What is Graves’ Disease (Toxic Goiter)? Symptoms and Treatment

by Abbas Jahangir · June 22, 2024

Graves’ disease is an autoimmune disease that causes the thyroid glands to work excessively and therefore produce excessive amounts of thyroid hormone. This disease, also known as toxic goiter, is one of the most common causes of hyperthyroidism. Does toxic goiter kill? What is good for toxic goiter? The questions are explained in detail later in the article.

What is Graves’ Disease (Toxic Goiter)?

Graves’ disease is an autoimmune disease, also known as toxic goiter. This disorder causes the thyroid gland to work hard and produce excessive amounts of hormones. Increase in thyroid hormone levels causes hyperthyroidism. Hyperthyroidism may occur due to many different reasons, especially Graves’ disease.

Thyroid hormones; It affects many different areas, from nervous system function to brain development, from body temperature to metabolism. Changes in thyroid hormone levels also affect all these areas. Symptoms related to hyperthyroidism develop in almost every part of the body.

What Causes Graves’ Disease (Toxic Goiter)?

Graves’ disease is an autoimmune disorder. In autoimmune diseases, a problem occurs in the immune system, whose main task is to fight harmful microorganisms that enter the body. The immune system perceives the person’s own body cell as ‘foreign’ and tries to destroy it. This causes damage to the tissues where the relevant cell is located.

In Graves’ disease, the immune system produces antibodies against a part of the cells in the thyroid gland.

Under normal conditions, the function of the thyroid gland is controlled by a hormone secreted from the pituitary gland in the brain. In Graves’ disease, the antibody produced by the immune system (thyrotyropine receptor antibody, TRAb) mimics the hormone secreted from the pituitary gland. This antibody causes the thyroid gland to become overstimulated, thus producing excess hormones. High thyroid hormone levels also cause hyperthyroidism.

Graves’ ophthalmopathy is an eye disease caused by toxic goiter. In Graves’ ophthalmopathy, some carbohydrates accumulate in the muscle and other tissues behind the eye. Although the cause of this situation is not exactly known, it is thought that antibodies called TRAb, which disrupt thyroid functions, play a role in this change that occurs around the eyes.

Graves’ ophthalmopathy usually occurs simultaneously with hyperthyroidism or several months after hyperthyroidism begins.

In the presence of certain conditions, a person’s risk of developing Graves’ disease may increase. Graves’ disease risk factors:

Family History: Individuals with a family history of toxic goiter have an increased risk of contracting this disease. This may be an indication that genetic structure also plays a role in the development of Graves’ disease.
Gender: Toxic goiter disease is more common in women than in men.
Age: Graves’ disease usually develops before age 40.
Other Autoimmune Diseases: People with autoimmune diseases such as type 1 diabetes and rheumatoid arthritis have a higher risk of toxic goiter, which is also an autoimmune disease.
Emotional or Physical Stress: Situations such as illness, experiencing a stressful event; It may trigger the development of the disease in people who are genetically predisposed to Graves’ disease.
Pregnancy: Women who are pregnant or have recently given birth are more likely to suffer from toxic goiter.
Smoking: Smoking affects the immune system and increases the risk of toxic goiter. Graves’ disease patients who smoke are also more likely to develop Graves’ ophthalmopathy.

What are the symptoms of Graves’ Disease (Toxic Goiter)?

Common Graves’ disease symptoms are as follows:

Anxiety
Unrest
Sensitivity to heat, sweating even in warm weather, moist skin
Weight loss despite no change in diet
Enlargement of the thyroid gland (goiter)
Change in menstrual pattern
erectile dysfunction
Decrease in sexual desire (libido)
Frequent bowel movements
protruding eyes
Tiredness
Thickening and redness of the skin on the calf and heel
Increased heart rate (tachycardia)
Irregular heartbeat (palpitations)
Sleeping disorders

Approximately 30% of Graves’ patients have signs and symptoms of Graves’ ophthalmopathy. In Graves’ ophthalmopathy, inflammation occurs in the tissues around the eye. Graves’ ophthalmopathy symptoms:

eyes bulging out
Feeling of sand in the eyes
sensitivity to light
Feeling pressure or pain in the eyes
double vision
Swelling or pulling of the eyelids
Eye redness, inflammation
It can be considered as vision loss.

Graves’ dermopathy is a rare manifestation of Graves’ disease. In patients with Graves’ dermopathy, skin redness and thickening may be observed, especially in the heel and calf areas.

How is Graves’ Disease (Toxic Goiter) Treated?

Graves’ disease treatment is done to prevent excessive production of thyroid hormones and to normalize the effects of already produced hormones in the body.

One of the methods that can be used in the treatment of toxic goiter disease is radioactive iodine therapy. In this therapy, the patient is given radioactive iodine orally. Iodine is a substance that the thyroid gland needs to produce hormones. For this reason, the thyroid gland retains the radioactive iodine taken into the body. Radioactive iodine entering the thyroid cells begins to destroy the overactive thyroid tissue with the radiation it emits. The thyroid gland gradually shrinks and the symptoms of Graves’ disease ease. Radioactive iodine treatment continues over a period of several weeks to several months. Side effects of this treatment method include neck sensitivity and a temporary increase in thyroid hormone levels.

Radioactive iodine therapy is not used in pregnant and breastfeeding women.

Another method that can be used in treatment is anti-thyroid drugs. These drugs prevent the iodine needed by the thyroid gland to produce hormones from being taken into the cell. Thus, it reduces thyroid hormone synthesis. An example of anti-thyroid drugs is methimazole.

Beta blocker group drugs can also be used in the treatment of hyperthyroidism. These medications do not reduce thyroid hormone production. Beta blockers show their effects by neutralizing the effects of thyroid hormones in the body. Beta blockers; It helps eliminate symptoms such as increased heart rate, anxiety, restlessness, sweating and diarrhea. Propranolol, atenolol, metoprolol, nadolol; It is an example of beta blockers that can be used in the treatment of Graves.

Another method that can be used in the treatment of Graves is surgery. Toxic goiter surgery involves removing part or all of the thyroid gland. After the surgery, the patient may need to receive external thyroid hormone support. During Graves’ disease surgery, the nerves that control the vocal cords may be damaged, and the parathyroid glands, which are located above the thyroid gland and maintain calcium balance in the body, may be damaged. However, the risk of complications is very low in surgery performed by an experienced surgeon.

If Graves’ disease is left untreated, it can lead to very serious health problems. Complications that may develop due to Graves’ disease are as follows:

Problems During Pregnancy: Problems such as miscarriage, premature birth, fetal thyroid dysfunction, poor fetal development, maternal heart disease, and preeclampsia are complications of toxic goiter that can be seen during pregnancy.
Heart Diseases: If Graves’ disease is left untreated, it can lead to heart rhythm disorders, structural changes in the heart muscle and heart failure.
Thyroid Storm: Thyroid storm is a rare but potentially life-threatening complication of Graves’ disease. This condition, also known as thyrotoxic, occurs especially in people with severe hyperthyroidism.

A rapid and severe increase in thyroid hormones has many effects on the body. These effects; These symptoms include fever, sweating, diarrhea, vomiting, delirium, extreme weakness, cardiac arrhythmia, seizures, jaundice, low blood pressure and coma. Thyroid storm is a health problem that requires urgent intervention.

Fragile Bones: Hyperthyroidism causes osteoporosis, which causes weakness and fragility in the bones. For bones to be strong, they must contain sufficient calcium. The increase in thyroid hormones causes the calcium-binding capacity of bones to decrease.

Graves’ disease is one of the most common causes of hyperthyroidism. If this disease is left untreated, it can cause serious health problems. It would be beneficial for people who show one or more of the symptoms of Graves’ disease to immediately contact a health center and have the necessary check-ups.