The thyroid is a vital organ of the human body. It is responsible for much of the regulation of metabolism. As a secreting gland/organ, it secretes many hormones and catalysts that ensure the proper functioning of all of body systems. The thyroid is a butterfly shaped organ located within the neck. When things go wrong with the thyroid, two things can happen, 1) with a decrease in the secretion of TSH ( Thyroid Stimulating Hormone ) a person develops a condition known as hypothyroidism aka Hashimotos syndrome, and 2) Occasionally the thyroid will go into hyper drive and secrete an excess of TSH, this leads to a condition known as hyperthyroidism aka Graves disease. This condition was first described by a Irish physician in the mid 1800's. Dr. Robert Graves 1796-1853. For unknown reasons, this condition is 5 times more common in females than in males. And most often manifests between the ages of 30-60.
So how does one develop this disease?. A great question, but the exact cause is still at this point unknown. It is suspected and partially corroborated by additional testing, that shows that the disease is familial ( hereditary ) and that somehow certain thyroid stimulating auto antibodies adhere to the TSH molecules inducing a surge in the production of these hormones. The initial source appears to be related to an initial infection of the thyroid and/or great emotional stress. One of the most pronounced indicators of this condition is the manifestation of exophthalmos ( protrusion of the eyes ). all persons with graves disease develop bulging eyes in which the orbits are distinctly protruded. A number of other sign and symptoms are most often present such as nervousness, fine hand tremors, weight loss, fatigue, breathlessness, palpitations, increased heat intolerance, increased metabolic rate, and increased bowel motility. More rare, the patient may also experience an enlarged thymus, enlarged thyroid, generalized hyperplasia of the lymph nodes, blurred or double vision, localized myxedema, atrial arrhythmias, and osteoporosis. Lets examine each sign and symptom a little more in depth:
NERVOUSNESS- Nervousness is a condition in which a person seems to have inordinate amount of energy. It is characterized by the inability to sit still, the person fidgets, taps their feet, drums their gingers, twists their hair, or constantly paces. Sleep disorders are common with a nervous condition. sometimes anti anxiety medications such as lorazepam may be prescribed.
FINE HAND TREMORS- Fine hand tremors are the result of the excessive metabolism occurring. One will see the hands shaking uncontrollably. These are not to be confused with parkinsonian type tremors, but rather these tremors are very rapids and fine.
WEIGHT LOSS- With the increase in metabolism, the person may experience anorexia, which is the loss of appetite. When the bodies metabolism goes into overdrive, to fuel this system, energy is taken from secondary systems, hunger is one such casualty. So often a person may be prescribed an appetite stimulant such as Megestrol
FATIGUE- This is common due to the high energy outputs. A physician may recommend scheduling additional sleep or naps to help combat this. Since the body is already in hyper drive, it would be a bad idea to prescribe stimulants such as methylphenidate
BREATHLESSNESS- The cause of the breathlessness is unknown, but is thought to be related to the excess TSH. With the metabolism in high gear it is using more oxygen, and oxygen demands are higher.
PALPITATIONS- Again with the higher amounts of hormones circulating, this can cause the heart to work overtime. Often people feel this extra work being done by the heart as a racing sensation aka palpitations.
INCREASED HEAT INTOLERANCE- When you have a series of chemical reactions occurring at high levels, one of the by products is a lot of heat. A person with graves disease may have a base line temperature of 100 degrees f or greater. with this excess heat, any additional heat is very uncomfortable, and can be life threatening.
INCREASED BOWEL MOTILITY- what this means is that the person with graves disease will digest and purge at an accelerated rate. Bowel sounds will be hyperactive, and the person might have excess flatulence.
INCREASED METABOLIC RATE- See above descriptions
ENLARGED THYMUS- The thymus is a gland in the mediastinum, more or less in the middle of the chest just above the heart. It is the primary organ of the endocrine system, which in turn assists with the regulation of the immune system. When this organ is malfunctioning, the immune system can attack any and all organs and systems. So this is why it is imperative to be under a physicians care specializing in endocrine issues. The thyroid is an endocrine related organ.
ENLARGED THYROID- The thyroid becomes enlarged and swollen, resulting in a visibly larger neck.
HYPERPLASIA OF THE LYMPH NODES- This means that the lymph nodes are swollen and inflamed.
MYXEDEMA- This term refers to swelling of the face, eyes, neck, mouth, trachea, hands, feet. It means that the body can not get rid of water. This can lead to coma or death.
ATRIAL ARRHYTHMIAS- Often graves disease can lean to atrial fibrillation or atrial flutter. Sometimes this leads to blood clots, because the atria can not properly contract sending the blood through the ventricles.
OSTEOPOROSIS- This is a condition in which the bones thin and weaken. with graves disease, for unknown reasons, osteoclasts ( bone builders ) are destroyed and a surge of osteoblasts ( bone eaters ) are produced. This leads to bones that are weak and easily fractured.
So how is this condition treated. Most commonly it is recommended to increase the amount of iodized salt. but often other medications such as methimazole, prophlthiouracil, or an iodine preparation. these medications work to inhibit the secretion of the thyroid stimulating auto antibodies. If the condition is serious enough, the patient may be admitted to the hospital and receive radioactive iodine. As a last ditch treatment, the thyroid may be removed altogether. Although a total thyroidectomy is not ideal, sometimes it is the only option after all other options have been tried. you may also know the condition of an enlarged thyroid as a goiter.
So if the thyroid has to be removed, what is in store for the patient. Well, since there is no longer a thyroid, the patient now has hypothyroidism and must take a replacement hormone known as levothyroxine sodium or synthroid. Our bodies need this hormone in order to metabolize our nutrients and helps with our energy stores. good news is that Graves disease is reversible in most cases. If successfully treated, the patient will need to have occasional check ups, but there is no reason why they can not lead a normal healthy life.