What is Grave's disease?

Grave’s disease is an autoimmune disorder causing hyperthyroidism, an overactive thyroid, and an abnormally high production of the thyroid hormone.

Despite being one of Australia's most common thyroid issues, few people have heard about the disease and the medical community has no real reason why it strikes one person over another.

So what do we know about the disease? 

Symptoms
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“But for the majority of people, it actually escalates and pretty much causes havoc in all aspects of their life."

Grave’s disease typically causes a goitre around the thyroid gland.

The release of excess thyroid hormone also speeds up the body’s metabolism and many of its processes.

That means people with Grave’s disease are prone to experiencing anxiety or nervousness; difficulty concentrating; fatigue; frequent bowel movements; heat intolerance; skin issues; increased sweating; increased appetite; muscle weakness; infertility and menstrual irregularities.

Insomnia or sleeping troubles, heart palpitations or arrhythmia, shortness of breath with exertion, tremor and weight loss, are also common symptoms. 

Head of the Department of Endocrine and Oncology Surgery at Sydney’s Royal North Shore Hospital and specialist endocrine surgeon, Dr Mark Sywak, says some patients with Grave’s can have a very mild attack of the disease and get back to good health.

“But for the majority of people, it actually escalates and pretty much causes havoc in all aspects of their life,” says Dr Sywak, Clinical Associate Professor at the University of Sydney.

“You can’t quite sleep so you are tired in the day, your personality changes so you are more likely to be aggressive.

“You would find it hard to exercise because basically you’ve got this resting heart rate that is incredibly high. So if you jumped on a treadmill with Grave’s disease, you’d pretty quickly get over 150 or 170 and be uncomfortable.”

Graves’ disease can also cause ophthalmopathy (eye disease) with common problems including double vision and eye swelling to upper eyelid retraction, irritation and tearing. This is because the thyroid gland and the eye’s extraocular muscles may share a common antigen that is recognised by the antibodies attacking the thyroid.

Who gets Grave’s disease?
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Grave's disease is the most common cause of hyperthyroidism.

According to a paper published in Australian Family Physician, around five to 10 times more females will be diagnosed with Graves disease than men.

It can occur at any age, but Dr Sywak says it is most common in women aged in their 20s and 30s.

“Around five per cent of all women in their lifetime will have a thyroid condition. And Grave’s disease probably makes up for a third or half of all of that.

“So up to about one per cent of all women in Australia [around 110,000 females] will potentially develop an overactive thyroid through Grave’s disease.”

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Complications
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Grave’s disease can cause serious health issues during pregnancy including miscarriage, preterm birth, fetal thyroid dysfunction, poor fetal growth, maternal heart failure and preeclampsia – a maternal condition that results in high blood pressure and other serious signs and symptoms during pregnancy.

The autoimmune disease can also cause heart disorders and if left untreated, can lead to congestive heart failure.

Untreated or undertreated hyperthyroidism also can lead to osteoporosis, as too much thyroid hormone can interfere with the body’s ability to absorb calcium into your bones.

Accelerated hyperthyroidism or ‘thyroid storm; is a rare but life-threatening complication of Graves' disease that occurs when the condition is left untreated in the long-term.

A dramatic increase in thyroid hormones can result in fever, delirium, severe weakness, seizures, markedly irregular heartbeat, yellow skin and eyes, severe low blood pressure, and coma.

"Untreated or undertreated hyperthyroidism also can lead to osteoporosis, as too much thyroid hormone can interfere with the body’s ability to absorb calcium into your bones."

Overactive thyroid v Grave’s disease
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It’s important to note that Grave’s disease and overactive thyroid are not interchangeable conditions.

Grave’s disease, an illness caused by an abnormal immune system response, does not equal hyperthyroidism although they are obviously intertwined.

“There a number of conditions that cause an overactive thyroid,” explains Dr Sywak.

“But one of the most common ones is Grave’s disease. Other potential causes are nodules in the thyroid, an excess of thyroxin, a tumor in the pituitary gland of the brain.”

To better understand the relationship between the two clinical conditions, it’s important to recognise that all Grave’s disease patients have overactive thyroids but not all overactive thyroids are caused by Grave’s disease.

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Causes
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No one knows why the body’s disease-fighting immune system turns on itself and causes the thyroid to malfunction, as is the case with Grave’s disease.

But it is believed that around 30 per cent of people with Grave’s disease inherit it. No single gene has been identified to cause the disease and no one knows why it turns on in some family members and not others.

“The remainder of people develop it as a sporadic one-off and the cause is unknown,” says Dr Sywak.

Smoking, psychological stress and the postpartum period (after childbirth) are associated with the development of Grave’s disease.

A lack of iodine is also linked to causing thyroid issues: goitre, cancer, nodules.

“There have been some good studies to show that in NSW, we are also quite iodine deficient,” he says.

“All of us should have an intake of iodine in our diet. A normal healthy diet with a small amount of iodine salt is safe and good for the thyroid.”

Dr Sywak adds that the disease might be also oestrogen and progesterone related but more research is needed to determine the true cause of Grave’s disease.

“All of us should have an intake of iodine in our diet. A normal healthy diet with a small amount of iodine salt is safe and good for the thyroid.”

Diagnosis
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If you are concerned about your health, visit your GP to receive a full examination of your neck to check for an enlarged thyroid, heart rate and other signs. You should also receive a thyroid function and antibodies test.

“People don’t really know anything about the thyroid, what it does or where it is but it is very easy to test for a thyroid condition and find out if you have one or not.

“So if you’re not feeling well, are tired or have a heat intolerance and heart palpitations, don’t put up with it. Go and see your GP. It’s very simple to get a blood test.”

Health risks post-diagnosis
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One of the largest studies available examining the risk of diagnosis of coexisting autoimmune diseases, looked at more than 3,000 cases with well-characterised Graves' disease or Hashimoto's thyroiditis.

It concluded that people with both thyroid diseases, but more so with Graves, are likely to develop other autoimmune illnesses in addition to their original thyroid condition.

For example, coeliac disease is common in patients with Grave’s disease and this risk persists after treatment.

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Treatment
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“Everyone has very different experience of Grave’s."

Grave’s disease and its symptoms can be treated and managed with anti-thyroid medications, radioactive iodine or thyroid surgery. Beta-blockers might also be used to treat symptoms like a rapid heart rate, sweating, and anxiety until the hyperthyroidism is controlled.

“Everyone has very different experience of Grave’s,” explains Dr Sywak.

“There are probably 40 per cent of people who are put on medication for a year once they are diagnosed. The condition settles after a year and they get back to normal.

“Then there are others where it reoccurs. Some people might struggle with it for decades or a lifetime.”

An endocrinologist can provide Grave’s disease patients with specialist information and tips on medication, weight management, pregnancy and maintaining a positive sense of wellbeing.

An eye specialist can also work with your endocrinologist or GP to ensure any eye-related symptoms are addressed.

More information
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The Australian Thyroid Foundation will be running a nationwide awareness campaign about thyroid issues, including Grave's disease, throughout the month of May.

If you are in need of information or support support, contact Australian Thyroid Foundation

For more information, visit Thyroid Australia.