A Simple Guide to Graves's Disease, Diagnosis, Treatment and Related Conditions

This book describes Graves's Disease, Diagnosis and Treatment and Related Diseases

Recently a young man 26 years of age consulted me because he had been losing weight and tired for the past 6 months after beginning work for the first time.
He also had very fast heart beats and feeling hot all the time.
On examination he also had a swollen thyroid gland.
It was an obvious Graves's thyrotoxicosis caused by anxiety and stress from work.
I took his blood for a thyroid profile test.
In the meantime I started him on propranolol for his heart rate and ativan for anxiety.
When the blood results showed low TSH and high T3 and T4, thyrotoxicosis was confirmed and I started him on carbimazole 5mg three times daily.
This dose has since been weaned down to carbimazole 5mg every morning.
He is now back to normal.

Graves's disease is an autoimmune disease which mainly involves the thyroid gland.

Graves's disease is the most frequent cause of an overactive thyroid.

Graves's disease must be diagnosed and treated early since the disorder can involve heart function, bone structure and the eyes.

It is not known what causes autoimmune illnesses like Graves's disease.

Autoimmune illnesses are more frequent in females.

Graves's disease is more frequent in women aged 20 to 40 years and in people who have a family history of the disorder.

Like all autoimmune diseases, it happens more often in patients with a positive family history.

It is more frequent in monozygotic twins than in dizygotic twins.

It is triggered by environmental factors like stress, smoking, infection, iodine exposure, and postpartum, and after highly active antiretroviral therapy (HAART) due to immune reconstitution.

Manifestation of Graves's disease is dependent on the age of beginning, severity, and duration of hyperthyroidism.

In the elderly population, symptoms may be mild or masked, and they may manifest with non-specific signs and symptoms such as:
Fatigue,
Weight loss, and
New onset atrial fibrillation.

In younger patients, frequent presentations are:
Heat intolerance,
Sweating,
Fatigue,
Weight loss,
Palpitation,
Tremors.

The first test for diagnosis of hyperthyroidism is the thyroid-activating hormone (TSH) test.

If TSH is suppressed, the doctor needs to order Free T4 (FT4) and Free T3 (FT3).

Suppressed TSH with high FT4 or FT3 or both will validate the diagnosis of hyperthyroidism.

Features indicative of Graves's disease are:
Positive family history of Graves's disease,
Presence of orbitopathy,
Diffusely enlarged thyroid with or without bruit
Pre-tibial myxedema.

If the diagnosis is in doubt due to absence of one or more of these features, these tests can be ordered:
Measurement of TSH receptor antibody (TRAb)
Radioactive iodine uptake scanning with I-131
Thyroid Ultrasonogram with Doppler

CT or MRI of orbits can be conducted to diagnose Graves's orbitopathy in patients who manifest with orbitopathy without hyperthyroidism

The treatment comprises rapid symptoms control and reduction of thyroid hormone secretion.

A beta-adrenergic blocker should be started for symptomatic patients, specifically for patients with heart rate more than 90 beats/min, patients with a history of cardiovascular disease, and elderly patients.

There are three methods to reduce thyroid hormone synthesis:
Anti-thyroid drugs which block thyroid hormone synthesis and release
Radioactive iodine (RAI) treatment of the thyroid gland
Total or subtotal thyroidectomy.

TABLE OF CONTENT
Introduction
Chapter 1 Graves's Disease
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Thyroid Eye Dis

Dettagli