Graves-Basedow Disease: Symptoms, Causes, Treatment

The Graves-Basedow's disease Is a pathology that affects the functioning of the thyroid gland (American Thyroid Association, 2016).

It is considered one of the most frequent causes of hyperthyroidism, especially in the child population (Zanolli, Araya, Cattani, Orellana, Martín-Aguayo, 2008).

At the clinical level, it is usually identified an excessive thyroid activity that produces various pathologies related to ocular alterations and cutaneous diseases (American Thyroid Association, 2016).

The most frequent signs and symptoms include goiter, hyperthyroidism and ophthalmopathy (Enes Romero, Martín-Frias, de Jesús, Cabellero Loscos, Alonso Blanco and Barrio Castellanos, 2014).

The specific causes of this disease are not known with exactness. It is usually related to autoimmune processes secondary to a genetic predisposition, stressful events, etc. (American Thyroid Association, 2016).

In the diagnosis of Graves-Basedow disease it is essential to identify the clinical characteristics. Typically, it was done through physical examination and laboratory testing (American Thyroid Association, 2016).

As for the medical approach of this pathology, the most common is to use the classic medical procedures of the treatment of Hyperthyroidism (American Thyroid Association, 2016).

Therapeutic options are based on three alternatives: surgery, radioiodine administration or treatment with antithyroid drugs (Boix, Moreno, López and Picó, 2004).

Characteristics of Graves-Basedow's Disease

Graves-Basedow disease is considered a disorder of the immune system resulting in an overproduction of thyroid hormones (Hyperthyroidism) (Mayo Clinic, 2014).

There are a wide variety of pathologies that can affect the functioning of the thyroid gland, although Graves-Basedow disease is one of the most common (Mayo Clinic, 2014).

The thyroid gland is located in the neck, in the frontal areas (American Thyroid Association, 2016).

Its main function is the production of thyroid hormones that go to the bloodstream and expand into all body systems and tissues (American Thyroid Association, 2016).

This type of glands has a wide variety of functions. They all allow multiple organs such as brain , Heart or muscle groups work effectively (Cleveland Clinic, 2015).

In addition, they help the body to manage energy through caloric expenditure and temperature regulation (National Institutes of Health, 2016).

In the case of Graves-Basedow disease, the presence of an impaired immune system results in excessive production of thyroid hormones (Cleveland Clinic, 2015).

The immunological anomaly that causes this pathology is based on the production of various antibodies (thyroid stimulating immunoglobulins -IET-) that stimulate thyroid gland growth and hormone production (Toft, 2014).

When the body has elevated levels of thyroid Hormones, this medical condition is called Hyperthyroidism (Cleveland Clinic, 2015).

The clinical course of severe disease is usually related to medical complications secondary to hyperthyroidism and the development of orbitopathy (Colegio Médico de Chile, 2016).

The first references to this pathology correspond to an ophthalmologist surgeon called Saint Yves. In 1773 some of her clinical reports referred to thyroid orbitopathy (Martínez Gutiérrez, 2007).

Subsequently, Parry in 1786 managed to describe an association between goitre and the presence of exophthalmos (Martínez Gutiérrez, 2007).

Graves in 1835 carried out the publication of three cases whose main symptom was exophthalmos and in 1840 Basedow affirmed the association between this and the thyroid alterations (Martínez Gutiérrez, 2007).

The denomination of this condition as Graves' disease is common in the United States, whereas the use of the term Basedow is more frequent in Europe (Toft, 2014).

Graves' disease is usually not a potentially deadly medical condition (Cleveland Clinic, 2015).

Pharmacological and technological advances have allowed the development of different medical approaches for the treatment of symptoms and medical complications (Cleveland Clinic, 2015).

About us

Hyperthyroidism and alterations related to increased levels of thyroid hormones are frequent disorders in the general population (Basedow, 2016).

They are affected by more than 200 million people worldwide, with the majority of women affected (Basedow, 2016).

At the clinical and experimental levels, different types of hyperthyroidism associated with different causes have been identified. In the case of the immunological origin, Graves' disease is the most common (Basedow, 2016).

Epidemiological studies on this disease have shown the following data (Jim Yeung, 2016):

Frequency

Graves' disease is the most common cause of hyperthyroidism in the United States. Some research estimates its incidence at about 30 cases per 100,000 people each year.

This pathology represents more than 50% of thyrotoxicosis cases worldwide. In the UK its incidence reaches 100-200 cases per 100,000 inhabitants.

Sociodemographic Characteristics

• Race : The most recent research has identified a genetic susceptibility to thyroid-related pathologies in white people. Genetic predisposition seems to be influenced by different genes located on chromosome 6.
• Sex : The proportion of women affected by this pathology reaches a ratio of 3.5: 1 compared to the male sex.
• Age : Although Graves' disease may appear in any age range, the typical onset time is between 20 and 40 years of age.

Morbidity

If proper treatment is not used, Graves' disease can lead to a wide variety of secondary pathologies: cardiac complications, muscle degeneration, or neuropsychiatric disorders.

Signs and symptoms

The most frequent signs and symptoms in Graves' disease are related to the clinical course of hyperthyroidism, the presence of ophthalmological alterations and the development of dermatological abnormalities.

Hyperthyroidism

Elevated levels of thyroid hormone in the blood can lead to a wide pattern of multisystemic involvement.

Some of the more common alterations include (Basedow, 2016):

• Tachycardia: Several alterations related to the speed of contraction of the ventricles of the heart can appear. The most common is to identify an increase in heart rate.
• Arterial hypertension : Cardiac complications can lead to an increase in the pressure that the blood exerts when passing through the arterial ducts. This medical condition can lead to other pathologies such as the development of Aneurysms , Cognitive alterations, renal anomalies, ophthalmological lesions, infarcts or cardiac inefficiency, etc.
• Weightloss: Thyroid hormones can lead to reduced appetite and food intake. Consequently a significant reduction in body weight can be identified.
• Heat intolerance and sweating: An increase in sensitivity to temperature changes usually occurs. A continuous profusion of sweat can be seen.
• Tremor : Rhythmic and involuntary muscle movements may occur. It affects the hands, arms and head preferentially.
• Humor changes : Those affected are usually characterized by episodes of irritability and the state of nervousness recurrent.
• Sudden paralysis : If there is an affectation of the muscular structures or of nervous regions, episodes of paralysis may appear.
• Goiter : Enlargement of the thyroid gland is one of the most common alterations. This pathology can cause respiratory and / or phonological problems, difficulty swallowing solid foods and even episodes of pain.
• Menstrual disorders : In affected women it is possible to identify various disorders, many of them related to the loss of the menstrual cycle.
• Sleep disorders: Sleep-wake cycles can be modified by generating episodes of drowsiness or insomnia .
• Changes in vision: Eye structures often develop inflammation and redness.

Ophthalmologic Alterations

Graves-Basedow disease can lead to severe inflammation of the ocular and adjacent soft tissues (Colegio Médico de Chile, 2016).

About 30% of those affected will suffer some type of symptom related to the eyes and vision. Some of the most common include (Mayo Clinic, 2014):

• Progressive loss of vision.
• Double vision or blurred.
• Increased sensitivity to light stimuli.
• Inflammation or redness of several areas.
• Inflammation or retraction of the eyelids.
• Feeling of pain or pressure.

The most frequent is to observe the presence of orbitopathy and malignant exophthalmos (Colegio Médico de Chile, 2016).

• Orbitopathy: This pathology produces an enlarged volume of extraocular muscle groups accompanied by an abnormal accumulation of fat in the orbits of the eyes. Irritation, tearing, corneal exposure, strabismus, decreased visual acuity, etc. may occur.
• We exophthalmos : Protrusion of the eyeballs is another frequent medical finding. In some patients it can become a serious condition due to the development of conjunctivitis, ulcers or ocular edema.

Dermatological Alterations

Graves' disease can also lead to skin anomalies.

The skin usually presents several characteristics related to the presence of dermopathy (Mayo Clinic, 2014):

• Thickening of different areas of the skin.
• Development of lesions, pimples and pimples. It especially affects the upper part of the feet.

Another common pathology is pretibial myxedema (Cleveland Clinic, 2015). This produces inflammation in severe reddening of the skin due to the infiltration of mucous substances in the skin tissues.

Causes

The origin of Graves-Basedow disease is associated with the presence of abnormalities in the immune system.

Although the body is responsible for protecting the organism against malignant (internal and external) agents, it can sometimes act against healthy cells (Cleveland Clinic, 2015).

In this disease, various antibodies attach to the surface of the thyroid gland stimulating the production of hormones and generating hyperactivity (Cleveland Clinic, 2015).

Current research has not yet accurately identified the etiologic factor that causes this abnormal immune process.

The Mayo Clinic (2014) points out some of the risk factors most associated with the development of this type of alterations:

• Physical and / or emotional stress : Some cases have been identified whose onset has been associated with the suffering of a stressful event.
• Pregnancy : Recent motherhood or pregnancy may increase the risk of developing Graves' disease in women with a genetic predisposition.
• Smoking : The consumption of tobacco and other harmful substances can increase the risk of suffering immunological pathologies.
• Autoimmune diseases : The presence of other types of alterations of the immune system can generate an increased risk of the onset of severe disease.
• Age : This pathology is more frequent in people whose age does not exceed 40 years.
• Sex : There is a higher prevalence in the female sex. Women are more likely to suffer from this type of disease.
• Family history : The presence of antecedents and a family inheritance of immunological pathologies increases the probability of occurrence.

Diagnosis

As noted in the initial description, the identification of this disease is based on clinical signs and symptoms (American Thyroid Association, 2016).

It is essential to perform a physical examination composed of an ophthalmological and cutaneous analysis (American Thyroid Association, 2016).

In addition, another fundamental part of the diagnosis is the study of blood levels of thyroid hormone through different laboratory tests (American Thyroid Association, 2016).

Treatment

Treatment of Graves-Basedow's disease focuses on three basic approaches (Cleveland Clinic, 2015):

• Antithyroid drugs: This type of medication reduces the production of hormones. The most used are propylthiouracil and methimazole. In many cases, it is necessary to use combination therapy as they have a high probability of relapse.
• Radioactive iodine: With this therapy it is possible to eliminate hyperactive thyroid cells, those that produce high amounts of hormones.
• Surgery : It is used to remove parts or the whole of the thyroid gland. When it is eliminated completely it is necessary to undertake a hormonal compensation treatment.

References

1. American Thyroid Association. (2016). American Thyroid Association. American Thyroid Association . Retrieved from the American Thyroid Association.
2. Basedow. (2016). Symptoms and signs of hyperthyroidism . Obtained from Basedow.
3. Boix, E., Moreno, O., López, A., & Picó, A. (2014). Treatment of Graves-Basedow's disease with thrombosis: an alternative with risks. Endrocrinol Nutr .
4. Cleveland Clinic. (2015). Graves' Disease . Obtained from Cleveland Clinic.
5. Medical College of Chile. (2016). Graves-Basedow's Disease . Obtained from Internal Medicine Based on Evidence.
6. Martínez GutierrezJ. (S.f.). GRAVES-BASEDOW. 2007 .
7. Mayo Clinic. (2014). Graves' disease . Obtained from Mayo Clinic.
8. NIH. (2016). Graves' disease . Obtained from MedlinePlus.
9. Romero, E., Martín-Frías, M., Jesús, M., Caballero Loscos, C., Alonso Blanco, M., & Barrio Castellanos, R. (2014). Efficacy of treatment with I131 in Graves' disease. An Pedriatr (Barc) .
10. Toft, D. (2016). Graves' Disease Overview . Obtained from EndrocrineWeb.
11. Yeung, J. (2016). Graves Disease . Obtained from Medscape.
12. Zanolli, M., Araya, A., Cattani, A., Orellana, P., & Martínez-Aguayo, A. (2008). Severe Basedow's disease in pediatric patients. Rev Chil Pediatr .