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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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My quest for a cure: by listening to my feelings instead of my test results, I was able to find a solution to my hyperthyroid disease - One Reader's Succes
From Natural Health, 1/1/02 by Sharon Reese

IN APRIL OF 1998 I HAD THE WORST cold of my life. After it was over, I was eager to start jogging again, so I began walking daily to regain my strength. But I felt weaker than ever. I couldn't walk even a few blocks without feeling nauseous or go down a flight of stairs without holding on to a banister. I developed a continuous high temperature and lost my sense of taste. My ankles swelled. Even though I forced myself to eat a lot, I kept losing weight. And I was irritable and disoriented.

After a few months of worsening symptoms, I went to the hospital for tests and discovered I had Graves' disease, a common form of hyperthyroidism. An auto-immune disorder, it has no known cause, its symptoms can be eased with drugs, and the only cure is removal of the thyroid gland. I was totally in shock: Because I took such good care of myself, ate a healthy vegetarian diet, exercised, and meditated, I thought I was safe from disease.

I wanted to use an alternative treatment rather than prescription drugs, so I found a naturopath I felt comfortable with and began to work with her. However, the vitamins and herbs she suggested made me feel worse than ever. I began to have severe abdominal pains, and I was still weepy and quick to anger. Because I was in perimenopause, which has many of the same symptoms as Graves' disease, the conditions were aggravating each other.

A Desperate Choice

Six weeks after my diagnosis, I was so desperate that I went to an endocrinologist, who put me on the prescription medicine Tapazole (methimazole) and warned me that if I wasn't better in a year, my thyroid would have to be removed--chemically with radioactive iodine or surgically. Both sounded hideous.

I started to feel better, but I knew the drug was damaging my body. Within a month, I got three of its many side effects: skin eruptions, hepatitis like symptoms like fatigue and nausea, and changes in my white blood cell count. I took liver-supporting herbs to help my body cope, and my naturopath gave me a bimonthly liver enzyme test to monitor my liver function.

But a few months later, at my next appointment, the endocrinologist found that I had gained 13 pounds, which indicated that the Tapazole had forced my thyroid too far in the opposite direction and made it underactive. For the next several months, the doctor went on raising or lowering my dose based on my blood tests, completely ignoring how sick the side effects were making me. I eventually gave up trying to tell her.

A New Perspective

I began reading everything I could find on thyroid conditions. I learned that my illness had probably begun years before, and that specialists cite stress as a contributing factor. In my case, I had gone through the worst year of my life six years before I fell ill. In one 10-month period I divorced my husband, I moved to another state to start a new life, and my mother died.

Viewing my illness as my body's response to anxiety and loss made a lot of sense to me. I told my naturopath that I thought it would be better for me to learn how to live with my real feelings than to pop a pill, and she suggested that I wean myself off the Tapazole. I took my last fraction of a pill on July 14, 1999.

There was no dramatic consequence. The only symptoms I still had were typical menopausal ones--hot flashes, rapid heart beats, and mood swings. To prevent muscle loss, a common consequence of untreated hyperthyroidism, I ate more protein than usual, especially fish, and to support my liver and adrenal glands, I took herbs. Every day I also took high doses of vitamins C and E and other supplements.

But the following winter, I started to feel bad again. I had trouble falling asleep, partly because I had hot flashes that lasted more than 30 minutes, and I woke up crying several times a night. My naturopath tried several different homeopathic remedies. Some of them worked for a while, and when they no longer did, we'd try something else.

In January I went to a new endocrinologist, who said he'd never seen anyone control her symptoms without Tapazole. I walked out of his office with the prescription in hand, but I vowed to prove him wrong. (I still have that piece of paper.)

What got me through this period was talking to my naturopath every week. During these difficult months, we'd developed a close relationship, and I believed she really cared how I felt. Every week she would encourage me to hold out a little longer, and I'd feel better for a while. After a few weeks of this, she suggested I make an appointment with a Chinese physician who teaches at the naturopathic clinic. She said he was also a 12th generation Chinese healer.

Listening to My Body

In early spring I began seeing the Chinese doctor. Every two weeks he gave me an acupuncture treatment and foul-tasting herbs, and one bright summer morning I awoke with the realization that I'd slept through the night for the first time in six months. I also began falling asleep easily, without feeling shaky and anxious.

There were more nights like that, and I gradually stopped feeling exhausted and overwhelmed. Every day I did yoga and took a long walk. As the months passed, my symptoms slowly diminished and my physical strength returned.

I've been living a normal life for more than a year now. When my nurse practitioner saw me a few weeks ago she told me how good I looked. She did some in-office tests and remarked that I don't have the reflexes of a hyperthyroid--no signs at all of muscular weakness.

My blood tests still show that I'm hyperthyroid, but I don't care what they say. I know how I feel and I no longer feel ill.

Tell Your Tale Have natural therapies helped you improve your life? Please share your story. Send your manuscript, address, and daytime phone number to My Story, Natural Health, 70 Lincoln Street, 5th Floor, Boston, MA 02111. Your manuscript should be approximately 1,500 words, typewritten and double-spaced. If we publish it, we will pay you $100. Manuscripts will be edited and cannot be returned.

Sharon Reese works for the Institute for Social Research at the University of Michigan and is studying for a master's degree in holistic nutrition.

COPYRIGHT 2002 Weider Publications
COPYRIGHT 2002 Gale Group

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