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This is the thyroid gland. It is a small butterfly like gland at the centre of our throat.It’s responsible for producing our thyroid hormones which has important functions.However the thyroid gland can become sick. As a result it may produce excessive amount or insufficient amounts of thyroid hormones. Today we will talk about a condition where the gland produces excessive amount of thyroid hormones Causing hyperthyroidism. This condition is known as Graves’ disease.

Firstly, what is hyperthyroidism? Hyperthyroidism occurs when your thyroid gland produces too much thyroid hormones. This will accelerate your body’s metabolism causing a whole spectrum of symptoms. 1) heat intolerance 2) excessive sweating 3) Increased appetite - eating much more than usual 4) yet losing weight 5) palpitations 6) anxiety, nervousness and irritability 7) fatigue or tiredness 8) change in bowel habit - going to the toilet more often 9) tremors or trembling of fingers and hands 10) swollen neck in some cases 11) in ladies, change in your menstrual pattern

And in Graves’ disease, you may also noticed Protrusion of your eyeballs with red and dry eyes. In some cases, even double vision. If you have any of the above symptoms, please see your doctor early for evaluation.

One of the most common causes of hyperthyroidism is Graves’s disease. This is an autoimmune condition. Your body produces an antibody that instead of attacking external invading agents, attacks your own thyroid gland. The name is thyrotropin receptor antibody or TRAb for short. TRAb will circulate in the blood stream and attaches itself onto the thyroid gland resulting in an excessive production of thyroid hormones.

Your chance of getting graves’ is higher if - you have a family history - or have a history of other autoimmune conditions like rheumatoid arthritis or SLE - if you are a female in your forties - if you are under intense stress- if you are pregnant - or smoker

Now if I suspect a patient of having hyperthyroidism from graves’, I would send off their blood sample for - thyroid hormone levels and - the thyrotropin receptor antibody ( TRAb ) And if physical examination revealed a swollen thyroid gland I would order an Ultrasound of the neck to confirm the diagnosis.

Treatment of Graves’ disease involves 3 key process

Firstly, reduce the symptoms caused by high thyroid levels so that the patient will feel better. A class of medications we often use to achieve this is the beta blockers. It can help to reduce the palpitations, trembling of hands and even anxiety and nervousness. Some patients report symptoms relief within hours to days of starting this medication.

Secondly, reduce the thyroid hormone levels by administering anti thyroid drugs such as carbimazole, methimazole or propylthiouracil. These medications cause the thyroid gland to produce less thyroid hormones. Generally upon starting these medications, I expect the thyroid hormone levels to normalise in 2 months’ time.

Thirdly, to treat the grave’s disease itself. The first option would be radio-iodine. This involves the taking radioactive iodine in a capsule of liquid form that slowly destroys the cells of the thyroid gland, thereby reducing hormonal production. It may eventually result in hypothyroidism.

This treatment is not suitable for pregnant ladies or breastfeeding mothers. The other option would be to remove the thyroid gland through a surgery. This is only considered if the thyroid gland is so swollen that it is pressing on your windpipe causing breathing issues or sometimes in pregnant ladies who are unable to tolerate or are allergic to all the antithyroid medications.

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