Graves' disease (Basedow's disease)
What is Graves' disease?
Graves 'disease (Graves' disease) is an autoimmune disease of the thyroid gland associated with hyperthyroidism and inflammation of the thyroid gland (thyroiditis).
In Basedow's disease there is an excess of thyroid stimulating hormone TSH (thyroid stimulating hormone). As a result of a disturbance of the immune system, endogenous antibodies against the thyroid tissue, so-called TSH receptor antibodies (TRAK) are formed, which dock to the TSH receptors on the tissue surface of the thyroid, stimulate a decoupled from normal hormonal regulation system overproduction of thyroid hormones and successively cause hyperthyroidism.
Graves 'disease is usually characterized by a different degree of goiter (enlarged thyroid gland), often in combination with endocrine orbitopathy (protruding eyeball) and tachycardia (palpitations). This syndrome is also referred to as Merseburg's triad in Graves' disease.
The causes of Graves' disease are still unknown. However, a genetic predisposition (predisposition) is assumed, since the disease occurs more frequently in certain families and manifests itself in common cases in identical twins.
Furthermore, those affected by Graves' disease have specific common genetic characteristics. In addition, it is believed that environmental factors, hormonal changes and stress factors influence the manifestation and the course of Graves' disease. For example, a pregnancy is considered to be a guaranteed trigger factor, although it has not yet been conclusively proven that this is due to the hormonal changes (altered estrogen and progesterone levels) during and after pregnancy.
In addition, infections by bacteria (eg Yersinia enterocolitica) and viruses (including retroviruses) as well as excessive iodine intake are discussed as possible causes of Graves' disease.
Symptoms, complaints & signs
The overproduction of thyroid hormones in Graves' disease affects many body functions and can cause very different symptoms. A disturbed metabolism is noticeable by steady weight loss despite adequate food intake, typical are also sweats, hot flashes and frequent bowel movements. Sleep-in and sleep-through disorders as well as increased irritability indicate an involvement of the autonomic nervous system.
The heartbeat can accelerate and does not slow down at night, as can high blood pressure and shortness of breath. Women often suffer from menstrual disorders, as a result of which there is no menstruation - thereby reducing fertility. In men, in the context of Basedow's disease, potency disorders often appear; in both sexes, the pleasure sensation may be limited.
Disturbance of bone metabolism can induce osteoporosis, which is manifested by decreased bone density and increased susceptibility to bone fractures. Often a muscle weakness develops, even muscle pain at rest or under stress occur. Occasionally, an increased tremor of the hands is observed.
Often, the eyes of the affected person have "grave eyes" ("Basedow's Goggle Eyes"). The changes in the eyes are often accompanied by painful pressure, visual disturbances, irritation of the conjunctiva and increased photosensitivity. Other typical signs include enlargement of the thyroid (goiter), very warm, dry skin and excessive hair loss.
Diagnosis & HistoryThe doctor feels the enlargement of the thyroid gland in Graves' disease
Graves' disease can be palpated using the goiter (enlarged thyroid gland). More than 50 percent of those affected by Graves' disease have endocrine orbitopathy, in which the eyes emerge as a result of inflammatory processes in the eye sockets and ocular fundus.
In addition, sonography (ultrasound) of the thyroid shows hypoechoic (hypoechoic) tissue structures. As part of a scintigraphy (nuclear medicine imaging method), the increased production of thyroid hormones can be detected. In addition, a precise blood test to determine the hormone and antibody concentration of a backup of the diagnosis and is used in differential diagnosis to distinguish Graves disease from other autoimmune diseases of the thyroid gland (eg Hashimoto's thyroiditis).
Thus, the TRAK concentration in patients affected by Graves' disease is usually increased. Graves' disease has a chronic course, which can be very different and is characterized by spontaneous remissions (spontaneous healing) as well as relapses (relapse).
Graves' disease is a disease that can cause complications. If the condition is not medically treated in the long term, heart problems such as cardiac arrhythmia or cardiac insufficiency (heart failure) are threatened. Among the dreaded effects of Basedow's disease is the thyrotoxic crisis, which is a serious derailment of the metabolism.
Although it occurs only rarely, but represents a life-threatening emergency situation. The risk of thyrotoxic crisis increases in severe hyperthyroidism or by the discontinuation of prescribed drugs. But even a wrong treatment with iodine-containing agents comes as a possible cause into consideration.
The thyrotoxic crisis is first manifested by palpitations, constant diarrhea, vomiting, anxiety, and restlessness. Furthermore, high fever, impaired consciousness and disorientation can be used. In the further course the case threatens into the coma, the failure of the cycle as well as restrictions of the kidney functions.
Complications of Basedow's disease may also be possible during pregnancy and may even occur during a meaningful therapy. Thus, it is conceivable that antibodies to the thyroid within the blood of the mother form and also penetrate the placenta.
In such cases, there is a risk that the hormone production of the unborn child will be increased, resulting in overproduction. This threatens the child premature birth or too low a weight at birth. In the first week of life the mortality of the baby is increased.
When should you go to the doctor?
If an unplanned and unintended continuous decrease in weight develops, a doctor should be consulted. Weight loss indicates metabolic disorders and is characteristic of Graves' disease. Sweats, flushes, or inner restlessness are signs of an existing irregularity that should be presented to a physician to enable diagnosis. Sleep disorders, problems falling asleep and severe tiredness are signs of a health incongruity. A visit to a doctor is necessary as soon as the symptoms persist for several days or weeks or increase in intensity. For irritability, behavioral problems or mood swings a doctor is needed.
If the sufferer has a heart rhythm disorder, high blood pressure, muscle weakness or mobility problems, a doctor's visit is needed. Hair loss or changes in the appearance of the skin should also be examined and treated. Increasing fractures are considered to be of particular concern and should be medically clarified by further testing. If it comes to blurred vision or shortness of breath, a doctor's visit is recommended as soon as possible. It threatens a further deterioration of the state of health. If sexually mature women experience disorders or irregularities in their menstrual period, they should consult a doctor. Reduced libido in both sexes is another indication of impairment that should be followed up.
Treatment & Therapy
Since the causes of Graves' disease are not clear, the therapeutic measures are designed to be symptomatic and aim at the elimination or reduction of thyroid hyperfunction.
For this purpose, antithyroid drugs (thiamazole, carbimazole, propylthiouracil) are used, which act in the thyroid gland to inhibit hormone synthesis, secretion or iodine incorporation into the hormone precursors. The long-term medication usually lasts for 12 to 18 months, with the dosage decreasing with the duration of the therapy.
In addition, in the case of Graves' disease, β-blockers are often used to treat concomitant symptoms (tachycardia, increased blood pressure). In some cases, this treatment leads to complete healing (40 to 70 percent). If after a relapse, another drug therapy is not successful (about 80 percent of recurrence cases), definite therapeutic measures such as surgery or radioiodine therapy for thyroid removal or destruction are eligible.
Radioactive iodine is used to administer radioactive iodine, which causes temporary and thyroid-restricted radiation that causes the thyroid tissue to die. If the thyroid gland is greatly enlarged, it will be removed during surgery. As a result of radioiodine therapy and surgery, there is a hypofunction that needs to be treated hormonally for life.
Outlook & Forecast
The prognosis of Basedow's disease is very different for each individual. It may even be 50 percent of all cases that a remission occurs. This means that the disease symptoms often diminish permanently or temporarily. In such cases, however, the disease may reappear after many years. Conservative treatment in the form of treatment lasting one to one and a half years leads to a successful cure in approximately 50 percent of those affected. But this also means that about every second person affected develops a so-called relapse, this is the recurrence of the disease.
After a radioiodine therapy or an operative removal of the complete thyroid gland, also called thyroidectomy, however, a definite cure of the existing hyperthyroidism in those affected is possible. In both cases, however, patients will then have to take special thyroid hormones daily throughout their lives to achieve normal hormone levels in the body. In spite of this, 50 percent of those affected have the option of healing Graves' disease on their own.
Nevertheless, a treatment is necessary. Because even after the cure, the disease can flare up again. Also during the course of the disease, a thyrotoxic crisis may occur. This is a dreaded complication because it causes death in 20 to 30 percent of cases.
Since the causes of Graves' disease are not clear, the disease can not be prevented. However, any factors that adversely affect the immune system may contribute to the manifestation of Graves' disease. These include stress and psychological stress, hormonal contraceptive methods as well as excessive intake of iodine (X-ray with iodine-containing contrast agents, iodine salt). Nicotine consumption can also trigger Graves 'disease and worsen the course of Graves' disease.
Graves' disease can result in lifelong aftercare. This is independent of the respective treatment method. In addition, it must be prevented that it comes to eye problems due to endocrine orbitopathy, which is possible in about 50 percent of all patients. In addition, the after-treatment of Basedow's disease requires much effort and patience. Thus, the therapeutic strategies are designed for the medium to long term.
In the case of conservative drug therapy, the patient receives antithyroid drugs for one to two years. Depending on the starting position, the risk of relapse is 30 to 90 percent. The follow-up visits must take place every four to eight weeks.
The safest and fastest treatment methods for Graves' disease are radioiodine therapy and surgery. Following these procedures, however, it is necessary to take thyroid hormones for the rest of life. Only in this way can the resulting hypofunction of the thyroid gland, ie a lack of thyroid hormones, be compensated. If regular follow-up examinations are necessary at first, these are limited to one to two examinations a year.
Immediately after a surgical procedure on the thyroid, the patient receives thyroid hormone in a standard amount. How many hormones the patient ultimately needs will be determined in the time after the operation and individually adjusted accordingly. The target values vary and are determined by the family doctor or an endocrinologist.
You can do that yourself
In the case of Graves' disease, there are some measures that the affected person can take to improve their quality of life. At the beginning there is the certainty of being diagnosed with physical and emotional stress during the treatment period. There are self-help groups for those affected by the Basedow disease and other conversation offers. These offers of conversation can be especially valuable if Graves' disease has already led to visible physical symptoms.
Emotional stress and stress can be lessened by creating targeted freedom and relaxation techniques. Since it is an autoimmune disease, the condition of the person affected has a not insignificant influence on the course of the disease. In order not to burden the thyroid additionally, iodine-containing foods should be avoided. The same applies to dietary supplements containing iodine. This can slow down the course of the disease and possibly have a favorable effect on a therapy.
With regard to possible involvement of the eyes, they should be protected against strong stimuli. This means avoiding strong sunlight, cold wind, breezes and so on as much as possible. Since Graves' disease can be very different and occurs quite frequently, it is also valuable to get comprehensive information about the disease. This often allows better management of the disease and its treatment.