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Grave's Disease

Grave's Disease is a condition caused by hyperactivity of the thyroid gland. Due to hyperthyroidism, a person appears nervous and anxious. This is due to the higher metabolic rate set by overactive thyroid. The body's immune system is triggered. Typically Grave's disease affects women in the age group of 20 - 40 years.


Symptoms of Grave's disease include enlarged thyroid gland, rapid heartbeat, nervousness, anxiety and difficulty in sleeping. A person suffering from Grave's disease experiences increased sensitivity to heat and moist skin. In cases of Graves' ophthalmopathy, the eyes may appear reddened or inflamed. There is increased sensitivity to light and the eyes may experience excessive tearing. Other symptoms of Grave's disease are weight loss without loss of appetite, bulging eyes and enlarged thyroid gland. Patient suffering from Grave's disease may have increased sweating, hand tremors and muscular weakness. Women may have infertility problems.


Blood levels of thyroid hormones - thyroid-stimulating hormone (TSH) and thyroxinecan help in identifying Grave's disease. A short course of radioactive iodine helps in reducing the hyperactivity of the thyroid. This treatment shrinks the thyroid cells. Sometimes the thyroid is removed, in part or completely. Anti thyroid medications such as propylthiouracil and methimazole are prescribed to reduce the production of thyroid hormones.

Thyroid

Thyroid is a gland in the neck overlying the windpipe that regulates the speed of metabolic processes by producing a hormone with the eponymous name thyroxin. Thyroid is an endocrine gland. The thyroid gland which resembles a butterfly, sits astride the trachea. Its secretion - thyroxin, a hormone that regulates the metabolic activity of the body. Too much thyroxin races the metabolism resulting in weight loss, temperature elevation, nervousness and irritability. On the other hand, too little thyroxin slows down the metabolism rate resulting in deep voice, weight gain and water retention. This can result in retardation in physical growth and mental development in children. Both conditions equally affect hair and skin growth, bowel function and menstrual flow.

The thyroid gland is often enlarged whether it is secreting too much hormone, too little or even when it is functioning normally. The thyroid is controlled by the pituitary gland, which secretes Thyroid Stimulating Hormone (TSH) in response to the amount of thyroxin in the blood. TSH increases the amount of thyroxin secreted by the thyroid and also causes the thyroid gland to grow.




Hyperthyroid Goiter : If the amount of TSH is high, the thyroid will both enlarge and secrete too much thyroxin. The result is termed as Hyperthyroidism with a goiter. Graves' disease is the most common form of this disorder.



Euthyroid goiter : If dietary iodine is insufficient, too little thyroxin will be secreted and the pituitary will sense the deficiency and produce more TSH. The thyroid gland will enlarge enough to make sufficient thyroxin.

Hypothyroid goiter: If dietary iodine is severely low, even an enlarged gland will not be able to make enough thyroxin. The gland may keep growing under the influence of TSH, but it may never make enough thyroxin.

An endocrinologist who specializes in the endocrine system can also be consulted for thyroid problems and diseases. Specialists who deal with thyroid problem are called thyroidologists. Thryoidologist and endocrinologist are specially trained doctors who diagnose and treat diseases affecting the thyroid gland. A thyroid specialist continues specialized education focused on thyroid issues after obtaining a Masters degree in medicine. He is qualified and trained to treat conditions that are complex and involve many systems within the body that may be affected due to thyroid imbalance.


A primary care doctor too often misses the diagnosis of a thyroid disease. Sometimes primary care doctors refer patients to a thyroid specialist when there is problem in the endocrine/ hormone systems. Thyroid specialists treat patients with too much or too little thyroid hormone. The thyroid specialist helps the patients to reach a hormone balance by replacing or blocking thyroid hormone. Thyroid specialists also receive special training to manage patients with thyroid growths or thyroid cancer and enlarged thyroid glands. There are times when the services of a thryoidologist or an endocrinologist become absolutely necessary.


  • A thyroid specialist has to be consulted when a patient is suffering from the hyperthyroid autoimmune - Graves' disease. This is a condition which can be treated only by a thyroid specialist and not by a regular GP. Graves's disease and hyperthyroid management involves a number of therapies, anti thyroid drug use, radioactive iodine treatments and even surgery if necessary.
  • Evaluation and treatment for thyroid nodule can be rendered only by thyroid specialists. Thyroid nodule is evaluated by ultrasound and fine needle biopsy process. This is done to rule out the possibility of thyroid cancer.
  • Thyroid cancer is rare and less than 15000 new cases are diagnosed every year. An expert thyroid specialist is highly recommended to diagnose, evaluate, treat and help in long term follow up and support management of thyroid cancer.
  • Thyroid surgery is performed when the gland becomes so large that is cosmetically disfiguring. This is normally done if a thyroid has markedly enlarged for years. Thyroid surgery should be performed by an experienced thyroid surgeon. Only an experienced thyroid surgeon can handle the complications that can arise due to thyroid surgery.
  • A thyroid specialist can assess hypothyroidism levels. This is done by evaluation of TSH level. S/He considers other options such as symptoms, family history and clinical factors to make a thyroid diagnosis.
  • After a person has been diagnosed for hypothyroidism, a thyroid specialist treats and manages the patient for other signs and symptoms as well. Such symptoms are weight gain, depression, brain fog, hair loss, shortness of breath, intolerance to heat and cold, muscle aches and joint pains, constipation, carpal tunnel, high cholesterol, infertility, Fibromyalgia and chronic fatigue syndrome.


Exophthalmos

Exophthalmos, also known as Proptosis, refers to a protrusion or bulging of one (unilateral) or both (bilateral) the eyeballs out of the orbit. Exophthalmos is not a medical condition in itself; but a sign or a symptom of some other disease. There are many underlying conditions that can result in exophthalmos, but most often it is caused by thyroid- related conditions such as Graves disease. Graves disease induced Exophthalmos is one of the manifestations of thyroid eye problems.


Exophthalmos caused due to Graves' disease is usually bilateral. Apart from thyroid problems, there are other conditions that may lead to Exophthalmos. They include cancerous tumor, Mucocoele (mucus-filled cyst), blood clot, trauma (eye injury), inflammation of the orbit structures and very rarely Retrobulbar hemorrhage (bleeding in the eye socket).



Signs and symptoms of Exophthalmos

Exophthalmos caused by Graves disease normally produces symptoms such as pain, watering, dryness, irritation, sensitivity to light, double vision and loss of vision. Tumor-induced exophthalmos presents itself with severe eye pain, headaches and double vision.


Diagnosis of Exophthalmos

Exophthalmos is easily noticeable by its appearance during clinical examination. Ophthalmologist uses exophthalmometer to measure the degree of bulging or protrusion. Blood tests are normally advised, if doctor suspects hypothyroidism, to evaluate thyroid gland function.

If the bulging has occurred in one eye, MRI or CT scan is done to rule out the presence of tumor. These tests also help in diagnosing Orbital cellulitis and Retrobulbar hemorrhage.


Treatment of Exophthalmos

Treating the exophthalmos at an early stage is essential as it is a progressive disease and if left untreated patient may be unable to close the eyes totally. This may dry out the cornea leading to infections and ulcers eventually resulting in vision loss.

In case of thyroid related exophthalmos, the aim of the treatment is to restore the thyroid function and bring the thyroid hormones to normal levels. Medications such as thionamides and radio iodine are given orally to treat overactive thyroid gland. In severe cases, corticosteroids are also administered to provide relief from pain and inflammation. Lubricants are also prescribed to treat dry, red and sore eyes. If the exophthalmos is caused by a tumor, treatments such as radiotherapy, chemotherapy and surgery may be appropriate.

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Collection of Pages - Last revised Date: June 20, 2019