Graves' Disease

Grave’s Disease Pathology, Symptoms and Treatment

Renz L. Salumbre

Introduction • Thyrotoxicosis • Hyperthyroidism • Autoimmune Disorder

Objectives • To define Grave’s disease • To enumerate the factors that contributes to its cause

• To define the autoimmune

characteristic of Grave’s disease

• To describe available treatments

Pathogenesis • Genetics • Familial predisposition • Existing history of autoimmune disorders

• Autosomal dominant • CTLA-4, HLA, LYP

Pathogenesis • Genetics (cont...) • Polygenic / complex disorder • Abnormal production of

immunoglobulins is triggered by an external factor and which the immune system fails to to stop because of an inherited defect

Pathogenesis • Stress • Physical and psychological • E.g. Nazi Prisoners • State of immunosuppression • Secondary complications of cortisol and corticotropinreleasing hormone

Pathogenesis • Overcompensation by immune system follows immunosuppression

• Greater immune activity

• Infection • Pathogenic species that may

cause Grave’s disease e.g. Y. enterocolitica

Pathogenesis • Infection (cont.) • Thyroid gland infections • Gender • 5 Females : 1 Male • Estrogen • X chromosome

Pathogenesis • Diet • Consumption of iodine-rich foods

Autoimmune disease is an autoimmune • Grave’s Characteristics disorder • T lymphocytes sensitized to thyroid antigens

• B lymphocytes are stimulated to produce Ab to the produced antigen

• Directed against TSH receptor (TSAb / TSI)

Autoimmune Characteristics • thyroid gland growth and

increased rate of function

•

Signs and Symptoms Anxiety, irritability, difficulty in sleeping, fatigue, rapid/irregular heartbeat, tremors, perspiration, heat sensitivity, rapid weight loss, brittle hair and nails, frequent bowel movement, goiter

• Irregular to light menstruation in women

• Hypokalimia in Asian Males

Signs and Symptoms • Important Manifestations of the Disease

• Exophthalmos • Thyroid Dermopathy

Exophthalmos • Grave’s ophthalmopathy • Inflammation of the tissue around the eye

• TSH-R • links the thyroid and the eyes found in the thyroid follicular cells and orbital fibroblasts

Thyroid Dermopathy • Thickening of the skin on the lower extremity

• Pretibial

myxedema

• Accumulation of GAGs

Signs and Symptoms • Thyrotoxic Crisis • Thyroid storm • Exacerbation of all symptoms • Dangerous • CNS and Gastrointestinal Symptoms

Diagnosis • Physical Examination • Obvious signs and symptoms • Patient History • Determine other members with Grave’s Disease; physical disposition

• Laboratory Tests • High FT + Low TSH = Grave’s 4

Disease

Treatment • Antihyperthyroid Drugs • Thionamides • Radioactive Iodine Therapy • Sodium iodide (I ) • Surgery • Special cases 131

Antihyperthyroid Drugs • Thionamides - PTU and Methimazole

• Blocks T and T • 2 Regimens: • Tapering •+ T 4

4

3

production

Antihyperthyroid Drugs • Up to 2 years of treatment • Regular check up • Laboratory tests • May cause allergic reactions • Rashes and Agranulocytosis

Radioactive Iodine Therapy • Sodium iodide taken as a single capsule

• 2 to 6 months • Routine • Precautionary measures • Pregnant women • Geriatric patients with other conditions

Surgery • Situations where antihyperthyroid drugs fail to act

• Radioactive iodine is not allowed

Treatment for Symptoms • Beta-blockers for palpitations • Propranolol and metoprolol • Potassium chloride and

spironolactone for hypokalimia

• Glucocorticoids for exophthalmos