Grave’s Disease

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      • Grave’s Disease
        • Autoimmune disease causing hyperthyroidism due to antibody, which stimulates TSH receptor (MCQ)
        • Pathophysiology
          • Antibody is produced that interacts with the receptor for TSH resulting in continuous excess secretion.
          • Cause of the exophthalmos (infiltrative opthalmopathy) in Graves’
          • immunoglobulins that interact with self-antigens in the extraocular muscles and on orbital fibroblasts. (MCQ)
          • These antibodies are not the same antibodies as those interacting with the TSH receptor.
        • Signs and symptoms
          • Diffusely enlarged thyroid
          • Exophthalmos
          • Pretibial myxedema
          • Tachycardia, palpitations
          • In elderly patients the presentation is less classic. (MCQ)
            • Apathy can be present without the common hyperactivity signs (apathetic hyperthy- roidism).
            • Cardiovascular features may be prominent and hyperthyroidism may not be suspected initially.
        • Diagnosis
          • High radioactive iodine uptake on a radionuclide scan. (MCQ)
            • If uptake is present but low, then diagnosis is thyroiditis or factitious hyperthyroidism
          • Elevated free thyroid hormones (T3, T4)
          • Undetectable TSH levels
          • High thyroglobulin level
        • Treatment
          • Long-Term Antithyroid Therapy
            • Usually accomplished with propylthiouracil (PTU)
            • Methimazole is as effective as PTU when administered at one tenth of the PTU dosage.
            • PTU
              • has the advantage of inhibiting the peripheral conversion of T4 to T3, thus there is usually a more rapid symptomatic improvement. (MCQ)
              • Twelve- to 24-month course is usually used and one third to one half of patients remain well indefinitely.
              • Complication: Leukopenia (MCQ)
                • check CBC before initiating therapy
                • Stop medication if absolute PMN drops below 1,500 cells/ìL.
                • If patient develops fever or sore throat, he or she should be instructed to return.
          • Radioactive Iodine Ablation Therapy (Preferred Treatment)
            • Can produce the same effects as surgery without the surgical complications
            • Tends to produce hypothyroidism over time.
            • Forty to 70% for patients will develop hypothyroidism within 10 years of therapy.
            • Some prefer to reserve radioactive iodine ablation therapy for patients over 30 years of age because of a higher incidence of hypothyroidism in younger patients. (MCQ)
            • Complications:
              • Radiation thyroiditis commonly appears within 7 to 10 days after therapy and is associated with accelerated release of thyroid hormone into the blood. Rarely, this results in thyrotoxic crisis. (MCQ)
          • Adrenergic Antagonists
            • Propranolol is the agent of choice. (MCQ)
            • Should be used only as adjunctive therapy because it does not treat the underlying problem.
          • Subtotal Thyroidectomy
            • Still used for younger patients or when ablation therapy is unsuccessful
            • Prior to surgery, patients should be euthyroid (pre-treated with PTU);
            • then give iodine to cause involution of thyroid gland.
            • Immediate complications include hemorrhage, which can result in airway compromise.
            • Delayed complications include hypoparathyroidism (can be life threatening) and hypothyroidism. (MCQ)
        • Clinical pearls :
          • Graves’ disease is the most common cause of hyperthyroidism(MCQ)
          • Graves’ (and Hashimoto’s thyroiditis) are sometimes associated with other autoimmune diseases (type I diabetes mellitus, vitiligo, myasthenia, pernicious anemia, collagen diseases) (MCQ)


Natural Treatment For Graves Disease (hyperthyroidism)
Video overviews causes and natural treatments for Graves Disease.
Uses a naturopathic / functional medicine perspective
Autoimmune disease and triggers, molecular mimicry, yersinia, h. pylori.

5 Potential Causes Of Graves Disease
Graves’ Disease and Hashimoto’s Thyroiditis
Comparison and contrast Graves’ disease and Hashimoto’s thyroiditis, two autoimmune diseases of the thyroid
The Emotional Impact of Graves’ Disease
The Emotional Impact of Graves’ Disease”
Graves’ Disease – Hyperthyroidism – Everything You Need to Know – MADE EASY
his information is intended for educational purposes only, and should not be interpreted as medical advice. Please consult your physician for advice about changes that may affect your health.
Hashimoto’s vs. Graves’ Disease
Graves’ Disease Education
Final – Healthy Policy Course – CSUMB
-A patient education video which describes Graves’ Disease. The second half of this video discusses the impact of The Affordable Care Act on Graves’ Disease patients, and the possible impact of the implementation of the California State University BSN Healthy Aging Policy.