The most common cause and symptoms of hyperthyroidism – Graves' disease
Graves' disease is an autoimmune disorder that is the most common cause of hyperthyroidism. The disease is caused by the presence of antibodies that stimulate the thyroid gland to overproduce hormones, leading to the development of hyperthyroid symptoms. The gland itself also enlarges, leading to the development of a parenchymal goiter, and extrathyroidal symptoms may occur, including exophthalmos (orbitopathy), pretibial edema, and painless swelling of the fingers or sometimes toes, accompanied by subperiosteal bone thickening (acropachysm).
This disease can develop in any age group and is ten times more common in women.
Causes of Graves' disease
The appearance of autoantibodies against the TSH receptor (TRAb—thyrotropin receptor antibodies) results from immune system dysfunction. The exact mechanism of this phenomenon in the body is not fully understood. The development of the disease depends on the interaction between genetic and environmental factors.
These include, among others:
- Hereditary predisposition – plays an important role and is of a polygenic nature, the contribution of genes is estimated at 80%.
- Smoking – increases the risk of hyperthyroidism approximately twice, adversely affects the effectiveness of treatment and increases the risk of developing orbitopathy approximately 7–8 times.
- Emotional stress is one of the factors triggering the development of the disease.
- Excess iodine in the diet.
Clinical picture of hyperthyroidism in adults
Hyperthyroidism
Symptoms of hyperthyroidism include:
- Weight loss (despite often good appetite), weakness, feeling hot,
- anxiety, irritability, psychomotor agitation, difficulty concentrating, insomnia, hand tremors,
- increased sweating and skin congestion, easily falling out, thin and brittle hair; thin and brittle nails,
- weakening of muscle strength,
- heart palpitations, heart rhythm disturbances,
- frequent bowel movements or diarrhea,
- sometimes decreased libido, erectile dysfunction, gynecomastia, infrequent periods or, exceptionally, amenorrhea.
Parenchymal goiter
Parenchymal goiter (less commonly nodular goiter) causes an enlargement of the neck circumference.
Ocular changes
Overt orbitopathy occurs in approximately 25% of patients and may include symptoms resulting from sympathetic nervous system stimulation, such as very wide-open eyes (a sensation of staring) and infrequent blinking. Furthermore, bulging of the eyeballs (orbitopathy) may occur.
Dermopathy (2-3% of patients)
A rare symptom is edema in patients, which manifests as swelling of the shin without involvement of the feet (dermopathy).
Acropachysys (<1% of patients)
An exceptionally rare symptom is thyroid acropachys, a condition in which the tips of the fingers become thickened and rounded.
| The most typical feature of Graves' disease is its relapsing course, with periods of exacerbation and remission (withdrawal of symptoms). |
Diagnosis of hyperthyroidism
Initial suspicion of the disease may be based on an interview and physical examination, but a firm diagnosis requires additional tests:
- hormone levels that indicate thyroid function – TSH tests (usually reduced), FT3 and FT4 (increased),
- antibodies, their concentration is usually increased (especially antiTSHR (TRAb) is the most characteristic),
- Thyroid ultrasound – characteristic features include decreased echogenicity of the thyroid parenchyma and increased vascularization and enlargement of the gland (so-called vascular goiter).
Treatment of hyperthyroidism
The main goal of treating hyperthyroidism in Graves' disease is to achieve euthyroidism, i.e., normal thyroid hormone levels.
There are three main treatments for Graves' disease:
- pharmacological treatment,
- radioactive iodine treatment,
- surgical treatment – thyroidectomy.
It usually starts with pharmacological treatment, and in the case of recurrence of hyperthyroidism, a radical approach is preferred – radioiodine treatment or surgery.
Pharmacological treatment
Treatment involves the use of antithyroid medications, which not only inhibit thyroid hormone production but also act as an immunosuppressant on the thyroid, reducing TRAb antibody levels. Pharmacological treatment is typically administered for at least 12–18 months. The goal is to achieve euthyroidism (normalization of all hormones) and remission (reduction in TRAb antibody levels).
All patients with Graves' disease should stop smoking because it is a significant risk factor for the development and more severe course of orbitopathy.
Radioactive iodine treatment
In many cases, a single dose of radioactive iodine is sufficient to destroy the overactive thyroid tissue.
Radioiodine treatment is particularly used in:
- elderly patients whose comorbidities increase the surgical risk,
- patients with contraindications to treatment with antithyroid drugs,
- women who are planning a pregnancy.
Surgical treatment
Surgery is preferred in cases of large goiter >80 ml, suspected thyroid cancer, the presence of large nodules, and in patients with moderate to severe active Graves' orbitopathy. It is an alternative to radioiodine therapy in women planning a pregnancy.
The final decision on the choice of treatment is made by the doctor in consultation with the patient.
Dr. Ewa Obel, MD,
PhD, Endocrinology Specialist
The information contained in this article is for general informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. It is recommended that you consult a physician or other qualified healthcare professional for advice regarding specific symptoms, ailments, or health conditions.