Graves' disease is one of the forms of hyperthyroidism in which your thyroid gland makes too much thyroid hormone and upsets the working of the rest of the body.



WHAT IS GRAVES' DISEASE?

This thyroid disease was named for the Irish physician Robert Graves who first described it more than a l00 years ago. It is also called "diffuse toxic goiter" -- "diffuse" because the whole thyroid gland is involved; "toxic" because you look feverish, hot, and flushed, as if with an infection; "goiter" for the enlargement of the thyroid gland which swells in the neck.



WHO GETS GRAVES' DISEASE AND WHY?

Perhaps 10 to 15% of people in the United States have an immune system which is vulnerable to autoimmune disease -- that is, to having the body's own system of protection against infection turn against some part of the body itself. In Graves' disease, cells of the immune system attack thyroid cells, stimulating them to make too much thyroid hormone.

Graves' disease is not the most common of thyroid diseases, but because of its involvement with heart and eye problems, it can be one of the most serious. Both President and Mrs. Bush developed Graves' disease while in the White House.

It can occur at any age, and is 4 to 8 times more common in women than men. It affects perhaps 0.32% of men in the US and 3.2% of women.

It is not known exactly what sets the disease process going. Sometimes a severe physical or emotional stress, loss of a job, death of a loved one, comes before the development of Graves' disease. Occasionally a young mother may experience Graves' disease (or another form of hyperthyroidism) after pregnancy.



SYMPTOMS

*Like other thyroid problems, Graves' disease usually begins slowly.
*You lose some weight, or find it easy to keep your weight down.
*You begin to have problems with muscle weakness, especially of large muscles in upper arms and thighs. Your hands may shake.
*You have trouble sleeping.
*Your pulse is faster and may be irregular.
*Your hair gets finer, and breaks easily.
*Your skin is thinner and you may perspire more.
*You have more frequent bowel movements.
*For women, periods are shorter, and may be further apart.
*Your thyroid gland enlarges and you may notice the swelling or "goiter" in the lower front of your neck. Associated with Graves' disease in many cases is eyelid retraction, making your eyes appear larger. About 5% of patients experience more serious eye problems, in which the tissue around and behind the eyes becomes inflamed and swollen. This may make your eyes protrude, and it may be difficult to close them completely at night. Rarely, there may be problems with double vision or diminished vision.



DIAGNOSIS

If you have several of the symptoms described above, your doctor will perform a number of tests to check the level of the thyroid hormones in your blood, and the level of "messenger hormone" (Thyroid Stimulating Hormone or TSH) that the pituitary sends to the thyroid controlling thyroid function. If the thyroid hormone level is high and the TSH is low, it is clear you have some kind of hyperthyroidism.

A scan of your thyroid gland will show whether the whole gland is overactive (as in Graves' disease), or whether one or more nodules or lumps is making the trouble (as in Toxic Nodular Goiter), but a scan is not needed in all cases.




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