What is Graves’ Disease?

What exactly is Graves’ disease and what triggers it? Learn how you can avoid this condition and how functional medicine can help with treatment.

Graves’ Disease

One of the most common causes of hyperthyroidism is Graves’ disease. Here, we look at this autoimmune disorder, why it causes hyperthyroidism and how functional medicine plays an important role in giving patients a better quality of life.

Thyroid diseases are so common around the world that some people are not even aware that they have it because they don’t feel any symptoms. According to the American Thyroid Association (ATA), at least 20 million Americans have a form of thyroid disease with up to 60% of them unaware of their condition.

There are two common types of thyroid disease: hypothyroidism that affects 4.6% or 5 in every 100 people in the United States and hyperthyroidism that only affects 1 out of 100 Americans.

But while hyperthyroidism is not as common as hypothyroidism, it still deserves prompt medical attention, especially since complications can be devastating and patients may suffer for the rest of their lives if they don’t seek treatment right away.

An introduction to the thyroid gland

The thyroid gland is a butterfly-shaped organ located in the anterior aspect of the trachea on the lower neck. It consists of two lobes connected through the thyroid isthmus and its blood supply comes from the thyroid artery, which branches from the thyrocervical trunk.

The thyroid gland is primarily responsible for the production and secretion of thyroid hormones thyroxine (T4) and triiodothyronine (T3). Both of these hormones play an important role in cellular processes.

When the thyroid gland fails to function properly, it either under produces or over produces thyroid hormones that disrupt the balance in the body’s processes.

Hypothyroidism is a medical condition where the thyroid gland fails to produce enough thyroid hormones that the body needs, which in turn affects metabolism. People with hyperthyroidism usually have slow metabolism causing them to feel tired easily, become forgetful, become more sensitive to cool temperatures and even experience depression. Hashimoto’s thyroiditis is the most common cause of hypothyroidism.

Hyperthyroidism, on the other hand, results from an overactive thyroid that produces more hormones than the body requires. Patients with hyperthyroidism have fast metabolism that leads to nervousness, muscle fatigue, rapid heart rate, diarrhea, sudden weight loss, goiter and difficulty sleeping.

Although less common, hyperthyroidism can cause serious health problems with the bones, heart, muscles and even fertility. Graves’ disease is the most common cause of hyperthyroidism.

Understanding Graves’ disease

Graves’ disease is a type of autoimmune disorder that affects the thyroid gland and eventually other organs including the skin and eyes. It accounts for up to 80% of hyperthyroidism cases, making it the most common cause of the thyroid disorder.

In the United States, hyperthyroidism has a prevalence rate of 1.2% and it occurs more in women who are between 20 and 50 years old. Graves’ disease was named after Dr. Robert Graves, an Irish physician who first described this type of hyperthyroidism.

The pathophysiology

The body is equipped with its own immune system that fights against bacteria and viruses. But in the case of Graves’ disease, the body’s immune system attacks the thyroid gland causing it to produce more thyroid hormone than the body needs.

Grave’s disease is primarily caused by the thyroid stimulating immunoglobulin (TSI) that’s synthesized by B lymphocytes. The disease process begins with the B lymphocytes being stimulated by T lymphocytes that are also sensitized by an antigen in the thyroid gland.

The resulting thyroid stimulating immunoglobulin then binds with the thyroid-stimulating hormone receptor (TSH), which triggers the action of the TSH. This process results in the stimulation of both the growth of the thyroid gland and the synthesis of the thyroid hormone causing hyperthyroidism.

The risk factors

Although Graves’ disease can occur at any age, studies have shown that it is most common among people between 20 and 50 years old, and it’s also eight times more common in women than men. Other risk factors for Graves’ disease include:

  • A family history of the disease. It is said that your chances of developing Graves’ disease is much higher if other family members have the disease.
  • Other autoimmune system. Studies have revealed that individuals with pre-existing autoimmune disorders like rheumatoid arthritis, systemic lupus erythematosus, celiac disease, pernicious anemia and Type 1 Diabetes have a higher risk for developing Graves’ disease. Patients with the condition are also more susceptible for contracting other forms of autoimmune diseases.
  • Gene variations. According to research, some gene variations like those belonging to the human leukocyte antigen (HLA) complex could make an individual more prone to developing Graves’ disease.

The HLA complex aids the immune system in distinguishing its own proteins from those produced by viruses and bacteria, so any dysfunction could lead the immune system to believe that it is attacking a foreign invader when in fact, it is targeting the thyroid gland.

  • Women who are pregnant or those who recently gave birth are at a higher risk for developing Graves’ disease, especially when they have a familial history of the condition.
  • Some studies have shown that stressful events or the existence of another physical illness could trigger the onset of Graves’ disease.
  • Cigarette smoking, which could disrupt the immune system is believed to be a strong causative factor for developing Graves’ disease. Smokers who also have the condition are at a higher risk for developing a complication called Graves’ ophthalmology.

The signs and symptoms

A lot of patients who are diagnosed with Graves’ disease experience the classic signs and symptoms of hyperthyroidism.

But these will also depend on the age of the patient, the severity of the condition and the length of time that hyperthyroidism has been present. Some of the classic signs and symptoms of Graves’ disease include:

  • Fine tremors of the hands or fingers
  • Low tolerance to high temperatures
  • Abrupt weight loss even without changes in eating habits
  • Irritability, nervousness and anxiety
  • Muscle weakness and fatigue
  • Rapid or irregular heartbeat
  • Difficulty in sleeping
  • Frequent bowel movements or diarrhea
  • Enlargement of the thyroid gland also known as goiter
  • Menstrual cycle changes and decreased libido
  • Graves’ dermopathy or a thick, red skin on the shin or top of the foot
  • Graves’ ophthalmology or bulging eyes

The signs and symptoms

These signs and symptoms are more typical for younger individuals and they can also include eye symptoms like redness, double vision, swelling of the lids and ocular pain. A palpable goiter is also more common among younger patients.

The elderly population, on the other hand, may experience non-specific symptoms like sudden weight loss, atrial fibrillation or fatigue that may result to misdiagnosis. Older patients also experience a lesser common form of hyperthyroidism known as apathetic thyrotoxicosis.

Once Graves’ disease becomes extrathyroidal, signs and symptoms would include the retraction of the eyelids, exposure keratitis, periorbital edema and scleral injection.

The complications

A lot of people neglect their signs and symptoms thinking that they wouldn’t get any worse or affect important body functions. But Graves’ disease is a serious medical condition that demands prompt attention. If left untreated, these are just some of the many possible complications of the disease:

  • Thyroid storm. Although it happens very rarely, a thyroid storm could be a life-threatening complication if not treated right away. In a thyroid storm, hyperthyroidism progresses fast causing the thyroid gland to produce huge amounts of thyroid hormones.

This results to sweating, fever, vomiting, delirium and diarrhea. Patients who experience a thyroid storm need immediate emergency care or they could die from it.

  • Heart disorders. Graves’ disease can also lead to atrial fibrillation or irregular heartbeats and other heart rhythm disorders that if left untreated could result to heart failure.
  • Pregnancy problems. If a woman is diagnosed with Graves’ disease during pregnancy, it could lead to poor fetal growth, pre-eclampsia, fetal thyroid dysfunction, pre-term birth or even a miscarriage. This is why it’s very important to get treatment right away to avoid any issues during and after the pregnancy.
  • An overproduction of thyroid hormones could lead to osteoporosis, a conditions that results in weak and brittle bones. This is due to the fact that thyroid hormone plays a role in calcium being deposited into the bones.

The diagnosis

When diagnosing Graves’ disease, doctors usually look for the most common characteristics of this condition including an enlarged thyroid or goiter and elevated laboratory tests.

A doctor may order thyroid function tests to determine if the thyroid-stimulating hormone is suppressed or there are elevated free T4 and free T3 levels, which will confirm the diagnosis of hyperthyroidism.

To differentiate Graves’ disease from other types of hyperthyroidism, further tests could be ordered including the measurement of TSH receptor antibody (TRAb), a radioactive iodine uptake scan with I-123 or I-131 and a thyroid ultrasonogram with Doppler. T3/T4 ratios of more than 20 micrograms or FT3/FT4 ratios of more than 0.3 SI Unit should also suggest Graves disease.

The role of functional medicine

Although the tests ordered in conventional process are important in the diagnosis of Graves’ disease, they are sometimes not conclusive, which means that misdiagnosis could happen.

This is where functional medicine comes in, a practice that focuses on determining the exact cause of a disease and all the factors contributing to it.

The hallmark of functional medicine is to identify the root cause and cellular stressors that’s causing a disruption in the thyroid’s physiology not only to address Graves’ disease or any other form of thyroid problems but also to prevent other forms of autoimmune diseases from sprouting in the future.

Both hypothyroidism and hyperthyroidism have the same foundational concepts where every patient is treated differently from the other.

Unlike conventional medicine where every patient who’s diagnosed with Graves’ disease should undergo the same forms of treatments, functional medicine looks deeper into the patient’s history, laboratory tests and lifestyle choices to create a holistic intervention plan that addresses the problem and prevents it from happening again.

Some of the factors considered in treating a patient using functional medicine include:

  • Food allergies, especially gluten. Studies have shown that patients consuming a high amount of gluten-rich foods have higher risks for developing hyperthyroidism.
  • Poor gut health. Autoimmune diseases are often linked to poor gut health. For instance, Yersinia eneterocolitica has been studied to possibly trigger Graves’ disease and there may also be a link between the disease and Helicobacter pylori.
  • Although the thyroid gland itself may be intact, there are instances when toxicity or lymphatic stagnation due to trauma or infections on the surrounding organs could trigger Graves’ disease. This is why functional medicine practitioners usually look into any history of trauma to the head and neck, any respiratory infections, tonsillitis, ear and sinus infections, and any dental work.

Once all the causes and risk factors are determined, a practitioner will then create a treatment plan that aims to address existing issues and prevent future complications.

Functional medicine recommends therapies that help improve lymphatic circulation and increased blood flow to the thyroid gland. This includes hydrotherapy and the use of some herbs.

Biotherapeutic drainage is a form of therapy that utilizes compound homeopathics to detoxify the thyroid gland and other parts of the body to help regulate the signs and symptoms of Graves’ disease.

Supplements are also recommended including lithium that has been proven to help control the symptoms of hyperthyroidism. This should be taken with caution, however to prevent hypothyroidism in higher doses and other common complications.

Selenium is another supplement that should be taken daily to reduce the symptoms of the disease, especially Graves’ opthalmopathy. Herbs like Melissa officinalis and Leonorus cardiaca have also been studied to help with the symptoms of hyperthyroidism.

Of course, there’s always the importance of switching to a healthier lifestyle, which is encouraged by functional medicine practitioners to not only prevent Graves’ disease from getting worse but also to promote overall health, which is a hallmark of functional medicine practice.

At the end of the day, functional medicine is all about focusing on giving each patient with Graves’ disease the best chance of recovery through personalized treatment plans.