What is it?
Graves’ disease is a condition that affects the thyroid gland, making it overactive. The thyroid gland is located in front of the neck and produces some hormones that help in controlling the body’s metabolism (energy use).
Graves’ disease is only one of the several causes of an overactive thyroid gland. We have chosen to discuss it because it is very common in our environment. It is due to a problem with the immune system causing it to attack the cells of the thyroid gland and cause them to produce larger quantities of hormones.
Graves’ disease, just like other autoimmune diseases is commoner in women. The risk is also slightly higher in smokers.
What are the symptoms and signs?
• Heat intolerance; i.e. feeling uncomfortable in heat, even at temperatures which do not cause discomfort to others around
• Excessive sweating
• Unexplained weight loss
• Awareness of heartbeat (palpitations)
• Faster-than-normal heartbeat
• Neck swelling (goitre)
• Bulging, red or watery eyes
• Irritability. Graves’ disease can cause
• Irregular heartbeat
• Muscle weakness.
What treatments work?
Treatment aims to get the levels of the thyroid hormones back within normal range. There are a number of effective ways of achieving this.
A commonly used treatment for an overactive thyroid is radioactive iodine. Taken just once as a drink or capsule, the iodine is absorbed by the thyroid and the radiation shrinks the thyroid, reducing hormone production. However, this radiation makes it unsuitable for pregnant or breastfeeding women.
The major downside of this modality is that sometimes the thyroid gland can be shrunken so much that it doesn’t even produce enough hormones to maintain the body’s needs. When this happens, these hormones need to be replaced artificially for life.
Pregnant and breast-feeding women, and those who choose not to take radioactive iodine can take antithyroid drugs. These drugs can either be taken over a long term or briefly to regulate their hormone production before going on to have other treatments.
Such drugs include carbimazole, thiamazole and propylthiouracil. The latter is safest during the early stages of pregnancy. Your doctor will direct you on how to take the drugs based on your case scenario.
Surgery is another option which is usually recommended to women who are 4 to 6 months pregnant, children, and people with a very large neck swelling. One may be required to take antithyroid drugs for about a week to prepare the thyroid for surgery.
In addition to the thyroid drugs, the doctor might also prescribe drugs to protect the heart and make one feel better until other treatments can get the hormones under control. Steroids can also help reduce the risk of getting eye problems from Graves’ disease (called Graves’ ophthalmopathy).
What will happen to me?
Treatment for Graves’ disease are quite effective, but some people need more treatment in future.
Long-term antithyroid drug use is likely to normalise the thyroid hormone level after about a couple of years. A lot of people will need to continue taking the drugs for much longer or choose another treatment option.
A majority of the eye problems caused by an overactive thyroid go away after treatment. About 20 percent of people need specialist treatment for their eye problems.