16 May 2012 

GRAVES’ disease is an autoimmune disease characterised by hyperthyroidism, which is caused by production of antibodies that have the unintended effect of attacking the thyroid gland.

These antibodies bind to, and activate, the thyrotropin receptors causing the gland to enlarge and its follicles to increase hormone production.

This genetic predisposition to this autoimmunity may interact with environmental factors or life events to precipitate the onset of Graves’.

The thyroid hormones control our body’s metabolism, which is vital in managing our mood, weight, and mental and physical energy levels. However, the excessive hormones produced could lead to all kinds of health complications.

Essentially, Graves’ disease represents a basic defect in the patient’s immune system. Similar antibodies may also attack the tissues in the eye muscles and the skin on the front of the lower legs.

In some patients, the disease represents a part of more extensive autoimmune processes leading to dysfunction of multiple organs.

Graves’ disease is associated with pernicious anemia (chronic illness caused by impaired absorption of vitamin B12 because of a lack of intrinsic factor in gastric secretions), vitiligo, diabetes mellitus type 1, autoimmune adrenal insufficiency, systemic sclerosis, myasthenia gravis, Sjögren syndrome, rheumatoid arthritis, and even systemic lupus erythematosus.

Graves’ symptoms include weight loss, constant fatigue, rapid heart rate, heart palpitations, intolerance to heat, insomnia, anxiety attacks, frequent bowel movements, scant menstruation in affected women, bone thinning, hair loss, changes in the appearance of the eye (bulging or staring), and goitre (a visible enlargement of the neck caused by a pair of swollen thyroid gland).

Pathogenesis

Graves’ disease tends to manifest in the third or fourth decade of life and the female-to-male ratio is between 7:1 and 10:1.

Although there is a higher incidence in women, it is non-contagious. There is a tendency for parents of Graves’ patients to have a history of hyperthyroidism.

Researchers have found that stress plays a role in the onset of Graves’ disease. Psychiatric manifestations such as mood and anxiety disorders are common.

The disease can run its own natural course with its symptoms waxing and waning in response to environmental triggers, including dietary habits and infection.

Patients with mild symptoms and low levels of stimulating TSH receptor antibodies may eventually go into remission without medical intervention.

The levels of thyroid hormone or thyroid stimulating hormone (TSH) are not in themselves predictive of Graves’. However, most Graves’ patients will have TSH levels of <0.1.

Studies suggest that dental amalgam (mercury) fillings are associated with major health disorders and autoimmunity and interference with immune function as well as thyroid disorders.

Other heavy metal toxicity from lead and cadmium could lead to hyperthyroidism too.

An excess production of the thyroid hormone over the long term promotes osteoporosis since bone loss is accelerated.

Graves’ disease also increases muscular energy expenditure and muscle protein breakdown.

The heart is adversely affected by arrhythmia, atrial fibrillation, tachycardia and palpitation. Cardiomyopathy and congestive heart failure can occur.

Visual loss due to corneal lesions or optic nerve compression (above) could be seen in severe Graves’ ophthalmopathy. Smoking only worsens the condition.

Benign tumours of the thyroid gland can secrete excessive hormone on their own whereas cancerous tumours seldom do.

The choice of therapy may be influenced by cost, age, the size of the goiter, the degree of thyrotoxicosis, pregnancy status, patient preferences, and response to initial treatment.

Complementary medical therapies for Graves’ disease include dietary and lifestyle modifications designed to reduce stress, such as having adequate sleep at night, exercising regularly or performing light cardiovascular workouts, practising meditation, and reducing intake of stimulants such as alcohol and caffeinated drinks.

It is helpful to reduce consumption of seaweed, which is rather rich in iodine that promotes increased production of thyroid hormones. Virgin coconut oil as a natural thermogenic stimulant can raise metabolism further and possibly worsen, among others, heart palpitation.

The medium-chain fatty acids are known to be 300% more effective at raising metabolism than most other cooking oils.
A diet high in animal protein or fish may create similar thermogenic effects.

Goitrogens, which mimic antithyroid drugs, are food substances that block our body’s uptake of iodine.

Since the thyroid hormone is made of 67% iodine, its production is substantially inhibited by increasing intake of goitrogenic foods.

These include broccoli, kale, radish, cabbage, Brussels sprouts, cauliflower, mustard green, spinach, turnips, soy protein isolate, tofu, millet and nuts.

Nutraceuticals and herbal extracts used in treating Graves’ hyperthyroidism should only be administered by a licensed nutritional therapist.

This article was published in www.thesundaily.my on 6 February 2012