What is Graves' disease?
Graves’ disease is also known as Graves’ disease. This is an autoimmune disease: the immune system’s defense cells do not attack foreign pathogens – as they are supposed to – but instead target the body’s own tissue. The thyroid gland in particular is affected; it is located at the front of the neck under the larynx. In around half of patients, there are also changes to the eyes; in most cases these are barely noticeable, but in five to 25 percent of patients they can be very pronounced.
Around two to three percent of women are affected by Graves’ disease. The incidence in men is five times lower. In many cases, the disease appears between the ages of 20 and 40, but it can also occur in all other age groups.
Causes: How does Graves' disease develop?
The body’s immune system normally produces antibodies to fight pathogens. In the autoimmune disease Graves’ disease, certain antibodies attach themselves to the surface of thyroid cells instead. This stimulates the thyroid gland to produce more hormones; in medicine, this hyperfunction is called hyperthyroidism. In addition, the thyroid gland often reacts to the antibodies by becoming excessively enlarged.
Other sites where the antibodies can dock are in muscle and fat cells in the eye socket. Swelling often develops here: The eye bulges or even protrudes out of the eye socket; this condition is called endocrine orbitopathy or exophthalmos.
It is unclear why all this can happen at all. Sometimes sufferers have relatives in their family who also have Graves’ disease, which is why a genetic predisposition is likely. Rarely, Graves’ disease also occurs together with type 1 diabetes. In some patients, Graves’ disease appears after an emotionally stressful experience or during a period of life dominated by stressful situations. However, the disease can also occur in people who have previously felt completely carefree.
Symptoms: How does Graves' disease manifest itself?
Basedow’s disease often causes three symptoms, which are known in medicine as the “Merseburg triad” (because the doctor Karl Adolph von Basedow, who gave the disease its name, died in the town of Merseburg). These three characteristics are so-called leading symptoms. This does not mean that they necessarily occur in all patients – the phenomenon of protruding eyes only affects less than half of all patients. However, if you are diagnosed with these main symptoms, they are a strong indication that Graves’ disease is present.
These are the three typical symptoms of Graves’ disease:
Enlarged thyroid gland
If misdirected antibodies from the immune system stimulate the thyroid gland to grow more rapidly, a goitre can develop. This swelling below the larynx is also called a goiter. A goiter in Graves’ disease usually develops evenly and without nodules.
Increased heart rate
Hyperthyroidism accelerates the entire metabolism and also stimulates the heart to beat faster. The increased heart rate, called tachycardia, can cause numerous symptoms:
Bulging eyes
Approximately less than half of those suffering from Baselow’s disease experience their eyeballs protruding from their eye sockets. This phenomenon, called exophthalmos or endocrine orbitopathy, does not always affect both eyes equally. The protrusion often prevents the palpebral fissure from closing completely, i.e. the gap between the upper and lower eyelid through which the eye can be seen.
If the eyes are involved in Graves’ disease, this usually occurs at the same time as the other symptoms of the disease develop. Sometimes, however, the eye problems only appear months or even years later – even when the patient has long since received medical treatment.
Exophthalmos can lead to a variety of impairments:
- Reddened, irritated, itchy or burning eyes
- blinking too seldom, dry eyes
- swollen eyelids
- Lachrymation
- Light sensitivity
- Pain, pressure or foreign body sensation in the eye
- Visual disturbances (blurred vision, double vision)
The increased production of thyroid hormones in Graves’ disease and the overactive metabolism can lead to further symptoms. For example, diarrhea, hair loss and excessive sweat production.
Diagnosis: How can Graves' disease be diagnosed?
In most cases, two examination methods are sufficient to clarify whether Graves’ disease is present:
Blood values: In Graves’ disease, the proportion of thyroid hormones fT3 and fT4 in the blood is increased. The presence of an increased amount of certain antibodies (TRAK, TSH receptor autoantibodies) can then already prove the disease.
Sonography (ultrasound examination): Experienced doctors can see on a screen that the thyroid gland is supplied with more blood than normal; it is often also enlarged.
Scintigraphy is rarely performed as an additional examination. This method involves passing a weak radioactive substance through the body. It temporarily accumulates in the thyroid gland and provides information about its metabolic activity. If it is elevated – a clearly visible indication of Graves’ disease – this can be seen on the image (scintigram), which is produced by a special camera.
To determine whether Graves’ disease also affects the eyes, a thorough eye examination is usually carried out in hospital or at an ophthalmologist’s practice. If you have Graves’ disease, you should have your eyes checked regularly – even if you have no eye complaints.
Therapy: How is Graves' disease treated?
Medication can ensure that the thyroid gland produces and releases fewer hormones. These thyroid inhibitors are called thyreostatics. It usually takes seven to ten days before the production of new hormones comes to a standstill. Until then, beta blockers can provide temporary relief – they help against cardiac arrhythmia and the associated symptoms such as trembling or restlessness. If your doctor treats you with thyreostatics, you should expect the therapy to last 12-18 months. If treatment is too short, there is a risk that the thyroid problems will recur.
If drug therapy does not lead to the desired success, there is another option to combat the symptoms of Graves’ disease: reducing the size of the thyroid gland or even removing it completely. Both can be achieved either by surgery or by so-called radioiodine therapy: in order to achieve a targeted reduction of part of the thyroid tissue, the patient swallows a capsule or tablet containing weakly radioactive iodine. The iodine accumulates in the thyroid gland and kills the cells there that produce hormones. Ideally, all other cells of the thyroid gland remain intact.
If you suffer from endocrine orbitopathy as a Basesow’s disease patient, there are also products available to treat your eye problems. For mild or moderate symptoms, the trace element selenium, for example, can provide relief. And if severe swelling or bulging of the eyeballs is the problem, anti-inflammatory glucocorticoids can help (usually known as “cortisone”). In some cases, eye surgery or irradiation of the eye socket can also help.
Prognosis: How does Graves' disease progress?
Graves’ disease is a chronic disease – unfortunately, sufferers never hear the sentence “You are cured forever”. Relapses after drug treatment are not uncommon. But Graves’ disease is not life-threatening, and modern medicine today offers many options for targeted help.
The course of the disease can vary greatly from person to person. Patients with a large goitre or particularly high levels of antibodies have a poorer prognosis. This also applies to smokers: they usually suffer from complaints that occur more frequently and more severely than non-smokers. If you smoke, you should therefore consider quitting – it can have a positive effect on your Graves’ disease. If sufferers neither smoke nor have particularly large thyroid glands, the chances are good that Graves’ disease treated with medication will no longer cause any serious symptoms after around a year.
If you are one of those affected by Baselow’s disease and suffer from changes to your eyes, you can make annoying or painful symptoms easier to bear. For example, tinted glasses, prism lenses (for double vision), eye drops, eye gel, an eye bandage and cool eye compresses are helpful.