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Grave's Disease Definition
Grave's disease is a disorder of the thyroid gland that results in its enlargement and increased production of thyroid hormone (hyperthyroidism). The thyroid gland produces an important hormone which regulates body metabolism. The underlying cause of Grave's disease is unknown but it is thought to be an autoimmune disease. In this case, an antibody is produced which stimulates the thyroid gland into over-producing thyroid hormone. Grave's disease is more common in females and affects as many as 1.9% of the female population. It is approximately 1/10th as common in males. The peak incidence of this disease is in the 30-50 age range. A strong family history for this disorder also appears to exist in many confirmed cases. The clinical presentation of the patient with Grave's disease is a female in her mid-twenties with the signs and symptoms of hyperthyroidism (see the DISEASEFILE).
The patient is often nervous, anxious, fidgeting, and speaks rapidly. Other symptoms include fatigue, heat intolerance, weight loss, and palpitations. Females may also complain of absent menstrual cycles (or reduced flow) and neck swelling secondary to thyroid enlargement (goiter). Advanced cases will demonstrate exophthalmos, a protruding of the eyes from their orbits. The diagnosis of Grave's disease can be made with laboratory studies such as the thyroid profile. Nuclear imaging of the thyroid gland is also helpful in diagnosing this condition and will also help exclude the diagnosis of a thyroid tumor. A thyroid biopsy is generally not necessary for diagnosis. Treatment is with anti-thyroid medications (e.g. propylthiouracil, methimazole) in most cases. In up to 50% of cases drug therapy will lead to remission of Grave's disease. Surgery (thyroid removal) is recommended in select cases (younger patients and those with extreme thyroid enlargement). Lifetime thyroid hormone supplementation (e.g. Synthroid) is necessary after removal of the thyroid gland.
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