Graves' disease

What Is It?

Graves' disease is a disorder of the immune system that causes the thyroid gland to become overactive. It can also produce eye and skin symptoms. It is an autoimmune disorder, an illness in which the body's immune system mistakenly targets the body's own cells rather than protect them from outside invaders. In Graves' disease, the body's immune system produces abnormal chemicals called immunoglobulins that stimulate the thyroid gland to produce high levels of thyroid hormone (hyperthyroidism). Although the exact trigger of this abnormal production of immunoglobulins remains a mystery, the fact that Graves' disease tends to run in families indicates that the disease may have a genetic (inherited) component. It is possible that the abnormal production of immunoglobulins is triggered by some unknown factor in the environment, and the immune system fails to stop this overproduction because of an inherited defect.

Graves' disease affects women more than men. It most frequently strikes between the ages of 20 and 40 but can occur at any age.

Symptoms

Graves' disease can cause the following symptoms:

• Nervousness
• Insomnia
• Dramatic emotional swings
• Sweating
• Tremors and shakes
• Increased heart rate
• Frequent bowel movements
• Unexplained weight loss (often despite increased appetite)
• Sensitivity to warm temperatures (feeling hot all the time)
• Muscle weakness
• Shortness of breath
• Palpitations

In women, menstrual periods may become less frequent or stop altogether. In older patients, there may be heart failure or heart-related chest pain called angina.

Graves' disease also may cause:

• Goiter — Goiter is a swelling in the lower front portion of the neck caused by an enlarged thyroid gland.
• Eye symptoms — Graves' disease can cause swelling of tissues around the eyes, which produces a characteristic "staring" or "frightened" appearance. The eyes bulge out and the eyelids are further back in the head than normal, there is less blinking. The person may have double vision, itching and weeping.
• Skin symptoms — There may be swelling of the feet and lower legs. Skin in this swollen area may appear thicker and darker than normal skin, and it may itch.

Diagnosis

Your doctor will look for physical evidence of Graves' disease, including goiter, eye signs and skin signs. He or she also will ask you about recent weight loss, nervousness, tremors (shakes), increased sweating, palpitations, unusually frequent bowel movements, menstrual irregularities and unusual sensitivity to warm temperatures (feeling hot all the time).