Grave's Disease

GRAVES’ DISEASE 

Graves’ is an autoimmune disorder that occurs when the body’s immune system mistakenly attacks the thyroid gland. This can cause the gland to overproduce the hormone, responsible for regulating metabolism. 

The disease is hereditary and may develop at any age in men or women, but it is much more common in women ages 20 to 30. Other risk factors include stress, pregnancy and smoking.
When there is a high level of thyroid hormone in bloodstream, body’s systems speed up and cause symptoms that are common to hyperthyroidism. These include:

 • Anxiety,
• Irritability,
• Fatigue,
• Hand tremors,
• Increased or irregular heartbeat,
• Excessive sweating,
• Difficulty sleeping,
• Diarrhoea or frequest bowel movements,
• Altered menstrual cycle,
• Goiter,
• Bulging eyes and vision problems.

Graves’ Disease: Diagnosis and Treatment: 

A simple physical exam can reveal an enlarged thyroid, enlarged bulging eyes, and signs of increased metabolism, including rapid pulse and high blood pressure. 

Blood tests to check for high levels of T4 and low levels of TSH, both of which are signs of Graves’ disease. 

A radioactive iodine uptake test may also be administered to measure how quickly thyroid takes up iodine. A high uptake of iodine is consistent with Graves’ disease. 

Treatment 

There is no treatment to stop the immune system from attacking the thyroid gland and causing it to overproduce hormones. However, the symptoms of Graves’ disease can be controlled in several ways, often with a combination of treatments: 

• β-blockers to control rapid heart rate, anxiety and sweating. 
• Antithyroid medications to prevent thyroid from producing excessive amounts of hormone. 
• Radioactive iodine to destroy all or part of thyroid. 
• Surgery to remove thyroid gland, a permanent option if one cannot tolerate antithyroid drugs or radioactive iodine.
  Successful hyperthyroidism treatment usually results in hypothyroidism and may require hormone-replacement medication from that point forward. Graves’ disease can lead to heart problems and brittle bones, if it is left untreated.
  

Thyroid Nodules 

Nodules are lumps or abnormal masses within the thyroid. Nodules can be caused by benign cysts, benign tumors, or, less commonly, by cancers of the thyroid (most nodules are not cancerous). Nodules may be single or multiple and can vary in size. If nodules are excessively large, they may causes symptoms related to compression of nearby structures. Some thyroid nodules may produce too much thyroid hormone and cause hyperthyroidism, or become too large, interfering with breathing or swallowing or causing neck discomfort. 

Thyroid Cancer 

Thyroid cancer occurs in the cells of the thyroid gland and it is more common among adult women than men or youth. 

About 2/3rd of cases occur in people under age 55. There are different kinds of thyroid cancer, depending upon the specific cell type within the thyroid that has become cancerous. Most cases of thyroid cancer have a good prognosis and high survival rates, especially when diagnosed in its early stages. 

Causes 

Thyroid cancer occurs when cells in thyroid undergo genetic changes (mutations). The mutations allow the cells to grow uncontrollably, multiply rapidly and produce lump. The cells also lose the ability to die, as normal cells would. The accumulating abnormal thyroid cells form a tumor. The abnormal cells can invade nearby tissue and can spread throughout the body. 

Exact cause of thyroid cancer is not clear but there are a number of things that can increase risk of thyroid cancer includes: 

• Other thyroid conditions, such as an inflamed thyroid (thyroiditis) or goitre – but not an overactive thyroid or underactive thyroid.
• A family history of thyroid cancer.
• Radiation exposure in childhood (Radiotherapy).
• Obesity.

• A bowel condition called familial adenomatous polyposis (FAP).

• Acromegaly, a rare condition where the body produces too much growth hormone.

Symptoms 

Thyroid cancer typically does not cause any signs or symptoms early in the disease. As thyroid cancer grows, it may cause: 

• A lump that can be felt through the skin on neck.
• Changes to voice, including increasing hoarseness.
• Difficulty in swallowing.
• Pain in neck and throat.
• Swollen lymph nodes in neck.

Types of Thyroid Cancer 

• Papillary thyroid cancer: The most common form of thyroid cancer, papillary thyroid cancer arises from follicular cells, which produce and store thyroid hormones. Papillary thyroid cancer can occur at any age, but most often it affects people in age 30 to 50. 

• Follicular thyroid cancer (Hurthle cell thyroid cancer): Follicular thyroid cancer also arises from the follicular cells of the thyroid. It usually affects people older than age 50. Hürthle cell cancer of the thyroid gland is a rare and potentially more aggressive type of follicular thyroid cancer which accounts for only about 3-10% of all differentiated thyroid cancers. 

• Medullary thyroid cancer: Medullary thyroid cancer begins in thyroid cells called C cells, which produce the hormone calcitonin. Elevated levels of calcitonin in the blood can indicate medullary thyroid cancer at a very early stage. Certain genetic syndromes increase the risk of medullary thyroid cancer, although this genetic link is uncommon. 

• Anaplastic thyroid cancer:  Anaplastic thyroid cancer is a rare and rapidly growing cancer that is very difficult to treat. Anaplastic thyroid cancer typically occurs in adults (age 60 and older).
• Thyroid lymphoma: Thyroid lymphoma is a rare form of thyroid cancer that begins in the immune system cells in the thyroid and grows very quickly. Thyroid lymphoma typically occurs in older adults.