Understanding Graves' Disease -- Diagnosis and Treatment

How Do I Find Out If I Have Graves' Disease?

Although Graves' disease can be diagnosed from the results of one or two tests, your doctor may use several methods to double-check the findings and rule out other disorders. An analysis of your blood will show if the levels of two hormones -- free thyroxine (free T-4) and triiodothyronine (free T-3), which are produced or regulated by the thyroid -- are higher than normal. If they are, and if levels of thyroid-stimulating hormone (TSH) in your blood are abnormally low, you are hyperthyroid, and Graves' disease is the likely culprit. Blood analysis can also detect the presence of the abnormal antibody associated with Graves' disease.

To confirm a diagnosis of Graves' disease, your doctor may conduct a radioactive iodine uptake test, which shows whether large quantities of iodine are collecting in the thyroid. The gland needs iodine to make thyroid hormones, so if it is absorbing unusually large amounts of iodine, it obviously is producing too much hormone.

If bulging eyeballs (called exophthalmos) is the only symptom, your doctor will probably run blood tests to check for hyperthyroidism, since this eye disorder is not always related to Graves' disease. The doctor may also evaluate eye muscles using ultrasound, a CT scan, or magnetic resonance imaging (MRI). Signs of swelling in any one of these tests will go along with the diagnosis of Graves' disease.

What Are the Treatments for Graves' Disease?

If you have Graves' disease, or even suspect that you have it, you should have a professional diagnosis and, if necessary, a treatment plan that suits your particular condition. Although the disorder is rooted in a malfunctioning immune system, the goal of treatment is to restore thyroid hormone levels to their correct balance and to relieve discomfort.

Conventional Medicine for Graves' Disease

Beta-blockers such as atenolol (Tenormin), propranolol (Inderal), and metoprolol (Lopressor), frequently prescribed to treat heart disease and high blood pressure, are also used by most patients to alleviate the heart palpitations and muscle tremors that characterize Graves' disease. Before prescribing beta blockers for this condition, however, your doctor needs to know if you are asthmatic or have any kind of heart trouble. These drugs aren't a cure; instead they are given to block some of the effects of thyroid hormones. They are used in conjunction with other treatments.

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The two most frequently used treatments involve disabling the thyroid's ability to produce hormones.

One common approach uses a strong dose of radioactive iodine to destroy cells in the thyroid gland. This procedure attempts to halt excess hormone production by thinning the ranks of cells responsible for manufacturing the hormones. The amount of radioactive iodine received depends on the estimated size of the thyroid -- determined either through a physical exam or by ultrasound -- and on the gland's level of activity, as indicated by the results of an iodine uptake test. Despite its destructive effect on thyroid cells, the iodine used in this procedure will not harm surrounding tissues and organs.

At the beginning of the treatment, you will be given a capsule or liquid containing the radioactive iodine. Either way you take it, you should not feel any effects as the substance enters your system. Most of the iodine will gather and remain in your thyroid; excess amounts will be excreted in urine. It is a good idea to drink several extra glasses of water per day for about a week after the treatment to help flush the material out of your body as quickly as possible. To be on the safe side, you should also limit contact with infants, children, and pregnant women for at least seven days after you ingest the iodine.

You probably won't notice any changes for several days after taking the radioactive iodine, but if your thyroid gland feels inflamed and sore, acetaminophen, ibuprofen, or aspirin can offer some relief. Over the next several months, the thyroid's hormone secretion should gradually begin to drop. During this time you need to see the doctor for periodic checkups to determine how well the treatment is progressing. Chances are good that a single dose of radioactive iodine will be sufficient to correct hyperthyroidism. However, if the condition hasn't improved three months or so after your initial treatment, your practitioner may give you a second dose of iodine. Once the doctor has decided that your Graves' disease is effectively under control, you will still need to have routine checkups to make sure that your thyroid levels remain within the normal range.

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It should be noted that most people become hypothyroid after taking radioactive iodine for Graves' disease. If this occurs, you will have to take thyroid replacement medication for the rest of your life.

Although radioactive iodine treatments are generally safe, they cannot be given to pregnant women because the chemical may destroy the thyroid gland in the fetus. Therefore, you must make sure that you are not pregnant before you take radioactive iodine for Graves' disease. It is best to let several months pass after your last dose of radioactive iodine before becoming pregnant; confirm the length of time you should wait with your doctor. Except during these periods following the treatment, radioactive iodine poses no health risks for women who want to become pregnant, and it will not affect the fertility of either women or men.

Antithyroid drugs such as propylthiouracil and methimazole (Tapazole), which interfere with thyroid hormone production, can be used to treat Graves' disease. After you begin treatment, it may take several months for hyperthyroid symptoms to subside. This is because the thyroid has already generated and stored enough hormone to keep it circulating at elevated levels. Once the stores are drained, hormone production should drop to its normal level. Although your disease may seem to go away entirely, you might still need drug therapy to keep your thyroid operating properly. Even if your case of Graves' disease does go into remission and your doctor says it's safe to stop taking medication, you will need to be evaluated every year or so to make sure hyperthyroidism has not returned since relapse is common.

Radioactive iodine treatments and antithyroid drugs are usually effective in slowing down thyroid hormone output, but in some cases surgery is the best approach for Graves' disease. If you develop the disorder before or during pregnancy, for example, or if you are reluctant or unable to undergo radioactive treatment or are allergic to antithyroid medication, your doctor may recommend subtotal thyroidectomy, a relatively safe and simple procedure in which most of the thyroid gland is removed.

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Because many conventional remedies severely limit the thyroid's ability to manufacture thyroid hormone, they increase the chances that you will develop hypothyroidism, a potentially serious condition marked by insufficient thyroid hormone production. Therefore, if you have undergone any treatments for Graves' disease, you must continue to see your doctor for periodic checkups to make sure the problem has not been overcorrected, causing your thyroid hormone levels to drop too low.

Some degree of eye complaints occur in 25%-50% of those that develop Graves' disease but most can be managed with the home remedies discussed below. Surgery is rare and reserved for those with severe symptoms.

Graves' disease patients with eye problems can find temporary relief from the redness, swelling, and pain through a number of drugs, including prednisone, methylprednisolone, and dexamethasone. However, these medications should not be used for long periods of time, as they can lead to bone loss, muscle weakness, and weight gain. Vision problems and severe cases of eye protrusion can often be corrected through radiation therapy and surgery. A person who has Graves' disease should also see an eye doctor. Make sure to ask your doctor about any possible complications before undergoing surgery.

Home Remedies for Graves' Disease

  • If your lids cannot close completely over your eyes, use eye patches at night. This will help keep eyes from drying out.
  • Use over-the-counter or prescription artificial tears to moisten eyes whenever they feel dry.
  • If your eyes are red and swollen in the morning, sleep with your head elevated.
  • Wear tinted glasses to protect the eyes from bright light, sunlight, and wind.

 

WebMD Medical Reference Reviewed by Minesh Khatri, MD on March 26, 2017

Sources

SOURCES:
 

National Library of Medicine.
The Mayo Clinic. 

Miller School of Medicine, University of Miami.
The American Thyroid Association.

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