Understanding Hyperthyroidism and Graves’ disease

What is a thyroid.

The thyroid gland is a small butterfly like gland at the centre of our throat. It is responsible for producing our thyroid hormones which has important functions to our metabolism and development of our body.

However the thyroid gland can become sick. As a result it may produce excessive amount or insufficient amounts of thyroid hormones.

What is hyperthyroidism and what are the symptoms?

Hyperthyroidism occurs when your thyroid gland produces too much thyroid hormones. This will accelerate your body’s metabolism causing a whole spectrum of symptoms :

1. heat intolerance
2. excessive sweating
3. Increased appetite - eating much more than usual yet losing weight
4. Palpitations
5. anxiety, nervousness and irritability
6. fatigue or tiredness
7. change in bowel habit - going to the toilet more often
8. tremors or trembling of fingers and hands
9. swollen neck in some cases
10. change in your menstrual pattern (Ladies)

In Graves’ disease, you may also notice protrusion of the eyeballs with red and dry eyes In some cases, even double vision

If one has any of the above symptoms, please consult a doctor early for evaluation.

What is Grave’s disease?

One of the most common causes of hyperthyroidism is Graves’s disease.This is an autoimmune condition where the body produces an antibody that, instead of attacking external invading agents, attacks your own thyroid gland. The name of the anti body is known as the thyrotropin receptor antibody or TRAb for short.

TRAb will circulate in the blood stream and attach itself onto the thyroid gland resulting in an excessive production of thyroid hormones.

• Your chance of getting graves’ is higher if
• You have a family history
• or have a history of other autoimmune conditions like rheumatoid arthritis or SLE
• if you are a female in your forties
• if you are under intense stress
• if you are pregnant
• or smoker

Diagnosing & Treating Graves’ Disease

Diagnosing

If a patient is suspected of having hyperthyroidism from graves’, blood samples will usually be called for :

• thyroid hormone levels and
• the thyrotropin receptor antibody ( TRAb ) levels

And if physical examination reveals a swollen thyroid gland an ultrasound of the neck may be administered to confirm the diagnosis.

Treatment

Treatment of Graves’ disease involves 3 key processes.

Firstly, reduce the symptoms caused by high thyroid levels so that the patient will feel better. A class of medications we often use to achieve this is the beta blockers. It can help to reduce the palpitations, trembling of hands and even anxiety and nervousness. Some patients report symptoms relief within hours to days of starting this medication.

Secondly, reduce the thyroid hormone levels by administering anti thyroid drugs such as carbimazole, methimazole or propylthiouracil.

These medications cause the thyroid gland to produce less thyroid hormones. Generally upon starting these medications, thyroid hormone levels are typically expected to normalise in 2 months’ time.

Thirdly, to treat the grave’s disease itself.

• The first option would be radio-iodine. This involves the taking radioactive iodine in a capsule of liquid form that slowly destroys the cells of the thyroid gland, thereby reducing hormonal production. It may eventually result in hypothyroidism. This treatment is not suitable for pregnant ladies or breastfeeding mothers.
• The other option would be to remove the thyroid gland through a surgery. This is only considered if the thyroid gland is so swollen that it is pressing on ythe windpipe causing breathing issues or sometimes in pregnant ladies who are unable to tolerate or are allergic to all the antithyroid medications.

Conclusion

Do note that there are pros and cons to each treatment. A detailed consultation with your endocrinologist is crucial to determine the best way forward.

Most importantly, recognise the symptoms of hyperthyroidism. See your endocrinologist or family physician to get it checked if you are suffering from hyperthyroid symptoms. It is very treatable.