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Graves' disease

Graves-Basedow disease is a form of thyroiditis, an autoimmune disorder that stimulates the thyroid gland, being the most common cause of hyperthyroidism (overactivity of the thyroid). Also known in the English-speaking world simply as Graves' disease, it occurs most frequently in women (8:1 compared to men) of middle age. Symptoms include fatigue, weight loss and rapid heart beat. Because similar antibodies to those stimulating the thyroid also affect the eye, eye symptoms are also commonly reported. Treatment is with medication that reduces the production of thyroid hormone (thyroxin), surgery thyroidectomy or with radioactive iodine if refractory. more...

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Christina Rossetti famously suffered from this disease in later life.

Signs and symptoms

Graves-Basedow disease is a disorder characterized by a triad of hyperthyroidism, goitre, and exophthalmos (bulging eyeballs).

Due to the many physiological actions of thyroid hormone, many symptoms and signs are linked to Graves' disease:

  • Cardiac: cardiac arrhythmias (especially atrial fibrillation), tachycardia (increased heart rate), collapsing pulse and widened pulse pressure (difference between systolic and diastolic BP) and congestive cardiac failure with peripheral edema, ascites, anasarca.
  • Endocrine: weight loss in the presence of increased appetite, intolerance to heat, elevated basal metabolic rate
  • Dermatological: profuse sweating, thyroid acropachy (clubbing) of the fingernails, onycholysis (fingernail destruction), palmar erythema, pretibial myxedema (3 to 5% of Graves' patients, not to be confused with the myxedema of hypothyroidism)
  • Neurological: tremor (especially noticeable on extending the arms), apprehension, weakness, headache, proximal myopathy (difficulty rising from a chair or squatting position) and hyperactive deep tendon reflexes
  • Gastrointestinal: diarrhea (common), vomiting (rare)
  • Ophthalmological: thyroid eye disease (TED) characteristic of Graves disease include lid retraction (Dalrymple sign) above the superior corneoscleral limbus, lid lag (von Graefe's sign), proptosis or forward displacement of the globes, periorbital swelling and chemosis.

Extremely manifested disease that can sometimes be life-threatening is called the thyroid storm.


On the basis of the signs and symptoms, thyroid hormone (thyroxine or T4, triiodothyronine or T3) and thyroid-stimulating hormone (TSH) are determined in the medical laboratory. Free T4 and Free T3 is markedly elevated, while TSH is suppressed due to negative feedback. An elevated protein-bound iodine level may be detected. A large goiter is sometimes seen on X-rays.

Thyroid-stimulating antibodies may be detected serologically.


Most features are due to the production of autoantibodies that bind to the TSH receptor, which is present on the follicular cells of the thyroid (the cells that produce thryoid hormone). These antibodies activate the cells in the same fashion as TSH itself, leading to an elevated production of thyroid hormone.

The infiltrative opthalmopathy (thyroid eye disease) that is frequently encountered has been explained by the expression of the TSH receptor on retroorbital tissue.

The exact cause of antibody production is not known. Viral infection may trigger antibodies against its epitopes, which cross-react with the human TSH receptor. There appears to be a genetic predisposition for Graves' disease, suggesting that some people are more prone than others to develop TSH receptor activating antibodies due to a genetic cause. HLA DR (especially DR3) appears to play a significant role.


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Earl G. Graves treated for prostate cancer; urges Black men over 40 to get tested for the disease
From Jet, 5/10/04

Black Enterprise Magazine Founder and Publisher Earl G. Graves, Sr. recently underwent surgery at Brady Urological Institute at Johns Hopkins for prostate cancer.

Graves received a revolutionary nerve-sparing procedure developed by Dr. Patrick Walsh and performed by Dr. Arthur Burnett, a full professor and leading urologist on staff.

The technique allows for prostate removal with the preservation of potency and continence.

Graves' first warning sign came in the form of an irregular PSA (prostate specific antigen) test and was later confirmed by a biopsy. Dr. Burnett deemed the operation successful and expects Graves to make a full recovery.

"The disease has changed my life forever," says Graves. "I must take a PSA test every three months for the rest of my life so that the condition can be constantly monitored."

Graves chose to come forward with his personal health situation after Dr. Burnett shared with him that as African-American men they belong to the ethnic group most likely to develop the disease. According to the National Cancer Institute, prostate cancer among Black males is almost at epidemic levels.

Black men in America are at least 50 percent more likely to develop prostate cancer than men of any other racial or ethnic group in this country. Roughly 66 percent of Black men diagnosed with prostate cancer survive at least five years compared to 81 percent of White men with the disease. This may be due, in part, to the fact that Black men tend to be diagnosed at later stages, after the cancer has grown. Mortality rates among Black prostate cancer victims are twice as high as that for White men, and this rate is increasing almost 2 percent a year.

"Prostate cancer can be treated successfully if caught early," Graves says. In the May issue of Black Enterprise, he issues an urgent call for all men age 40 and over to get tested and keep getting tested every year.

"Each and every person at risk needs to learn about the disease; commit to be tested and make the lifestyle, health and dietary choices that can help prevent the disease."

Graves' personal story, detailed in the Black Enterprise Publisher's Page, is followed by a prostate cancer resource guide to help direct men to local resources, including locations for PSA screenings in their area.

"I didn't want to get prostate cancer, no one does," Graves says. "But I am hopeful that coming forward with my story will convince those who are most vulnerable to take action."

COPYRIGHT 2004 Johnson Publishing Co.
COPYRIGHT 2004 Gale Group

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