Graves Disease - Dubai Thyroid Clinic at DRHC
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Graves Disease
- It is an overproduction of thyroid hormones of the thyroid gland.
- It is an autoimmune disease with the female preponderance (5:1), and peak incidence between the ages of 40-65 years.
- It is the most common cause of hyperthyroidism approximately 60-80% of cases.
Etiology
The exact etiology of Grave’s Disease is still unknown but there are risks factors:
- Postpartum state
- Iodine excess
- Lithium therapy
- Bacterial and viral infections have been suggested one of the cause
- Recently: genetic factors also play a role (HLA-B8, HLA- DR3, and HLADQA1*0501)
Mechanism:
T-helper cells stimulates B lymphocytes, which produce antibodies directed against the thyroid hormone receptor (TRS). The thyroid-stimulating antibodies stimulate the thyrocytes to grow and synthesise excess thyroid hormone, which is a hallmark of Grave’s disease.
Clinical Features
The clinical manifestations of Grave’s Disease can be divided into those related to:
How we can diagnose Graves' Disease and what is the investigation assessed?
- Signs and symptoms
- Blood tests
- TSH, FT3, FT4
- Anti- Tg, anti- TPO which are elevated up to 75% of the patients.
- TSH-R or thyroid stimulating bodies (TSAb) diagnostic of Grave’s Disease about 90%.
Radionuclide Imaging
- With I-123 and elevated uptake, with diffusely enlarged gland confirms the diagnosis of Grave’s disease.
- MRI scan of the orbits is useful in evaluating Grave’s Ophthalmopathy.
What are the treatment options?
Grave’s disease can be treated by any of the treatment modalities:
- Anti-thyroid drugs:
- Propylthiouracil (PTU): 100–300 mg three times daily.
- Methimazole: 10–30 mg three times daily, then once daily
- Radioactive Iodine Therapy (I-131): the I-131 dose is calculated after a preliminary scan and usually consists of 8–12 mCi administered orally.
Medications should be advised by your treating physician.
- Surgical Treatment:
- Absolutely Surgical Indications
- Have confirmed cancer or suspicious thyroid nodules.
- Young patients
- Pregnant or desire to conceive soon after treatment
- Have had severe reactions to anti-thyroid medications
- Have large goitres causing compressive symptoms
- Reluctant to undergo RAI therapy.
- Relative Surgical Indications:
- Patients, particularly smokers, with moderate to severe Grave’s Ophthalmopathy
- Those desiring rapid control of hyperthyroidism with a chance of being euthyroid
- Those demonstrating poor compliance to anti-thyroid medications.
*Advised to do total or near total thyroidectomy.
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