Grave's Disease

WHAT YOU SHOULD KNOW

Marked by nervousness and overstimulation, Grave's disease is the result of an overactive thyroid gland (hyperthyroidism). Thyroid hormones regulate metabolism and body temperature, and are essential for normal growth and fertility. But in excessive amounts, they can lead to the burn-out seen in this relatively common form of thyroid disease.

Causes

Doctors aren't sure what triggers this problem, but they do know that the immune system is involved. In Grave's disease patients, they find antibodies specifically designed to stimulate the thyroid.

Signs/Symptoms

Along with nervousness and increased activity, Grave's disease patients may suffer a fast heartbeat, fatigue, moist skin, increased sensitivity to heat, shakiness, anxiety, increased appetite, weight loss, and sleep difficulties. They also have at least one of the following: an enlargement of the thyroid gland (goiter), bulging eyes, or raised areas of skin over the shins.

Care

In many cases, drugs that reduce thyroid output are sufficient to control the condition. A short course of treatment with radioactive iodine, which dramatically reduces the activity of the thyroid, is another option for people past their childbearing years. In some cases, surgery to remove all or part of the thyroid (thyroidectomy) is needed. Surgery can also relieve some of the symptoms of Grave's disease. Bulging eyes, for example, can be corrected by creating enough extra space in the nearby sinus cavity to allow the eye to settle into a more normal position.

Risks

If left untreated, Grave's disease could lead to long-term eye complications. The muscles that control the eyes become unable to function properly, making it difficult or impossible to coordinate eye movements. The typical result is double vision.

Pregnant women who have uncontrolled Grave's disease can pass the disorder on to their unborn children. The condition can also cause miscarriage, stillbirth, or premature birth.

Another serious danger in Grave's disease is a condition called thyroid storm, also known as thyrotoxicosis. This sudden, extreme surge in thyroid activity leads to fever, weakness, confusion, psychosis, and even coma. It's considered a life-threatening emergency that requires immediate medical attention.

WHAT YOU SHOULD KNOW

• Sleep with your head elevated to lessen eyelid swelling.
• Take your medications as directed by your doctor. If you feel they are not helping, contact your doctor but do not quit taking them on your own.
• Talk with your doctor about using topical ointments or artificial tears to soothe your eyes.
• Wear glasses with sideguards to protect your eyes from dust and drying wind.
• Use steroid creams or ointments to relieve itching and rough skin on your shins.
• Eat a diet high in protein to replace tissue lost from thyroid over-activity.
• Eat a diet low in fat if you are overweight, and attempt to lose the excess weight.
• For more information, contact the National Grave's Disease Foundation at 2 Tsitsi Court, Brevard, NC 28712 or call them at 828-877-5251.

Seek Care Immediately If...

• You begin to experience such symptoms of thyroid storm as fever, sudden and extreme weakness, restlessness, confusion, and altered consciousness. THIS IS AN EMERGENCY. Call 911 or 0 (operator) to get to the nearest hospital or clinic. Do not drive yourself!

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may encounter the following procedures and equipment during your stay.

• Taking Vital Signs: These include your temperature, pulse, blood pressure, and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. These tests may be performed hourly.
• Iodine: This is administered to quickly reduce the amount of hormone being released by the thyroid.
• IV: A tube placed in your vein for giving medications or liquids. It will either be capped or have tubing connected to it.
• Blood: Taken from a vein in your hand or the bend in your elbow to be used for testing. The level of oxygen and other gases in your blood will also be evaluated in samples drawn from the wrist, elbow, or groin.
• Electrocardiogram: Also known as an ECG, EKG, or heart monitor, this device includes a set of electrical pickups, or patches, that are stuck to your chest. The patches are hooked up to a TV-type screen or small portable box that shows a tracing of each heartbeat.

After You Leave

• Your doctor may prescribe thyroid hormone medicine. Take it exactly as directed. Do not take any additional medications without first checking with your doctor.
• Do not take prescription pain medication longer than four to seven days.
• Rest in bed and limit your normal activities as much as possible for a few days. Afterwards, you may resume your normal activities when you feel up to them.

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