Graves' disease is an autoimmune disease that causes the body to produce too much thyroid hormone (hyperthyroidism). This disease can cause variety symptom, in between pounding heart, peweight loss, and shaking hands.
The thyroid gland is responsible for producing hormones that regulate several body functions, such as the nervous system, brain development, and body temperature. In people with Graves' disease, the thyroid gland produces more hormones than needed.
If not treated properly, overproduction of thyroid hormone can cause serious problems with the heart, muscles, menstrual cycle, eyes, and skin. Although many other disorders can cause hyperthyroidism, Graves' disease is the most common cause of the condition.
Graves' disease is most common in women and people younger than 40 years. However, basically this disease can be experienced by anyone.
Reason and Risk Factors Graves' disease
Graves' disease or Graves' disease occurs as a result of impaired immune system function. Under normal conditions, the immune system functions to protect the body from foreign disease-causing organisms, such as viruses and bacteria.
However, in people with Graves' disease, the immune system actually produces TSI antibodies (thyroid-stimulating immunoglobulins), which attacks the thyroid gland, thereby triggering the thyroid gland to produce thyroid hormone in higher amounts than the body needs.
However, it is not known for certain what causes the immune system to produce antibodies that attack the thyroid gland. However, the following factors are known to increase a person's risk of developing Graves' disease:
- Female gender
- 20–40 years old
- Have a family history of Graves' disease
- Suffering from other autoimmune diseases, such as rheumatoid arthritis or type 1 diabetes
- Experiencing stress
- Just gave birth in the span of 1 year
- Have you ever had infectious mononucleosis?
- Have a smoking habit
Symptoms of Graves' Disease
Graves' disease can cause a variety of symptoms. Symptoms generally appear mild at first or even invisible, then gradually develop to become more severe. Some of the symptoms are:
- Enlargement of the thyroid gland (goiter)
- Tremors in the hands or fingers
- Heart palpitations (heart palpitations) or an irregular heartbeat (arrhythmia)
- Changes in the menstrual cycle, including missed periods
- Erectile dysfunction
- Losing weight without losing appetite
- Mood is easy to change
- Decreased sexual desire
- Difficulty sleeping (insomnia)
- Diarrhea
- Hair loss
- Tired easily
- Easy to sweat
- Sensitive to hot air
In addition to the above symptoms, about 30% of people with Graves' disease or Graves' disease experience a number of typical symptoms, namely: Graves’ ophthalmopathy and Graves' dermopathy.
Symptom Graves’ ophthalmopathy It occurs due to inflammation or a disorder of the immune system, which affects the muscles and tissues around the eyes. The symptoms include:
- Protruding eyes (exophthalmos)
- Dry eyes
- Pressure or pain in the eye
- Swollen eyelids
- red eyes
- Sensitive to light
- Double vision
- Loss of sight
Graves’ dermopathhy less frequently found. Symptoms are skin that is red and thickened like an orange peel. Graves' dermopathy It most commonly occurs in the shin area and on the back of the foot.
When to go to the doctor
Check with your doctor if you experience the symptoms mentioned above. Early examination can increase the accuracy of the diagnosis and the effectiveness of treatment.
Go to the doctor or the nearest emergency room immediately if you experience heart-related symptoms, such as palpitations or an irregular heartbeat, or experience loss of vision.
Diagnosis of Graves' Disease
To diagnose Graves' disease, the doctor will ask questions about the symptoms and complaints the patient is experiencing, past medical history, and family medical history.
After that, the doctor will check the patient's vital signs, ranging from pulse, blood pressure, body temperature, to breathing rate. The doctor will also perform a physical examination, especially an examination of the thyroid gland in the neck, and look for the presence or absence of Graves' ophthalmopathy and Graves’ dermopathhy.
To confirm the diagnosis, the doctor may perform several supporting examinations, such as:
- Blood tests, to measure thyroid hormone levels as well as pituitary hormone levels that regulate hormone production from the thyroid gland
- Radioactive iodine test, to see the function of the thyroid gland by ingesting a low dose of radioactive iodine
- Antibody test, to determine the presence of antibodies that attack the thyroid gland
- CT scan or MRI, to see enlargement of the thyroid gland
- Ultrasound, to see enlargement of the thyroid gland, especially in patients who are pregnant
Graves' Disease Treatment
Treatment for Graves' disease aims to reduce the overproduction of thyroid hormone and its effects on the body. Some of the treatment options are:
Drugs
Medicines that can be given by doctors to treat Graves' disease include:
- Antithyroid drugs, such as methimazole and propylthiouracil, to inhibit thyroid hormone production
- Beta-blocking drugs, such as propranolol, metoprolol, atenolol, and nadolol, to reduce the effects of thyroid hormones on the body, such as irregular heartbeat, restlessness, tremors, excessive sweating, and diarrhea
Radioactive iodine therapy
Radioactive iodine therapy is done by taking pills containing low doses of radioactive iodine. These pills work to destroy overactive thyroid cells, as well as shrink the thyroid gland, so that symptoms will gradually decrease over a period of weeks to months.
Radioactive iodine therapy is not recommended in patients with Graves' ophthalmopathy because it can make symptoms worse. In addition, this therapy should not be used in pregnant women and nursing mothers.
Since this therapy works by destroying thyroid cells, the patient will most likely need additional thyroid hormone to increase the amount of thyroid hormone that is reduced by this therapy.
Operation
After surgery, the patient will require further therapy in the form of synthetic thyroid hormone to improve the low thyroid hormone levels due to removal of the thyroid gland.
This action risks causing damage to the nerves that regulate the vocal cords. The risk of damage can also occur to the parathyroid glands, which function to produce hormones that regulate calcium levels in the blood.
Need to know, Graves' ophthalmopathy can persist even if Graves' disease itself has been successfully treated. In fact, symptoms Graves' ophthalmopathy may still get worse for up to 3–6 months after treatment. This condition usually lasts up to a year, then begins to improve on its own.
If needed, Graves' ophthalmopathy will be treated with corticosteroids or teprotumumab. In some cases, surgery may be needed to prevent blindness.
Self care
In addition to the above treatments, Graves' disease patients are also advised to change their lifestyle to a healthier one, by taking the following steps:
- Eat a balanced nutritious diet, such as vegetables and fruits
- Exercise regularly
- Manage stress well
Meanwhile, patients who experience Graves' ophthalmopathy it is recommended to do the following:
- Using artificial tears, which can be obtained at pharmacies
- Taking corticosteroid drugs, which have been prescribed by a doctor
- Use sunglasses to protect your eyes from the sun
- Give a cold compress on the eye
- Elevate the head if you want to sleep
- Do not smoke
Patients with symptoms Graves' dermopathy You can also perform treatment using corticosteroid ointment, and compress the affected leg to reduce swelling.
Complications of Graves' Disease
Graves' disease that is not treated immediately can lead to dangerous complications, such as:
- Pregnancy disorders, such as premature birth, thyroid dysfunction in the fetus, decreased fetal development, high blood pressure in the mother (preeclampsia), heart failure in the mother, and miscarriage
- Heart problems, such as arrhythmias, changes in heart structure and function, and heart failure
- Osteoporosis
- Thyroid crisis (thyroid storm)
Prevention of Graves' Disease
Graves' disease is difficult to prevent because it is an autoimmune disease. However, you can reduce your risk of developing Graves' disease by having regular check-ups if you have a history of autoimmune disease or if you have a family history of Graves' disease.
In addition, the risk of developing Graves' disease can also be reduced by changing a healthier lifestyle, such as not smoking, maintaining an ideal body weight, and exercising regularly.