Graves' Disease (Thyroid Gland Problem)

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KEY POINTS

• Graves' disease is the most common type of hyperthyroidism. Hyperthyroidism is when your thyroid gland makes too much thyroid hormone.
• Hyperthyroidism may be treated with medicine, radiation, surgery, or a combination. Tell your healthcare provider right away if you are pregnant or breast-feeding, or if you get pregnant during your treatment.
• Follow the full course of treatment prescribed by your healthcare provider. You will need to have blood tests to check your thyroid hormone level every few months for the rest of your life.

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What is Graves' disease?

Graves' disease is the most common type of hyperthyroidism. Hyperthyroidism is when your thyroid gland makes too much thyroid hormone.

Your thyroid gland is in the lower front of your neck. This gland takes iodine from the food you eat to make thyroid hormones. Thyroid hormones are chemicals that control the way your body turns the food you eat into energy and how fast your body uses energy. They also control body functions such as temperature, heart rate, and appetite.

In older people, untreated hyperthyroidism can cause an irregular heartbeat that can lead to heart failure or a stroke. It can also speed up the process that causes weak bones (osteoporosis) and increase your risk for broken bones.

Graves' disease is more common in women. It usually starts in people under age 40.

Grave's disease usually does not cause severe illness. However, an uncommon, but serious problem called thyroid storm can happen. Thyroid storm is most likely to happen when you are under stress, such as from an injury, infection, or surgery. In thyroid storm, your blood pressure, heart rate, and temperature can get very high. Thyroid storm can be a life-threatening emergency. The best way to prevent it is to keep your Graves’ disease in good control.

What is the cause?

Grave's disease is an autoimmune disorder. This means that your body's defenses against infection attack your body's own tissue by mistake. In the case of Graves' disease, the autoimmune response changes the thyroid gland and causes it to make too much hormone.

What are the symptoms?

Symptoms may include:

• Feeling nervous and anxious
• Trouble sleeping
• Feeling tired, weak, or shaky
• Feeling hot, even sweaty, even when it is cold
• Shortness of breath with activity
• Fast or irregular heartbeat
• Enlarged thyroid gland (goiter) that makes your neck look swollen
• Bowel movements more often
• Weight loss

About half of all people with Graves' disease have an eye problem that keeps the eyelids from completely closing over one or both eyes. The eyes may bulge from their sockets and feel dry and irritated. The muscles that move the eyes may be affected, which may limit movement of the eyes. One eye may be affected more than the other.

A thyroid storm causes severe restlessness, confusion, sweating, and diarrhea. Your heart will beat very fast, your blood pressure will get very high, and you will have a high fever. Thyroid storm is an emergency. If you are having symptoms of thyroid storm, call 911 or have someone take you to the emergency room right away.

How is it diagnosed?

Your healthcare provider will ask about your medical history and symptoms and examine you. Tests may include:

• Blood tests
• A thyroid scan that uses radioactive iodine to see how well your thyroid gland is working

How is it treated?

Treatment for Grave's disease lowers the amount of thyroid hormone in your body. Hyperthyroidism may be treated with medicine, radiation, or surgery:

• Anti-thyroid medicine lowers the amount of thyroid hormone made by the thyroid gland. The medicine usually starts to control hyperthyroidism within a few weeks or months. You will likely need to keep taking the medicine for at least a year or two. Your healthcare provider may adjust your dosage often during that time. Your thyroid levels could go up again, even while you are taking medicine, so you will need to have regular blood tests and checkups with your healthcare provider.
• A pill containing radioactive iodine may be used to kill thyroid cells that are making too much hormone. After this treatment, you may need to take thyroid hormone medicine for the rest of your life. If medicine and radiation do not successfully treat the problem, you may need surgery to remove part or all of your thyroid gland. Surgery usually cures the disease, but you will need to take thyroid hormone medicine for the rest of your life.

Medicine called beta-blockers may be prescribed to help control your symptoms while other treatments take effect. Beta-blockers do not cure Grave's disease, but they can make you feel better within a few hours.

You may be referred to an eye specialist for an eye exam. Eye problems related to thyroid disease need to be treated to prevent loss of vision. Problems with the eye muscles and eyelids, as well as swelling, may be treated with steroid medicine or surgery. Eye problems related to hyperthyroidism may continue even after the thyroid problem is treated.

If you are pregnant or breast-feeding, high thyroid hormone levels can cause problems for both you and your baby. Medicines used to treat high thyroid levels can affect your baby’s thyroid gland. If you are pregnant or breast-feeding, or get pregnant during your treatment, tell your healthcare provider right away.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Don’t stop taking your medicine or change the way you take it unless your provider tells you to.

You will need to have blood tests to check your thyroid hormone level every few months for the rest of your life. The tests can help make sure you are getting the right amount of medicine.

Do not smoke. Nonsmokers respond better to treatment of thyroid disease than smokers. Smoking can worsen the eye problems that can happen with thyroid disease.

Ask your healthcare provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

Most healthcare providers recommend waiting at least a year after treatment to get pregnant. If you have a problem with your thyroid gland and are planning a pregnancy:

• Visit your healthcare provider before you try to get pregnant to make sure that your thyroid problem is controlled. Good control of a thyroid problem may make it easier to get pregnant.
• Be sure to follow your provider’s instructions carefully for taking medicine to control your thyroid hormone levels before and during pregnancy.