Shedding Light on Graves’ Disease

You may not realize it, but your neck is home to one of the most important glands in the entire body. The thyroid, a small gland in your neck that resembles a butterfly, produces hormones responsible for anything from metabolism to the energy you need to get through the day.

Any changes to your thyroid, known as thyroid malfunction, can create a litany of medical problems. One notable disease, called Graves’ disease, is responsible for a majority of overactive thyroid cases. We’ll dive deeper into what exactly causes Graves’ disease, which symptoms occur because of it and how it can be treated.

Is Graves’ disease an autoimmune disease?

There are more than 80 known autoimmune diseases that affect 24 million Americans. Graves’ disease is one of them, affecting about 1 in 200 Americans.

In most people, your body signals the immune system when a foreign invader (germs, bacteria, viruses, etc.) is present. The immune system initiates a defense via antibodies to eradicate these harmful pathogens. In people with autoimmune diseases, the body misinterprets healthy cells and organs for disease-causing cells. The subsequent response then causes autoimmune diseases.

Graves’ disease involves an autoimmune attack on the thyroid, which causes it to become overactive, a condition known as hyperthyroidism. Graves’ disease is the most common cause of hyperthyroidism.

While it can affect both sexes, Graves’ disease is eight more times common in women than men and occurs most in middle-aged people (30 to 50 years old).

What causes Graves’ disease?

The exact cause isn’t clear, although there is some belief underlying genetic abnormalities combined with a trigger, such as an infection, lead to Graves’ disease.

While some autoimmune diseases cause a reaction that destroys healthy cells, Graves’ disease has the opposite effect. The antibodies, called thyroid stimulating immunoglobulins (TSI), created during the immune system response binds to thyroid cells and mistakenly acts as a thyroid stimulator. This signals the pituitary gland to make more thyroid hormones – triiodothyronine (T3) and thyroxine (T4) are the two main thyroid hormones – even though it isn’t needed.

Graves’ disease symptoms

Hyperthyroidism is the main symptom associated with Graves’ disease, but your eyes and skin can also be affected.

Hyperthyroidism

Hyperthyroidism speeds up your body functions. Think of it this way: An overactive thyroid is like loading your body with stimulants. Stimulants increase your central nervous activity, which in turn make your heart beat faster. This explains why some people with Graves’ disease experience a rapid heart beat. 

It also speeds up your digestive system, leading to increased episodes of bowel movements or diarrhea. Just like drinking too much coffee can make you irritable or jittery, Graves’ disease can have the same effect. It’s common to have trouble sleeping or experience muscular complications. When too much thyroxine is released, it can make your muscles stiff and weak.

Too much thyroxine can cause thyrotoxicosis, which may lead to a swollen neck and the eventual development of a goiter.

Most of all, an overproduction of thyroid hormones sends your metabolism into overdrive. Unexpected weight loss is one of the more common symptoms of Graves’ disease. Many people gain the weight back once they begin hormone-controlling medications.

Graves’ eye disease

Graves’ disease and Graves’ eye disease (also called Graves’ ophthalmology) may occur at the same time or independently of each other, but they do stem from the same issue – a faulty immune system response. For this specific eye disease, the tissue around the eyes is the target of the immune system attack. The resulting swelling and inflammation can cause bulging eyes, increased pain and swelling around the eye sockets and decreased vision.

Skin disease

In rare cases, the skin on your shins can become red and thick, known as pretibial myxedema or Graves’ dermopathy. Most instances are mild.

Is Graves disease curable?

No. Unfortunately, this is a life-long condition. However, there are many treatment options available to create normal thyroid function. Medications or radioiodine therapy are typically the first course of treatment. Thyroid surgery is less common.

Medications

The most straightforward treatment includes taking antithyroid medicines, such as methimazole. When taken on a regular basis, the medication regulates thyroid hormone production to normal levels. The results are hardly instant, though. Antithyroid medications can take months to normalize hormone production, and treatment cycles can last as long as 18 months.

Antithyroid medications can address the problem (overactive thyroid), but they won’t treat the symptoms. For that, your doctor will likely prescribe beta blockers for symptomatic relief. Beta blockers help treat anything from rapid heartbeat to headaches, so the medication’s versatility is beneficial for the wide-ranging symptoms associated with Graves’ disease.

Radioactive iodine

It may sound scary, but radioiodine therapy uses a low, safe dose of radioactive iodine I-131 (an isotope of iodine that emits radiation) to slowly destroy thyroid gland cells. With fewer thyroid cells to produce hormones, your levels slowly return to normal.

As an unintended consequence, your thyroid can eventually seesaw to the other end of the spectrum and not produce enough thyroid hormone, also known as hypothyroidism. Hypothyroidism is much more manageable disease than hyperthyroidism, so the benefits of radioiodine therapy outweigh the risks.

Surgery

Surgery to remove the thyroid is less common and is generally only performed in cases in which a goiter is present or in patients who don’t respond well to treatment. A surgeon will either remove part of the thyroid or the entire gland (called a thyroidectomy). A total removal requires daily thyroid hormonal therapy to maintain function.

Graves’ disease diet

Many people wonder if there is a specific diet that can help Graves’ disease. The short answer is no. If anything, there are a few things to avoid.

For example, people undergoing radioactive iodine therapy may need to avoid high iodine foods leading up to treatment. A low iodine diet helps the thyroid absorb more radioactive iodine. 

Foods high in iodine include:

• Seafood
• Seaweed
• Eggs
• Butter
• Chocolate

You should also steer clear of caffeine. An overactive thyroid increases your body function as it is. Adding another stimulant to the mix such as caffeine can only make symptoms worse.

While there isn’t an official food schedule to follow for Graves’ disease, it’s always beneficial to eat fruits, vegetables, whole grains and lean proteins and limit processed foods, sugary sweets and fried foods.

Foods high in antioxidants, protein, calcium and vitamin D may also be beneficial for people with Graves’ disease. Antioxidants, such as those in berries and colorful vegetables, help support a strong immune system. 

When left untreated, excess thyroid hormone inhibits how much calcium gets to your bones. This can lead to osteoporosis, so eating calcium-rich foods will help keep bones strong. Your body also needs vitamin D to absorb calcium. Foods rich in vitamin D include mushrooms, fortified milk and fortified cereals.

If you suspect you may have Graves’ disease, talk to your primary care provider. They can refer you to an endocrinologist to help treat thyroid disorders.