severe cases, doctors may also use radioactive iodine to treat hyperthyroidism. This treatment, where radioactive iodine in either a capsule or in liquid form is administered, results in the destruction of thyroid tissue usually within two to three months. It doesn't harm other tissues in the body, and may help eliminate the "bug-eyed stare" of Graves' ophthalmopathy. With radioactive iodine, patients will need to take thyroid hormone supplements for the rest of your life.

If all else fails, surgical removal of the thyroid may also be an alternative, but you will also be required to take daily thyroid hormone supplements.

Many people ask: Can I prevent Graves' disease? No. But it is easily detected and even more easily managed, something that can't necessarily be said for all thyroid issues.