Treatment of Graves Disease (diffuse Toxic Goiter)

About the disease

Graves disease, also known as diffuse toxic goiter and Basedow disease, is a disease that causes the hyperplastic thyroid gland to produce an excessive amount of thyroid hormone. As a result, the body’s metabolism speeds up and the sufferer starts to notice dramatic weight loss. This is an autoimmune disease, meaning that the body’s immune system starts to fight against itself. According to American medical website MedScape, this disease is more common in women, with 2.7% of females and 0.23% of males being diagnosed with it. Most commonly, Graves disease affects pregnant and breastfeeding women. It is most prevalent in people aged between 30-40.

Graves disease is believed to be caused by genetic factors. Its development can be precipitated by postpartum depression and mental stress. Smoking and radiation on the neck can also contribute to the onset of Graves disease in people who have a genetic predisposition to it.  Previous surgery on the thyroid gland can also contribute to the development of Graves disease. The first manifestations of this disease are: unexplained loss weight, double vision and skin problems. In some cases, the skin can become red; in rare cases, a rash may also appear.  

Symptoms

• Weight loss
• Good appetite
• Sweating
• Muscle weakness
• Tremors
• Insomnia
• Heat intolerance
• Protrusion of the eyeballs, with mild vision loss in rare cases

Diagnosis

• A TSH test is usually used, to measure the amount of thyroid hormone in the patient’s body. An excessive amount of this hormone is the main indicator of the disease.
• A Radioiodine uptake test is also commonly used for the diagnosis of Graves disease. Radioactive iodine is administered in the form of a capsule or fluid, and the amount absorbed by the thyroid is assessed. If the absorsption level is high, this is another indicator of Graves disease.
• A thyroid scan can find out if the thyroid gland is enlarged and hyperplastic, which occurs if it is producing an excessive amount of hormone.
• An ultrasound is also used to assess the thyroid gland and surrounding organs. 

Treatment

• Conservative treatment includes radioiodine therapy and antithyroid drugs. Both these options aim to decrease the amount of thyroid hormone produced by the body. This treatment must be conducted for an extended period of time if symptoms are to be alleviated.
• A partial or total thyroidectomy is the partial or total resection of the thyroid gland, depending on the extent of the disease’s progression. It is usually recommended only if conservative therapy, such as drug treatment, is unsuccessful.

Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko