Graves’ disease is an autoimmune disease that leads to the overproduction of thyroid hormones (hyperthyroidism) and decreased levels of thyroid stimulating hormone (TSH) in the blood.
Basedow’s disease, also called Graves’ disease, is more common in middle-aged women (8:1 vs. men). Symptoms include fatigue, weight loss and accelerated heartbeat. Since the antibodies that attack the thyroid gland also involve the eyes, blurred vision and irritation of the eyes are often indicated.
Graves’ disease often occurs between the ages of 30 and 50.
A severe form of exophthalmos occurs only in a minority of patients with this disease, also known as endocrine ophthalmopathy or orbitopathy.
Graves’ disease does not cause thyroid nodules or a thyroid tumor and is not a risk factor for it.
What are the causes of Graves’ disease?
Graves’ disease is caused by a dysfunction of the immune system that attacks the cells of the body.
A normal response of the immune system is the production of antibodies to defeat viruses, bacteria or other foreign substances.
In Graves’ disease, the organism produces an antibody for unknown reasons, which attaches itself to a certain protein in the cell membrane of the thyroid gland.
Smoking, along with some medications (for example, amiodarone), is a risk factor for this condition.
Normally, thyroid function is regulated by the release of a hormone from a small gland at the base of the brain (pituitary gland).
The antibody associated with Graves’ disease can behave like the hormone produced in the pituitary gland. Therefore, the antibody cancels the normal regulation of the thyroid gland and as a result, an overproduction of thyroid hormones (hyperthyroidism) develops.
Consequences of hyperthyroidism
Thyroid hormones can affect various bodily functions, including:
- metabolism, the conversion of nutrients into energy for the cells;
- function of the heart and nervous system;
- Body temperature;
- Menstrual cycle;
Consequently, the effect of untreated Graves’ disease can be diffuse and mean a reduction in quality of life.
In the more severe cases, people with hyperthyroidism may experience a thyrotoxic crisis that can lead to death from heart failure.
Symptoms of Graves’ disease
The first symptoms of Graves’ disease can be confused with other conditions and make it difficult to make a correct diagnosis.
The most common symptoms are:
- Weight loss — despite increased appetite, but there is a variant called fat Graves, in which patients gain weight because they overeat
- Anxiety, restlessness, tremor, irritability, insomnia
- Heat intolerance
- Excessive sweating
- Loss of hair, which becomes dry and brittle
- Frequent bowel movements (with and without diarrhea)
- Irregular and weaker menstrual cycles
- Difficulties in controlling diabetes
- Decreased fertility
- Protruding and swollen eyes
- Visual disturbances (for example, double vision when the visual axes of the eyes are not aligned). The cause may be fibrosis and the retraction of an eye muscle (usually the inferior rectus muscle). The origin of contracture and fibrosis is edema or inflammation of these muscles.
Physical signs of Graves’ disease
If Graves’ disease is not treated, physical symptoms and signs may develop.
The nodular goiter is an enlargement of the thyroid gland. A goiter associated with Graves’ disease is a toxic diffuse goiter.
If the thyroid gland enlarges, the patient’s neck may appear filled and swollen.
A goiter sometimes made swallowing difficult, causes coughing and can interfere with sleep.
Eye problems associated with Graves’ disease can range from mild to very severe.
Less severe — but at least annoying: the eye symptoms include reddened eyes, lacrimation, feeling of sand or powder in the eyes, and exceptional sensitivity to light (photophobia).
In the more severe cases, one or both eyes may protrude from the eye socket.
Graves’ disease causes an inflammatory reaction in the eye muscles, the muscles and tissues swell. Since the posterior part of the eye socket is limited by a bone, the eyes are pushed forward and protrude.
The result is protruding eyes and limited eye movement.
The medical term for this phenomenon is exophthalmos and it can seem as if the eyes are staring at you.
Some patients with Graves’ disease may develop skin thickening on the front and sides of the upper lower leg below the knees. This disorder leads to skin lesions that are irregular and reddened, and the skin swells as in cellulitis. Rarely, other areas of the skin are affected.
This skin problem is also known as pretibial myxedema.
Diagnosis of Graves’ disease
During the clinical examination, the doctor examines the patient for a goiter (enlargement of the thyroid gland), a rapid arterial pulse (heart rate), tremor and any other evidence of Graves’ disease.
Blood tests are done to evaluate thyroid function.
The doctor may also order a scintigraphy of the thyroid gland and a radioiodine test.
These tests can help determine if the entire thyroid gland is working too hard or only part of the gland is hyperactive.
Absorption of radioactive iodine The body needs iodine
to produce thyroid hormones. The doctor administers a drug with a small amount of radioactive iodine 131, and then measures the amount that has entered the thyroid gland with a scintigraphy.
In this way, the doctor can determine the rate at which the thyroid gland absorbs the iodine.
High absorption of radioactive iodine indicates that the thyroid gland produces too many hormones.
The gamma camera of scintigraphy is an apparatus that can determine the origin of the radiation.
In this way, you can see which areas of the thyroid gland produce and release more hormones. As a rule, a patient with Graves’ disease has generalized hyperactivity.
imaging If the diagnosis of Graves’ disease is not clear from the clinical examination, the doctor may order an apparatus examination such as a computed tomography (CT). This is a technique with radioactive beams that shows images of the body cross-section.
The doctor may also order magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to display three-dimensional images or cross-sections of the eye sockets to assess the eye muscles and any compression of the optic nerve.
Echography serves to exclude other diseases, for example a lump.
List of differential diagnoses in Graves’ disease
For the diagnosis of Graves’ disease, the doctor must exclude the following diseases:
- Postpartum thyroiditis – for mothers who have just given birth
- Thyroid cancer
- Panic attack
- Atrial fibrillation
- Acute psychiatric disorders
- High estrogen levels
Treatment of Graves’ disease
In very rare cases, the disease heals on its own over time, but almost all patients require treatment to control symptoms.
Diet and nutrition for Graves’ disease
Three different diets are recommended:
- Blood group diet according to Dr. Mozzi, which avoids carbohydrates and sugar.
- Vegan diet, which is talked about in natural medicine and health hygiene by M. Lezaeta and H. Shelton.
- Traditional diet, which is based on the reduction of iodine consumption, but hardly leads to a solution to the problem.
In the blood group diet according to Dr. Mozzi, all cereals (especially cereals containing gluten) are removed from the diet, as well as starch (potatoes, Jerusalem artichokes, etc.), almost all fruits and sweets.
You can eat pseudo-grains such as quinoa and amaranth, legumes, nuts, seeds, vegetables, meat (except pork), fish and eggs.
Allowed fruits include lemons (all blood types), prunes, figs and kiwi, but only in small quantities and in the morning, absolutely avoid after 17 pm. Those who belong to blood group 0 should not eat fruit. In winter, any type of fruit is not recommended.
According to M. Lezaeta’s vegan/raw food diet, eat vegetable stew, fresh fruits and vegetables, wheat, barley and oats, cheese, egg yolks, nuts and almonds.
Avoid coffee, tea, chocolate, tobacco, meat and all animal fats.
Only drink when you feel thirsty.
Very important is exercise in the fresh air, for example a hike in the mountains.
Natural remedies according to Lezaeta’s natural medicine and health hygiene also include nightly mud packs on the stomach and neck and 15- to 30-minute genital baths.According to conventional medicine, only the intake of iodine must be reduced.
The thyroid gland needs 2 substances for the production of thyroid hormones: iodine and thyroxine. Restricting these elements complicates excessive production for the thyroid gland. Iodine can also stimulate the production of the antibodies, which is one of the causes of autoimmune diseases of the thyroid gland. The recommended amount of iodine per day is 150mcg.
The best source of iodine-rich foods are plants and animals that live in salt water, for example, shrimp, lobster, salmon, tuna, seaweed, norialgen, etc. Another iodine-containing food source is dairy products, in which iodine is used for purification and remains in the milk.
The preferred salt is that from the sea, but you should inform yourself exactly about the amount of iodine contained, because some types contain a lot of iodine.
Other hidden sources of iodine include energy and multivitamin bars, meat, some vegetables such as asparagus, certain medications, and many foods that contain red dyes.
Turkey contains a lot of iodine and also a lot of thyroxine.
According to the principles of naturopathy, the diet belongs to the natural and alternative forms of treatment. Foods that slow down the production of thyroid hormones include:
- Brussels sprouts shoots
- Soy (even if opinions differ on large quantities)
- Green mustard cabbage
These foods should preferably be eaten raw, as the beneficial properties are lost during the cooking process.
Patients with hyperthyroidism should refrain from all body-stimulating agents. These foods include caffeine, high-sugar products, processed foods such as hot dogs, sausages, sweeteners, artificial flavors, ingredients declared as “natural flavors,” etc.
A natural remedy that reduces the symptoms of Graves’ disease is regular exercise in the fresh air (daily or every other day).
Is it possible to recover by changing your diet? Case study of a patient
I present all the research results to prove that I was cured of hyperthyroidism by changing my diet.
In 2011, I was diagnosed with Graves’ disease, which leads to hyperthyroidism; below are the results of the examinations carried out in two different hospitals.
The endocrinologist prescribed me Euthyrox, but I never took it.
In 2013 I stopped eating meat, in 2014 I became vegan, so I gave up meat, fish, eggs, milk and dairy products.
As of July 2016, I left out gluten.
My diet consists of seasonal fruits and vegetables, nuts, seeds, legumes and cereals.
I don’t eat anything fried, sauces or coffee.
In November 2016, I repeated the thyroid examinations and the results show normal values for TSH, T3 and T4.
Medical treatment for Graves’ disease
Because Graves’ hyperthyroidism is caused by a genetic abnormality of the immune system, the problem is complex and there is currently no specific therapy to address this cause.
Since the end result of this problem is stimulation of thyroid function, symptom treatment provides for blocking the production of thyroid hormones with antithyroid drugs.
The therapy consists in the destruction of the thyroid cells with radioactive iodine or in the removal of the gland (thyroidectomy).
Although radioiodine therapy is much easier and more rewarding, doctors are very concerned about possible harm from radiation in young people.
Radioiodine therapy has been used for over 40 years and there is no evidence of harmful side effects.
In North America, most thyroid specialists recommend this therapy to patients with Graves’ disease who are over 20-25 years old because it offers a greater likelihood of success in the long term (termination of hyperthyroidism) than treatment with antithyroid drugs.
Radioiodine therapy is increasing among adolescents. But sometimes the eyesight deteriorates and often is treated preventively with cortisone.
Radioactive iodine is usually taken in the form of tablets.
The dose is calculated according to the size of the goiter and iodine absorption within 24 hours according to a “thyroid absorption test”.
The iodine enters the bloodstream and is absorbed by the thyroid gland. There it damages the thyroid gland, thus worsening its ability to function and reducing the production of thyroid hormones.
It takes about 2-3 months for the therapy to reach its full effectiveness, improvement occurs gradually, but initially worsening of symptoms is possible.
Since the radioactive iodine takes a few weeks to exert its definitive effect, the doctor administers antithyroid drugs until the full effect has been achieved.
After radioiodine therapy, it is hoped that part of the thyroid gland will be preserved for normal function.
Rarely (10-20% of patients) the thyroid gland becomes overactive again because the lymphocytes produce stimulating antibodies again.
Other patients are very prone to develop hypothyroidism – about 80% of all patients with Graves’ disease have to undergo thyroid hormone substitution (e.g. with euthyrox) forever at the end (1-10 years after radioiodine therapy).
However, this is not considered a problem because hypothyroidism is detected and treated. It is a major problem for patients who experience recurrence of hyperthyroidism due to insufficient removal of the thyroid gland or after administration of too low a dose of iodine.
In fact, some specialists suggest the deliberate destruction of the thyroid gland to avoid recurrence of hyperthyroidism and immediately prescribe thyroid hormones to prevent hypothyroidism.
The sea has no influence on Graves’ disease.
Drug therapy for Graves’ disease
Therapy in children and adults under 20-25 years of age usually consists of thyrostatic drugs (for example, propylthiouracil and methimazole).
These medicines can be taken at any age until Graves’ disease remission or by removal before therapy.
There are two main disadvantages of this type of therapy:
1. Patients need to take tablets for many months or years, the recommended duration of treatment is 12-18 months.
2. If therapy is discontinued, there is a 50% chance that the disease will recur as before (relapse).
Therefore, most patients require further treatment.
In addition, a small percentage of patients suffer from side effects that can rarely be serious, such as liver problems and low white blood cell counts (the drop in white blood cells can cause fever, sore throat and other infections).
Due to recent evidence of side effects of propylthiouracil on liver function, especially in children, the Food and Drug Administration in the USA has issued a ban on its use.
Propylthiouracil is still the drug of choice during pregnancy because there is no clear evidence of side effects on the fetus in the first trimester of pregnancy, while methimazole is only prescribed in the second and third trimesters of pregnancy.
Treatment of hyperthyroidism is preferred before pregnancy is considered.
Other medications that can be taken to treat symptoms of hyperthyroidism include propranolol or other beta-blockers. These drugs block the effects of the excess thyroid hormones on the heart, blood vessels, and nervous system, but have no direct effect on the thyroid gland. They are contraindicated in patients with asthma.
When should the thyroid gland be operated? Thyroidectomy
In general, surgery is recommended in 80% of patients under 20 years of age who have a recurrence of hyperthyroidism after taking antithyroid drugs.
Removal of the thyroid gland (thyroidectomy) is also recommended in people of all ages if the goiter has grown so large that it obstructs the trachea and causes difficulty swallowing, or in cases where rapid resolution of hyperthyroidism is required (for example, when it becomes difficult to treat a cardiac arrhythmia).
In England and Europe, for reasons of experience and tradition, a thyroidectomy is performed much more often in Graves’ disease than in America.
Thyroidectomy requires an inpatient stay of about 2 days to remove the gland.
Some clinics perform the operation on an outpatient basis using minimally invasive techniques and instruments that allow the thyroid gland to be displayed on a monitor.
After removal of the thyroid gland, lifelong substitution therapy with drugs based on thyroxine must be carried out.