Not So Grave
A particular type of hyperthyroidism that is caused by an autoimmune process, Graves’ disease isn’t as dire a condition as its name suggests.
By Rear Adm. Joyce Johnson, D.O

The thyroid is a butterfly-shaped gland located in the front of the neck. It is the size of a walnut and weighs less than an ounce. The thyroid produces hormones that regulate the rate of metabolism of other body functions. If it produces an inadequate amount of hormones, hypothyroidism (a slowing of bodily functions) results; too much heightens the metabolism (hyperthyroidism).

Symptoms of hyperthyroidism include a fast heart rate and high temperature. A higher metabolism could lead to increased sweating and heat sensitivity. Weight loss, despite a larger appetite and caloric intake, is common, as are restlessness, irritability, and difficulty relaxing and falling asleep. Other symptoms include tremors, especially of the hands; fatigue and muscle weakness; and, in women, menstrual changes.

In a person with hyperthyroidism from Graves’ disease, the body produces antibodies to its own thyroid gland. These antibodies attach to the thyroid, causing the gland to produce excessive hormones. Although Graves’ disease can be fatal if left untreated, it is usually recognized early, and most patients respond well to treatment.

Named after Robert Graves, the physician who first described it in the 19th century, Graves’ disease can cause two unique symptoms: painless redness and skin thickening on the shins, and eyes that bulge forward, with some swelling and inflammation. (Cigarette smokers are more apt to have eye symptoms.) Neither of these conditions is related to the degree of hyperthyroidism, and both generally resolve when the hyperthyroidism is controlled.

Hyperthyroidism is fairly easy to diagnose with a physical exam and blood tests. Treatment focuses on managing the acute symptoms with medication while working to reduce the body’s production of thyroid hormone. Two options are commonly used to reduce thyroid hormone production — radioactive iodine and antithyroid medications. (Although common at one time, surgical removal of the thyroid is rarely used today to treat Graves’ disease.)

Radioactive iodine reduces thyroid hormone secretion by selectively migrating to the thyroid gland cells and altering them. Specific antithyroid medications also affect thyroid tissue and reduce thyroid function. Because these treatments diminish or eliminate thyroid hormone production, supplemental thyroid hormones usually are needed. With a little patience, dosages can be regulated to maintain normal thyroid levels.

Patients with a history of Graves’ disease should have their thyroid hormone blood levels tested annually to assure thyroid supplement doses and hormone levels are properly regulated. It is important for long-term health that thyroid hormone levels stay in the normal range.

— Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources online at www.moaa.org/wellness.