Graves' disease is an autoimmune disease that impairs thyroid function. In German-speaking countries, it is named after the researcher Carl Adolph von Basedow. In English-speaking countries, the disease is known as Graves' disease.
Below you will find further information on this autoimmune disease and selected Graves' disease specialists.
The clinical picture of Graves' disease is associated with three characteristic symptoms. This trio, known as the Merseburg triad, consists of
This is accompanied by an overactive thyroid gland (hyperthyroidism), i.e. excessive production of thyroid hormones.
Graves' disease can occur at any age. There is an increased risk of developing the disease between the ages of 30 and 60. The disease often occurs for the first time during phases of hormonal restructuring of the body, such as
With a ratio of 6 to 1, women are significantly more frequently affected by Graves' disease than men. Around 3% of women and around 0.5% of men develop Graves' disease in the course of their lives.
The Merseburg triad occurs in around half of all patients.
An enlargement of the thyroid gland results in what is known as a goitre. It can be seen from a certain size on the outside of the neck.
Hyperthyroidism accelerates the metabolism so that the heart is often unable to keep up. It indicates the overload through rapid heartbeat (tachycardia).
Exophthalmos is a concomitant symptom of Graves' disease. The eyeball (bulb) protrudes visibly from the eye, while the eyelids gradually retract behind it. Exophthalmos usually occurs on both sides. However, it is also possible that only one eyeball protrudes.
However, exophthalmos tends to be classified as an autoimmune disease in its own right. Hyperthyroidism merely favors it.
Those affected lose weight faster than other people. However, the opposite is also possible. Hyperthyroidism causes constant cravings and increased food intake. This leads to obesity in people with a rather weak metabolism.
In many cases, hair loss occurs. The muscles are weaker and those affected sweat more. Those affected are limited in their physical and mental performance.
Other typical symptoms are
Studies on twins have shown that Graves' disease is often genetic. A high percentage of susceptibility to the disease is found in the genetic material, the DNA.
In addition, family trees have been analyzed. They show that around 30 percent of patients have relatives who also have or have had Graves' disease.
However, environmental factors can also be involved in the onset of the disease. In particular
increase the risk of developing Graves' disease. In contrast, the use of oral contraceptives appears to reduce the risk.
Graves' disease is an autoimmune disease. This means that the immune system attacks parts of the body. In Graves' disease, it forms antibodies against the receptor for TSH (thyroid-stimulating hormone, thyrotropin).
This disrupts the highly sensitive control circuit for the production of the thyroid hormones thyroxine (T4) and triiodothyronine (T3).
TSH is released in the pituitary gland in the brain. In a healthy person, TSH binds to the TSH receptor of the thyroid cells. As a result, the production of the thyroid hormones T3 and T4 is stimulated. These in turn have an indirect inhibitory effect on the formation of TSH in the pituitary gland.
Less TSH means fewer thyroid hormones. However, this reduces the inhibition of TSH formation. Therefore, more TSH and consequently more thyroid hormones are produced again.
This finely dosed control cycle is disrupted when antibodies bind to the TSH receptor. This leads to inflammation of the thyroid gland. This means that the TSH receptor is now permanently stimulated, resulting in increased release of the thyroid hormones T3 and T4. As described above, this leads to an inhibition of TSH production in the brain.
However, as the binding of the antibody to the TSH receptor disrupts the regulatory cycle, more and more T3 and T4 are produced. In addition, the thyroid cells are stimulated to grow. This permanent growth stimulus results in an enlargement of the thyroid gland and the formation of a goitre. The increased release of thyroid hormones then causes the symptoms mentioned above.
However, the antibodies can also cause changes in other parts of the body. In the eye, an endocrine orbitopathy (hormone-related eye socket disease) can develop, which manifests itself in the typical "Basedow's eyes" or "googly eyes" (exophthalmos). Inflammation of the connective tissue on the lower leg is called pretibial myxedema and is also known to be the result of excessive formation of antibodies against the TSH receptor.
The doctor performs a physical examination and checks the thyroid gland using ultrasound. This is followed by laboratory tests.
Some symptoms, such as goitre or exophthalmos, can put the doctor on the right track early on.
As part of the laboratory tests, TSH, thyroxine (T4) and triiodothyronine (T3) are usually first determined in the blood serum. Reliable laboratory tests are also available today to detect the antibody against the TSH receptor that triggers the disease.
If the TSH value is normal, Graves' disease is probably not present. If the TSH value is too low and at the same time the T3 and T4 values are too high, hyperthyroidism is present. If the antibody against the TSH receptor is also detected, Graves' disease can be diagnosed.
If larger nodules can be seen on ultrasound, the doctor will probably order a thyroid scintigraphy for further clarification.
Examination of the thyroid gland using ultrasound © Max Tactic / Fotolia
Treatment begins with thyreostatics. These drugs inhibit the formation of thyroid hormones by preventing the incorporation of iodine. In this way, they bring the metabolism back into balance.
In addition, beta-blockers are often used to relax the unnaturally high stress on the cardiovascular system. Once the T3 and T4 levels have been reduced to normal levels, the dose of thyrostatic drugs should be reduced. It is important to monitor the progress of therapy at regular intervals in order to adjust the dosage to the individual patient.
Patients can passively promote their recovery by
Iodine-containing products should be avoided completely. People with a tendency to obesity should pay particular attention to a healthy, balanced diet. They should also suppress their frequent cravings (e.g. by drinking sufficient fluids or meditating).
Those who suffer from severe weight loss, on the other hand, need to make sure they eat a rich diet. In this way, they can counteract the weight loss.
Graves' disease is highly recurrent, i.e. it can recur after improvement. Drug treatment is effective in around half of all patients and the symptoms disappear. However, the disease can still recur.
Patients for whom
two further options are available: Radioiodine therapy and surgical removal of thyroid tissue (thyroidectomy).
Radioiodine therapy requires the patient to take radioactive iodine. It causes the hormone-producing thyroid cells to die in a targeted manner. In the case of
this form of therapy is not possible.
In particularly severe cases or in a dramatic stage of endocrine orbitopathy, only surgery can help. Nowadays, the aim is usually to remove the entire thyroid gland (total thyroidectomy). Any remaining thyroid tissue could otherwise lead to hyperthyroidism again.
Patients who have had their thyroid gland removed or who have received radioiodine therapy must take thyroid hormones for the rest of their lives. Otherwise they would develop hypothyroidism. However, this therapy is generally well tolerated.
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