GRAVES’ DISEASE AND IT’S TREATMENTS

Supervised by Submitted by

Prem Prasad Dhiraj choudhary

(Associate professor) 0869PY131035

1Introduction

2 Literature Review3 Epidemiology4 Etiology5 Diagnosis6 Pathophysiology7 Treatment8 Conclusion9 References

Contents

LITERATURE REVIEW

01.Burch HB, et al (2015) “Management of graves’ disease”Management of Graves disease includes treatment with antithyroid drugs, RAI, or thyroidectomy. The optimal approach depends on patient preference and specific patient clinical features such as age, history of arrhythmia or ischemic heart disease, size of goiter, and severity of thyrotoxicosis. Physicians should be familiar with the advantages and disadvantages of each therapy to best counsel their patients.

02.Streetman DD, et al (2003) ;Diagnosis and treatment of disease”Julextensive experience with medical management, controversy prevails regarding choosing among the various drugs for treatment of Graves disease. None of the treatment options, including antithyroid drugs, radioiodine, and surgery, is ideal. Each has risks and benefits, and selection should be tailored to the individual patient.

Introduction

What is Graves’ Disease

It is an autoimmune condition that affects thyroid function, causing enlargement and overactivity (hyperthyroidism) of the thyroid

SYMPTOMSTremor: in the hands Whole body: excess sweating, excessive hunger, fatigue,

heat intolerance, high blood pressure, or sweating Heart: fast heart rate, irregular heart rate, or sensation of

an abnormal heartbeat Eyes: abnormal protrusion of eyes, puffy eyes, or watery

eyes Mood: anxiety or nervousness Also common: absence of menstruation, diarrhea,

enlarged thyroid, graves' ophthalmopathy, hair loss, insomnia, irritability, overactive thyroid, or weight loss

Ophthalmopathy Goiter Acropachy

Pretibial Myxedema

Symptoms

Epidemiology

It occurs about 7.5 times more often in women than men.

Accounts for 60 to 80% of thyrotoxicosis. 1 million cases per year in India

Etiology ( Causes)

Caused by abnormal immune system response that causes the thyroid gland to produce too much thyroid hormone (hyperthyroidism)

Diagnosis Of Graves’ disease

TSH , free T4 Thyroid auto antibodies Nuclear thyroid scintigraphy (I123)

B cells Plasma cellsAntbodies immobilize

antigen

immune system produces auto

antibodys called thyroid stimulating

ammunoglobulin (TSI) attech to thyroid cells

TSIs mimics the action of the TSH

TSI binds to TSH

recepters

Thyroid gland is stimulated to

produce excess amousnts of

thyroid hormones

This is where auto immune disorder occurs

Pathophysiology of graves’ disease

Treatments of Graves’ disease Focused on treating hyperthyroidism

by:1. Medication2. Surgery3. Radioactive Iodine

Antithyroid drugs

Propylthiouracil (Safe In Pregnancy) PTU also inhibits T4 to T3 conversionCarbimazole, methimazoleBoth inhibit thyroid peroxides(beta blocker)

Adverse effects Rash Urticaria GI Symptoms Agranulocytes ( WBC)

Surgery

ExpensiveIndications:A large goiter (especially when

compressing the trachea)’Suspicious nodules suspected cancer.SE: Damage recurrent laryngeal nerve

and Hypoparathyoidism Hypocalcemia

RADIOACTIVE IODINE

Most cost effectiveBest long term

management & permanent cure

SE: Hypothyroidism

NATURAL TREATMENT FOR GRAVES DISEASE

Manage Stress Levels Eat an Anti-inflammatory Diet Get Some Exercise Quit Smoking Lower Exposure

to Environmental Toxins Treat Sensitivity of the Eyes and

Skin

CONCLUSION Currant treatments for Graves’

disease is effective but the ideal treatment is still not available

Some symptoms may be prevented with proper diet, exercise and health care.

REFRENCES

1.american thyroid association 2.Brent, Gregory A. (Jun 12, 2008). "Clinical practice. Graves'

disease". The New England Journal of Medicine. 358 (24): 2594–2605. 2014).

3.Nikiforov, Yuri E.; Biddinger, Paul W.; Nikiforova, Lester D.R.; Biddinger, Paul W. (2012). Diagnostic pathology and molecular genetics of the thyroid (2nd ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 69

4.Tomer Y, Davies T (1993). "Infection, thyroid disease, and autoimmunity" (PDF). Endocr Rev. 14 (1): 107–20.

5.Menconi, F; Marcocci, C; Marinò, M (2014). "Diagnosis and classification of Graves' disease.". Autoimmunity reviews. 13 (4-5): 398–402.

6.Umena S, Takano T, Iijima T, Hidaka Y, Yagoro A, Takai S, et al. A case of repeated painless thyroiditis followed by Graves’ disease. Endocr J

7. Stocker DJ, Foster SS, Solomon BL, Shriver CD, Burch HB. Thyroid canceryield in patients with Graves’ disease selected for surgery on the basis of coldscintiscan defects. Thyroid 2002;12:305-11

8.page 157 in:Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins.

9.Bunevicius, R; Prange AJ, Jr (2006). "Psychiatric manifestations of Graves' hyperthyroidism: pathophysiology and treatment options.". CNS Drugs. 20 (11): 897–909.

10.Yeung SJ. Graves disease. Pathophysiology. Medcape. November 18, 2015. http://emedicine.medscape.com/article/120619-overview#a5. Accessed March 8, 2016.

11. Yeung SJ. Graves disease treatment & management. November 18, 2015. http://emedicine.medscape.com/article/120619-treatment. Accessed March 8, 2016.

12. Marcocci C, Chiovato L, Mariotti S, Pinchera A: Changes of circula.1ing thyroid autoantibody levels during and after therapy with methimazole in patients with Graves' disease. J Endocrinol Invest 5:13, 1982.

 13. Pinchera A, Liberti P, Martino E, Fenzi GF, Grasso L, Rovis I, Baschieri L: Effects of antithyroid therapy on the long acting thyroid stimulator and the antithyroglobulin antibodies. J Clin Endocrinol Metab 29:231, 1969.

14. Barbosa, J., Wong, E. & Doe, R.P. (1972) Ophthalmopathy of Graves’disease: outcome after treatment with radioactive iodine, surgery or antithyroid drugs. Archives of Internal Medicine, 130, 111–113.

 15. Vestergaard, H. & Laurberg, P.(1989) Radioiodine and aggravationof ophthalmopathy. Lancet, 8 , 653 – 647.