Grave's disease
Dr Leba Sarkis
HEAD AND NECK SURGEONWhat is Grave's disease
Grave’s disease is an autoimmune condition that is the most common cause of hyperthyroidism (overactive thyroid gland). It is caused by lymphocytes (B cell immune cells) within the thyroid gland producing antibodies (immunoglobulins) to the thyrotropin receptor (TRAb) that then activate the receptor, resulting in overproduction of thyroid hormone responsible for the clinical symptoms produced as well as thyroid growth which causes an enlarged thyroid gland (Goitre).
It is often regarded as a syndrome that may consist of hyperthyroidism, Goitre, thyroid eye disease (25-40%) or rarely dermopathy (5-15%).
Treatment options
There are 3 main treatment options which include:
1. Medical management: Antithyroid medications such as carbimazole block the synthesis of T4 and T3
2. Radioactive iodine
3. Surgery – Total thyroidectomy
The goals of management are to mitigate the symptoms of hyperthyroidism (palpitations, increased heart rate, tremor, heat intolerance and anxiety) using beta blocks such as propranolol, and also normalize thyroid hormone levels. (carbimazole or propylthiouracil). These medications are also used pre-operatively to normalize your thyroid function levels and reduce the risks of complications during surgery.
Surgery is the most definitive treatment of Grave’s disease and rapidly corrects the thyrotoxicosis along with its clinical manifestations.
In patients with Graves disease it is indicated in the following scenarios:
– Diffusely enlarge goitre with compressive symptoms
– Patients refractory to treatment with anti-thyroidal medications or experiencing significant adverse effects
– Concern for thyroid cancer
– Moderate to severe thyroid eye disease