CLINACASE

Data

ID: 255
Category: Autoimmune Disease
CreatedBy: 1
UpdatedBy: 1
createdon: 26 May 2023
updatedon: 26 May 2023

For Bots

Author: Khoa Tran
Published May 26, 2023
Updated May 26, 2023

Table of contents

Graves' Disease

Etymology and Pronunciation

Graves' disease (greyvz dih-zeez)

The disease is named after Robert James Graves, an Irish physician who first described the condition in the early 19th century. It is also sometimes referred to as Basedow's disease, after another physician who independently identified the same medical condition.

History of Graves' Disease

The history of thyroid diseases and the understanding of their pathogenesis and treatment have evolved over time, marked by significant milestones and discoveries. In 1786, Caleb Parry provided the first description of Graves disease, later recognized as hyperthyroidism. However, it wasn't until 1882-1886 that the pathogenesis of thyroid disease was discovered. The first thyroidectomy for hyperthyroidism was performed in 1880, and in the early 1940s, antithyroid drugs and radioiodine therapy were developed. Thomas Curling described hypothyroidism (myxedema) in 1850, and after 1883, the cause and suitable treatment were established. These historical landmarks in the understanding and management of thyroid disease are discussed in this paper, along with the scientific aspects of the thyroid gland and the evolution of endocrinology as a formal discipline.

The origins of endocrinology can be traced back to earlier speculations and theories. In 1690, Frederick Ruysch proposed that the thyroid gland secretes substances of physiological importance, followed by a similar theory put forward by Theophile de Bordeu. However, these ideas lacked experimental proof. French physiologist Claude Bernard, considered the father of endocrinology, established its principles as a formal discipline in the mid-19th century.

In 1786, Caleb Hillier Parry (1755–1822), a renowned practitioner from Bath, England, became the first person to describe the features of hyperthyroidism, later known as Graves disease. Parry encountered five cases characterized by exophthalmic goitre, palpitation, and anxiety. He vividly portrayed his patients, noting that "eyes were protruded from their sockets, faces exhibited an appearance of agitation and distress, the heart beat was so violent that each systole of the heart shook the whole thorax...". Parry initially attributed these symptoms to alterations in cardiac function and, in a posthumously published paper, described a case of exophthalmos associated with goitre and 'non-organic heart disease' to explain palpitation. Although Parry was the first to recognize hyperthyroidism, the initial published work on the subject was by Giuseppe Flajani in 1802.

In 1833, Robert James Graves (1796–1853) from Dublin, one of the founders of the Park Street School of Medicine, published a remarkable description of exophthalmic goitre, leading to the disease being commonly referred to as Graves disease, even though Parry had identified it 47 years earlier. Similar to Parry, Graves mistakenly believed that the disease resulted from cardiac function alterations. He eloquently wrote, "the sudden manner in which the thyroid used to increase and then diminish in size and the connection of this with the state of the heart's action are circumstances which may be considered as indicating that the thyroid is slightly analogous in structure to the tissues properly called erectile".

In 1840, Adolph von Basedow (1779–1854) from Germany added to the understanding of Graves disease by completing the picture of toxic goitre. While Graves had noted exophthalmos in only one of his three cases, Basedow observed exophthalmos in all four of his cases. Due to Basedow's practice in Merseburg, the characteristic signs of Graves disease, including goitre, exophthalmos, and palpitation, were often referred to as "Meresberg's triad." Basedow also mentioned additional thyrotoxic features such as restlessness, wasting, and diarrhea.

In 1855, Bernard introduced the term "internal secretions" while studying the liver's role in sugar metabolism. He distinguished between external secretions (such as bile) and internal secretions (including blood sugar). Important research in endocrinology took place from 1855 to 1902, with contributions such as Addison's account of suprarenal capsule disease, Brown-Séquard's demonstration of the delay in animal death after adrenalectomy through blood infusion, and Minkowski and Von Merring's experimental production of diabetes. During this time, diseases like Graves disease and acromegaly were described in relation to glandular dysfunction.

Until 1880, various causes and pathogenetic mechanisms were proposed for Graves disease. Parry and Graves, as mentioned earlier, believed in a cardiac lesion as the cause. Prior to this, the etiology of hyperthyroidism was thought to be a nervous system disorder. In 1880, Ludwig Rehn from Frankfurt performed the first thyroidectomy on a patient with Graves disease. The patient experienced improvement in symptoms and signs, leading Rehn to propose that the clinical features of the disease were a result of hyperactivity of the thyroid gland. In 1886, Paul Julius Mobius from Leipzig supported Rehn's perspective, suggesting an abnormal activity of the thyroid gland that "poisoned" the body. The issue was further addressed in 1909 when William Osler speculated that the symptoms of Graves disease were "due to disturbed function of the thyroid gland, probably a hypersecretion of certain materials which induce a sort of chronic toxaemia". The term hyperthyroidism was introduced by Charles Mayo in

In 1902, English physiologists William Bayliss and Ernest Starling made significant discoveries. While studying the effects of "pancreatic juices" on the duodenal mucosa, they isolated a substance called "secretin." Injecting secretin into an animal's bloodstream resulted in increased pancreatic secretion, supporting Bernard's concept of internal secretion. In 1905, Starling coined the term "hormone" for this internal secretion, and secretin became the first hormone to be isolated. Starling also differentiated between endocrine and exocrine secretions, leading to the term "endocrine."

Modern Understanding of Graves' Disease

Graves' disease is a health condition that affects the thyroid gland, which is located in the neck, and produces hormones that regulate the body's metabolism. When someone has Graves' disease, the immune system mistakenly attacks the thyroid gland, causing it to produce too much thyroid hormone. This condition is the most common form of hyperthyroidism, and it can affect people of all ages and genders, but is more common in women.

One of the hallmark symptoms of Graves' disease is a goiter, which is an enlargement of the thyroid gland that is visible in the neck. Other symptoms of this condition can include weight loss, rapid or irregular heartbeat, tremors, increased sweating, nervousness or anxiety, and changes in the eyes, such as bulging or redness.

The symptoms of Graves' disease can be distressing and even dangerous, which is why it's important to get an accurate diagnosis and treatment from a healthcare provider. There are several treatment options available for Graves' disease, depending on the severity of the condition and the individual's health status. Some of these treatments include medications to control the levels of thyroid hormone in the body, radioactive iodine therapy, and surgery to remove the thyroid gland.

While Graves' disease can be a challenging health condition to manage, many people are able to successfully manage their symptoms and live healthy, active lives with appropriate treatment and support. If you have symptoms of Graves' disease, talk to your healthcare provider to learn more about your options and get the care you need to feel your best.

Causes of Graves' Disease

Graves' disease is an autoimmune disorder that results in an overactive thyroid gland. The exact cause of Graves' disease is not known, but research suggests that it is caused by a combination of genetic and environmental factors.

One of the main contributing factors to Graves' disease is thought to be genetics. People who have a family history of autoimmune disorders are more likely to develop Graves' disease. Additionally, researchers have identified certain genes that are associated with an increased risk of developing the condition.

Environmental factors can also play a role in the development of Graves' disease. For example, smoking has been linked to an increased risk of developing the condition. Additionally, exposure to high levels of iodine can trigger the onset of Graves' disease in people who are genetically predisposed to the condition.

Stress and other emotional factors have also been shown to contribute to the development of Graves' disease, although the exact mechanisms by which these factors affect the disease are not well understood.

Overall, Graves' disease is a complex condition that is caused by a combination of genetic and environmental factors. Researchers continue to study the disease to better understand its underlying causes and develop more effective treatments.

Treatments for Graves' Disease

Graves' disease is a medical condition that causes an overactive thyroid gland. Treatment options may vary depending on the severity of the condition, but they generally include medication, radioiodine therapy, and surgery.

Medications used to treat Graves' disease include anti-thyroid drugs, beta-blockers, and corticosteroids. Anti-thyroid drugs work to reduce the amount of hormone produced by the thyroid gland. Beta-blockers help to alleviate symptoms such as heart palpitations, sweating, and nervousness. Corticosteroids are sometimes used to reduce inflammation around the eyes if it is present.

Radioiodine therapy involves taking a radioactive iodine capsule or solution, which destroys thyroid cells that are producing too much hormone. This treatment can make the thyroid gland underactive, so ongoing medication and monitoring are necessary after treatment.

Surgery is typically reserved for cases where other treatments have not been effective, or when the condition is severe. Surgery involves the removal of all or part of the thyroid gland, and it requires ongoing hormone replacement therapy.

Lifestyle Changes

While lifestyle changes alone cannot cure Graves' disease, they can play a supportive role in managing the condition and improving overall well-being. Here are some lifestyle recommendations for individuals with Graves' disease:

- Medication Adherence: It is crucial to follow the prescribed medication regimen as directed by your healthcare provider. Medications such as antithyroid drugs, beta-blockers, or radioactive iodine may be prescribed to control thyroid hormone levels and manage symptoms.
- Regular Medical Check-ups: Maintain regular follow-up appointments with your healthcare provider to monitor thyroid hormone levels, adjust medication dosages if needed, and assess overall health.
- Stress Management: Chronic stress may worsen symptoms of Graves' disease. Incorporate stress-management techniques such as relaxation exercises, deep breathing, meditation, yoga, or engaging in hobbies and activities that promote relaxation. Prioritize self-care and make time for activities that bring joy and reduce stress.
- Balanced Diet: Adopting a well-balanced diet can support overall health. Include a variety of nutrient-rich foods such as fruits, vegetables, whole grains, lean proteins, and healthy fats. Consider working with a registered dietitian who specializes in thyroid health to tailor a diet plan that suits your specific needs.
- Limit Stimulants: Stimulants like caffeine and alcohol can potentially exacerbate symptoms such as heart palpitations, nervousness, and irritability. It may be helpful to limit or avoid these substances or consume them in moderation.
- Adequate Sleep: Prioritize quality sleep and establish a consistent sleep routine. Aim for 7-9 hours of uninterrupted sleep each night. Create a relaxing environment, practice good sleep hygiene, and consider stress-reducing techniques before bedtime.
- Exercise Regularly: Regular physical activity can promote overall well-being and help manage stress. Engage in moderate exercise such as walking, swimming, yoga, or cycling, as tolerated. However, consult with your healthcare provider before starting any new exercise regimen.
- Supportive Network: Seek support from family, friends, or support groups to cope with the emotional and physical challenges associated with Graves' disease. Sharing experiences and information with others who have the condition can be beneficial.
- Protect Your Eyes: If you have Graves' ophthalmopathy, take steps to protect your eyes. Wear sunglasses, use lubricating eye drops, and avoid smoke and other irritants that may worsen eye symptoms. Consult an ophthalmologist for further guidance.

It is important to note that lifestyle changes should always be discussed with your healthcare provider, as they can provide personalized guidance based on your specific condition and medical history. They can also monitor your progress and adjust treatment accordingly.

Symptoms

-
1234
Sensitivity to heat
-
1235
Light or absent menstrual periods
-
1236
Frequent bowel movements
-
1237
Swelling of the thyroid (goiter)
-
1238
Uncontrollable shakes / Tremors
-
1239
Sweating
-
1240
Weight loss
-
1241
Muscle Weakness
-
1242
Difficulty sleeping
-
1243
Fatigue

Confirmation Tests

- Thyroid ultrasound
- Thyroid autoantibody tests
- TSH (Thyroid stimulating hormone) test
- Radioactive iodine uptake (RAIU) test

Similar Conditions

Comments