DEAR DOCTOR K: My best friend was just diagnosed with Graves' disease. I'd like to understand the condition and what her treatment will entail.
DEAR READER: Graves' disease is an autoimmune disease that can affect the thyroid gland, eyes and skin. In almost all cases, it causes the thyroid gland to be overactive.
The thyroid gland is located in the front of the neck, close to the Adam's apple. It produces hormones that control how our bodies use energy.
Thyroid hormones stimulate metabolism in all our cells. We need a certain amount of thyroid hormones for the body to function normally. When the thyroid gland is underactive, many body processes slow down. When it is overactive, and levels of thyroid hormone in the blood are too high, our cells and organs are overstimulated.
This overstimulation causes symptoms such as these:
- Brain and nerves: nervousness, insomnia, emotional swings, shaking (tremor) of the hands;
- Skin: sweating, feeling hot all the time;
- Heart and lungs: rapid heartbeat (palpitations), shortness of breath;
- Muscles: muscle weakness;
- Weight loss, because cells are burning calories more easily;
- Eyes: The eyeballs push out, so that a person looks "wide-eyed," or frightened;
- Thyroid: goiter, an enlarged thyroid gland that produces a bulge in the front of the neck.
What causes Graves' disease? The immune system makes antibodies that stimulate the thyroid gland to make excessive amounts of thyroid hormones. Those same antibodies cause the gland to grow larger in many people with Graves' disease.
Treatment focuses on a short-term and a long-term goal. In the short term, the goal is to rapidly relieve symptoms. In the long term, the goal is to slow the thyroid's production of thyroid hormone.
Symptoms such as palpitations, increased heart rate, tremor and nervousness are treated with a beta-blocker medication such as propanolol (Inderal). For anxiety and insomnia, a doctor may prescribe an anti-anxiety medication.
There are three treatments to stop the thyroid from producing too much hormone: anti-thyroid medications, radioactive iodine and surgery.
Graves' disease is most often treated with methimazole (Tapazole). This drug blocks the formation of thyroid hormones. Once her hormone levels are back to normal, your friend can choose to continue daily anti-thyroid medication or pursue radioactive iodine treatment.
Radioactive iodine is given by mouth and goes straight to the thyroid gland. It kills the thyroid cells that make thyroid hormones. Usually a large enough dose is given to completely stop the thyroid from producing thyroid hormone. Your friend would then have to take thyroid medication daily for the rest of her life, since her thyroid gland would no longer make thyroid hormones.
Surgery to remove the thyroid gland is rarely done these days. The exception is people with very large goiters.
If your friend has severe eye symptoms, glucocorticoid medications may help. They may be given alone or together with radiation treatments to the muscles that control eye movement. Although some of the staring appearance may remain, this treatment can lead to considerable improvement.
Dr.Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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