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Graves disease, https://**www**.nchmd.org/education/mayo-health…
Graves disease
clinical manifestations
goiter
enlarged thyroid gland
menstrual cycle changes
unexplained weight loss
increased metabollic rate
erectile dysfunction and/or reduced libido
heat sensitivity and increased sweating
increased bowel movements
tremor in the hands and fingers
Grave's opthalmopathy
bulging eyeballs, gritty sensation, redness, light . sensitivity, loss of vision
anxiety and irritability
fatigue
grave's dermopathy
thick red skin on the shins or tops of feet
sleep disturbance
palpations
Risk Factors
Family History- Altered genes within the human leukocyte antigen (HLA) complex are passed down which increases the risk of developing Graves disease.
Sex- Women are more susceptible to developing Graves disease than men.
Age- This disease typically develops in people before the age of 40.
Smoking- Because cigarette smoking affects one's immune system, it then increases the risk of developing Graves disease.
Autoimmune disorders- People that have other autoimmune disorders, for example rheumatoid arthritis, are more likely to develop this disease.
diet - increased iodine intake
stress
infection
Incidence / Prevalence
Most common cause of Hyperthyroidism
Grave's Disease accounts for about 60% - 80% of hyperthyroidism cases in US
Overall prevalence of hyperthyroidism is only about 1.2% in the US
affects over 10 million people within the US each year
it is 5x more likely to occur in women over the age of 30
3% of women and 0.5% of men in the US
treatment
surgery
thyroidectomy or subtotal thyroidectomy
removal of the thyroid gland
must take medication to supply body with the necessary hormones
risks: damage to the nerve that controls the vocal cord, damage of parathyroid gland,
beta-blockers
block the effects of thyroid hormone on the body
can provide rapid relief for palpations, anxiety, tremors, heat intolerance, sweating, diarrhea, and muscle, weakness
examples include: propranolol, atenolol, metoprolol, and nadolol
cautioned for use in those with asthma and diabetes
side effects include: bradycardia, lightheaded, cold hands or feat, weight gain
treating grave's opthalmopathy
prisms
prisms in glasses to correct double vision
Teprotumumab (Tepezza)
medication to treat opthalmopathy given through an IV every 3 weeks for 8 times
corticosteroids
decrease swelling behind the eyeballs,
Orbital radiotherapy
destroys some tissue behind the eyes
Orbital decompression surgery
removal of the bone between your eye socket and sinuses to create room for your eyes to return to their normal position
anti-thyroid medication
interfere with the thyroid glands ability to use iodine and create thyroid hormone.
examples: propylthiouracil and methimazole (Tapazole)
side effects: rash, joint pain, liver failure, and a decrease in WBCs
methimazole is used more commonly due to less risk for liver failure, however it is high risk for pregnant women and therefore propylthiouracil is used most often in pregnant women
radioactive iodine therapy
radioactive iodine (radioiodine) is taken by mouth, this is then taken up by the thyroid cells and the radioiodine begins to destroy the overactive thyroid cells causing the thyroid gland to shrink.
side effects include: new or worsen graves opthalmopathy, tenderness in the neck, short term increase in thyroid hormone, a major decrease in thyroid function that may require medication in the future.
Contraindicated in pregnant and breast feeding women
Citations
https://pubmed.ncbi.nlm.nih.gov/9534029/
https://www.ncbi.nlm.nih.gov/books/NBK448195/
https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240
https://www.nchmd.org/education/mayo-health-library/details/CON-20301716
https://www.mayoclinic.org/diseases-conditions/graves-disease/diagnosis-treatment/drc-20356245
Diagnostics
Blood Testing
Excess TSH: TSH stimulates the thyroid gland and people with Graves normally have lower-than-normal levels of TSH.
Free T-4 normally elevated
Free and total T-3 normally elevated
Thyroid stimulating immunoglobulin (TSI)- antibody specific to Graves disease
Thyroid stimulating hormone receptor antibody (TRAb)
Anti-thyroid peroxidase antibody- autoanitbody found in Graves and Hasimotos
Radioactive Iodine Uptake
Iodine is needed to make thyroid hormone, therefore by giving a small amount of radioactive iodine and then measuring the amount of residual in the gland, it can be determined how fast the thyroid takes up iodine to make thyroid hormone and can help differentiate Graves from other types of hyperthyroidism.
Imaging
Ultarsound
Ultrasound can show if the thyroid is enlarged and can be useful in patients who can't undergo radioactive iodine uptake, such as pregnant women.
Other imaging
Other imaging such as CT or MRI may be ordered if the diagnosis isn't clear from the other assessments.
Pathogenesis
autoimmune thyroid disease
type II hypersensitivity
These antibodies then bind to and activate the receptor, causing the autonomous production of thyroid hormones
the autoantibodies called thyroid-stimulating immunoglobulins (STIs) or thyroid receptor antibodies (TRABs) override the normal negative feedback loop that regulates thyroid hormone secretion
the TSIs stimulate the TSH receptors leading to hyper-stimulation, an enlarged thyroid gland (goiter) and increase thyroid hormone secretion (especially T3)
the excess production of these hormones then leads to the common symptoms of graves disease
Caused by the production of IgG autoantibodies directed against the thyrotropin receptor
Hyperthyroidism
excess secretion of thyroid hormones T3 and T4
https://**www**.nchmd.org/education/mayo-health-library/details/CON-2030171
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