Graves' Disease

Graves' Disease

The disease was first noted in 1786 by Caleb Hillier Parry 1755- 1822, physician from General Hospital, Bath, England. His account was published posthumously in 1825.

However Graves' disease is named after the Irish physician who described several cases in London Medical Journal in 1835. Graves' disease is also known as Parry's disease. In Europe, the disease is known as Basedow's disease. It is the most common cause of thyrotoxicosis (the morbid condition due to over activity of the thyroid gland).

The disorder has three major manifestations:

Hyperthyroidism with diffuse goiter

Ophthalmopathy

and Dermopathy

The three manifestations need not appear together. Indeed one or two never appear, and moreover, the three may run courses that are largely independent of one another.

Graves' disease can occur at any age but is unusual before puberty. It most commonly affects the 30 to 50 year age group. The disease is more frequent in women, the ratio of predominance in women may be as high as 7 : 1.

Genetic factors play a role. There is an association between the disease and the genes HLA ( human leucocyte antigen) B8, -DRw3, -Bw36, -Bw46. Indeed, a 50% concordance is found between identical twins. This means that if one individual in an identical pair of twins is afflicted with Graves' disease, the likelihood of the other sibling coming down with Graves' is 50%.

Being an autoimmune disease, there is a clinical and immunologic overlap between Graves' disease and other diseases with prominent autoimmune features. These include Hashimoto's thyroiditis, pernicious anemia, systemic lupus erythematosus ( SLE), rheumatoid arthritis ( RA), insulin- dependent diabetes mellitus ( IDDM), and Addison's disease.

Thyroid hormones are important mediators of growth and differentiation. The absence of which leads to cretins in childhood. The hormones are also responsible for the regulation of the various metabolic pathways which are vital for life. They are necessary for the normal function of many organ systems.

In the thyroid gland, multiple follicles make, store and release thyroid hormones into the surrounding capillaries. These little vessels then bring the hormones to the rest of the body where they are needed.

"Thyroid hormones" refers mainly to two hormones T3 and T4, which are single, amino acids containing iodine. They are p...

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...tient is willing to take replacement Thyroxine for life, the simplest approach may be the use of radioiodine. There are arguments for and against giving radioiodine to children and young persons who plan to have children. Previously, clinicians are unwilling to advise its use under the age of 45. This restriction is now rapidly being laxed as there is no convincing evidence that there is significant increase in the incidence of cancers occurring in adulthood secondary to its usage. Radioiodine can ensure that mothers are not taking anti- thyroid drugs during pregnancy and breastfeeding. Therefore, an argument can be made for using this treatment method for all age groups except when pregnant or breastfeeding.

Relapse of Graves' disease after medical therapy may be managed with a second course, but at this point radioiodine is preferred. During pregnancy and breastfeeding periods, PTU ( propylthiouracil) appears to be the safest drug to use. And surgery is advised in cases with the presence of concomitant suspicious nodule.

Each of the 3 major treatments ( anti- thyroid drugs, surgery and radioactive iodine) has their own advantages and disadvantages compared to the others.