Graves’ disease is named for the doctor who first described it in Ireland—Robert J. Graves. He noticed it in a patient in 1835. The disease is also referred to as Basedow’s disease—named after a German, Karl Adolph van Basedow, who described the disease in 1840. He didn’t know that Graves had described the same disease just a few years earlier. The term Basedow’s disease is more commonly used in continental Europe; in the United States, it’s called Graves’ disease. Graves’ disease is a type of autoimmune problem that causes the thyroid gland to produce too much thyroid hormone, which is called hyperthyroidism. Graves’ disease is often the underlying cause of hyperthyroidism. Thyroid GlandAutoimmune problems—of which there are many different types—develop when your immune system causes disease by attacking healthy tissues. Researchers do not completely understand what causes autoimmunity, although there seems to be a genetic connection, as cases of Graves’ disease tend to run in families. For unknown reasons, like many autoimmune diseases, Graves’ is also more likely to affect women than men. In Graves’ disease, your immune system creates antibodies that cause the thyroid to grow and make more thyroid hormone than your body needs. These antibodies are called thyroid-stimulating immunoglobulins (TSIs). The TSIs bind to thyroid cell receptors, which are normally “docking stations” for thyroid-stimulating hormone (TSH—the hormone responsible for telling the thyroid to produce hormones). The TSIs then trick the thyroid into growing and producing too much thyroid hormone, leading to hyperthyroidism. Symptoms The early symptoms of Graves’ disease may be confused with other conditions and make diagnosis a challenge. Some of the more common symptoms include: • Weight loss—despite increased appetite • Anxiety, restlessness, tremors, irritability, difficulty sleeping (insomnia) • Heat intolerance, sweating • Chest pain, palpitations • Shortness of breath, difficulty breathing • Increased stool frequency (with or without diarrhea) • Irregular menstrual periods • Muscle weakness • Difficulty controlling diabetes • Goiter • Prominent, bulging eyes • Vision problems (such as double vision) Physical Signs and Symptoms If Graves’ disease goes untreated, physical signs and symptoms may develop. • Goiter: A goiter is an enlarged thyroid gland. A goiter related to Graves’ disease is a diffuse thyrotoxic goiter. As the thyroid gets bigger, the patient’s neck may begin to look full or swollen. Sometimes a goiter makes swallowing difficult, causes coughing, and may disrupt sleep. • Eye Problems: Eye problems connected to Graves’ disease can go from very mild to very severe. Less severe—but still bothersome—eye symptoms include red eye, tearing, a feeling of sand or dust in the eye(s), and sensitivity to light. Eye disease related to Graves’ disease is called Graves’ ophthalmopathy. In more severe cases, one or both eyes may protrude from the eye sockets (also called the orbits). Graves’ disease causes an inflammatory response in the eye muscles; the muscles and tissues swell. Because of the orbits—the bony parts of your face that help hold your eyes in place—the swollen muscles and tissues are pushed outward. That’s because if enough swelling occurs, then the tissue has no place to go but outward, which causes protruding eyes and limited eye movement. The medical term for this is exophthalmos, and it can make you appear as though you are staring. • Skin Thickening: Some patients with Graves’ disease may develop thickening of the skin over the front of the lower leg called the tibia. The disorder causes skin lesions that are patchy and pink. Rarely are other areas of skin affected. This skin problem is also called pretibial myxedema.
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