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Unveiling the mystery of autoimmunity: What causes Graves' disease?
Graves' disease, also known as toxic diffuse goiter or Baxter's disease, is an autoimmune disease that affects the thyroid gland. This disorder is the most common cause of hyperthyroidism and often results in an enlarged thyroid gland. Symptoms include irritability, muscle weakness, sleeping problems, rapid heartbeat, heat intolerance, diarrhea and unexpected weight loss. You may also have thickening of the skin on your lower legs, called myxoma pretibialis, or bulging of the eyes, caused by Graves' ophthalmopathy. About 25 to 30 percent of patients experience eye problems. While the exact cause of the disease remains unclear, symptoms occur mainly because antibodies bind to thyroid receptors, leading to overproduction of thyroid hormones.
The symptoms of Graves' disease are a complex set of manifestations, and patients often experience anxiety or other psychological discomfort.
A combination of genetic and environmental factors is thought to be the cause of this disease. People with a family history of the disease have an increased chance of developing it. For example, if one identical twin has Graves' disease, there is a 30% chance that the other twin will also be affected. Episodes of the illness can be triggered by physical or emotional stress, infection, or childbirth, for example. Smoking is thought to increase the risk of disease and may worsen eye problems.
In Graves' disease, the antibodies are called thyroid-stimulating immunoglobulins (TSIs), which act like thyroid-stimulating hormone (TSH). The antibodies cause the thyroid gland to overproduce thyroid hormone. Diagnosis is usually based on symptoms combined with blood tests and radioactive iodine uptake tests. Blood tests typically show elevated T3 and T4, low TSH, and increased radioactive iodine uptake in all thyroid regions.
The diagnosis of this disease not only relies on laboratory data, but also requires a comprehensive assessment based on clinical manifestations and the patient's medical history.
When it comes to treatment options, there are three main options: radioactive iodine therapy, medication, and thyroid surgery. Radioiodine therapy involves taking iodine-131 orally, which concentrates in the thyroid gland and destroys excess thyroid tissue over weeks to months. The resulting hypothyroidism needs to be treated with synthetic thyroid hormones. Medications such as beta-blockers can help control some symptoms, and antithyroid drugs such as medetomidine can temporarily help patients. As for surgery, part or all of the thyroid gland is removed, and eye problems may also require additional treatment.
The incidence of Graves' disease in men is about 0.5%, while in women it is 3.0%, which is seven times higher in women than in men. The disease most often occurs between the ages of 40 and 60, but it can occur at any age. According to the National Institutes of Health, this is the most common cause of hyperthyroidism in the United States, accounting for approximately 50% to 80% of cases.
The symptoms and their progression are unique to each Graves' disease patient, making the disease challenging to diagnose and treat.
The development of Graves' disease may be related to a variety of factors including infection, stress, and current health status. Therefore, further research is needed to understand these transmission mechanisms. Additionally, patients often have other autoimmune diseases, such as type 1 diabetes and rheumatoid arthritis, which increase the risk of developing the disease.
Eye problems, or thyroid-associated ophthalmopathy, are the most common extrathyroidal manifestation of Graves' disease and may cause impaired vision or proptosis. Treatment includes lubricating eye drops or nonsteroidal anti-inflammatory medications for mild cases, while severe cases may require steroids or orbital decompression surgery.
Future research is needed to explore the underlying causes of this disease in order to provide more effective treatment options for Graves' disease patients. Is science today advanced enough in our understanding of the causes of disease to lift the veil on autoimmune disease?
