Graves' Disease: Its Symptoms in Females, Causes & More

Autoimmune disorders occur when the immune system mistakenly targets the body's own tissues. Notably, research indicates that nearly 80% of individuals diagnosed with autoimmune diseases are women. Factors such as stress, hormonal shifts, and pregnancy can heighten the vulnerability of women to these disorders. One such condition is Graves' disease, where the immune system erroneously targets the thyroid gland, leading to an excessive production of thyroid hormones.

Graves' disease is more prevalent in females, showing a 5:1 female-to-male ratio. Furthermore, it is the most common cause of autoimmune hyperthyroidism during pregnancy. This article explains how Graves' disease affects women, what symptoms they experience and how they can manage the condition better.

Causes of Graves' Disease

This disease derives its name from an Irish doctor, Robert Graves, who described this condition in the 1800s. Although researchers have not been able to pinpoint the exact causes of autoimmune disorders like Graves' disease, they suggest that it occurs due to a sudden trigger in the immune system. It prompts the immune system to produce thyroid-stimulating immunoglobulin (TSI), due to which the thyroid gland starts over-producing thyroid hormones. The following section describes some probable causes in detail:

Genetics

Although Graves' disease is a result of genetic and environmental factors, having a family history of autoimmune disorders increases one's chance of developing this condition. A mutation in one or more genes may cause deviation in regular thyroid function. It results in the production of more T3 and T4 (thyroid hormones). As per the study, Graves’ disease: Epidemiology, genetic and environmental risk factors and viruses,’ published in ‘Best Practice & Research: Clinical Endocrinology & Metabolism,’ journal, the risk of developing GD due to genetic predisposition is 79%.

Autoimmune Disorders

Associated autoimmune conditions like type 1 diabetes, vitiligo and pernicious anaemia can indirectly cause thyroid hormone imbalance, causing Graves' disease. The immune system gets compromised and may start attacking the thyroid gland. It results in an overactive thyroid, leading to this condition. Autoimmune disorders can coexist and increase the frequency of developing another autoimmune condition.

Environmental Factors

Infectious agents, toxins, high iodine intake, extreme stress and exposure to viruses may increase an individual's susceptibility to developing Graves' disease. Smoking is another environmental factor that may trigger this condition.

Symptoms of Graves' Disease in Females

Graves' disease is more common in females than males because of its autoimmune nature. Thyroid disorders due to Graves' disease may occur in pregnant and pre or post-menopausal women experiencing hormonal changes. Here are some symptoms noticed in females:

Hyperthyroidism

In Graves' disease, the immune system attacks the thyroid gland to make it overactive. Therefore, most symptoms in women match those of hyperthyroidism. They include unexpected weight loss, goitre (enlarged thyroid gland), hair loss, fatigue, anxiety, profuse sweating, mood swings and palpitations.

Eye Problems

Swelling around the eyes, reddish and inflamed eyelids, dry and gritty eyes, double vision, light sensitivity and pressure on the eyes are some common symptoms of eye problems associated with Graves' disease. Many patients with Graves' disease develop clinically symptomatic thyroid eye disease (TED).

Skin Changes

Bumpy rashes, itchiness, and inflamed and thickened skin are possible symptoms. Skin (usually on the shins and the top of the feet) turning rough and reddish are signs of Graves' dermopathy.

Emotional Changes

Anxiety, emotional turbulence, sensitivity, irritability, insomnia, and restlessness are emotional or mental symptoms associated with Graves' disease.

Menstrual Irregularities

Irregular menstrual cycle, too heavy or too light periods, and difficulty conceiving are symptoms of Graves' disease and an overactive thyroid. Amenorrhea (absence of a menstrual period for a long time) can also be a consequence. Hot flashes are also possible symptoms that may be confused with the early setting-in of menopause.

Diagnosis of Graves' Disease

Early diagnosis of Graves' disease provides a better chance of recovering soon. The good news is Graves' disease is easily diagnosable once the individual recognises the symptoms and consults the physician. The list of tests prescribed to diagnose this condition are:

Medical History and Physical Examination

Besides routine tests, such as blood pressure and pulse testing, doctors check for visible signs of hyperthyroidism that develop due to Graves' disease. If the physical examination reveals the presence of goitre, eye problems and skin rashes, the patient will have to conduct further tests. Doctors will also check the family history for thyroid disorders and assess the risk factors. To confirm the diagnosis, a doctor may prescribe additional tests described below.

Blood Tests

Thyroid blood tests help detect the levels of thyroid hormones and thyroid-stimulating hormone (TSH) in the bloodstream. A thyroid antibody test helps detect the presence of autoimmune antibodies. Thyroid-stimulating antibodies (TSI) and thyrotropin-binding inhibitory immunoglobulins (TBII) are two antibodies linked with Graves' disease.

Imaging Tests

CT and MRI scans, ultrasound of the eye and thyroid gland, and radioactive iodine uptake (to determine the amount of radioactive iodine taken up by the thyroid gland) can effectively diagnose this condition.

Treatment for Graves' Disease

Once diagnosed, it is easy to manage Graves' disease and its symptoms with timely and proper treatment. In most cases, lifelong medication may be necessary to manage associated thyroid conditions. If left untreated, it can get chronic. Here is a list of some standard treatment protocols for Graves' disease:

Antithyroid Medications

Also known as thionamide drugs, antithyroid medicines induce the overactive thyroid to make fewer thyroid hormones. However, the hormone levels may take several weeks or months to decrease. Some examples of antithyroid medications are:

• Methimazole

• Propylthiouracil

• Carbimazole

For pregnant women, propylthiouracil is preferable (during the first trimester of pregnancy) over methimazole as the latter may not be suitable for the foetus. In some individuals, these medicines may cause side effects like allergic reactions and liver failure. Hence, one should consult a medical practitioner before consuming them.

Radioactive Iodine Therapy

Radioactive iodine, also called radioiodine, is suitable for diagnosis and treatment. It gradually destroys the thyroid cells producing the thyroid hormones, thereby controlling their levels and bringing the thyroid gland back to its regular size. The individual must consume the radioactive iodine in liquid or pill form. The radiation gradually destroys the over-functioning thyroid cells.

Like any other advanced treatment, Radioiodine may have a few potential side-effects, but which are taken into account while starting treatment. Pregnant and breastfeeding women should refrain from this therapy as it may harm the foetus. One of the possible side effects of this therapy is developing hypothyroidism. But, this condition is simpler to treat and manage than hyperthyroidism.

Surgery

Surgery may be advisable in severe cases when the thyroid is too enlarged or in pregnant women. Doctors perform a thyroidectomy to remove a part or the whole of the thyroid gland. In the case of part removal, doctors may advise thyroid medications to prevent hypothyroidism symptoms. In the case of whole thyroid removal, lifelong consumption of thyroid medications may be necessary.

Beta-Blockers

Although these medicines do not stop thyroid hormone production, they reduce symptoms until other treatments start working. Common beta-blockers used for treating Graves' disease are propranolol and metoprolol. They cause the blood vessels to relax and protect the heart.

Lifestyle Changes to Manage Graves' Disease

Although conventional medicine is necessary to treat Graves' disease, lifestyle changes can help deal with the condition better.

• Following a healthy diet and including organic, low-calorie, nutrient-dense foods is beneficial.

• A structured exercise regime that includes walking, stretching and core muscle-strengthening can help normalise thyroid hormone levels.

• Avoiding smoking and alcohol consumption can reduce the risk factors associated with this disease.

• Identifying the stress inducers and de-stressing oneself can help balance hormones.

• Yoga and meditation can also help in controlling thyroid hormone levels.

Natural Remedies for Graves' Disease

The goal of naturally treating Graves' disease is to stop the disease progression and tackle the root cause. Besides conventional treatment options, here are some natural remedies to improve the condition.

• Starting a gluten-free diet may reduce thyroid antibodies.

• Consuming supplements like probiotics and vitamin D help prevent relapse.

• Using herbs like lemon balm and bugleweed can help balance thyroid hormone levels.

Although natural remedies have minimal side effects, they can interact with medications or aggravate certain symptoms. Hence, one must consult their personal physician before opting for them.

Conclusion

Graves' disease is one of the leading causes (60-80%) of hyperthyroidism. However, it is a curable and manageable condition. The treatment is symptom-based and requires the use of conventional medications. Natural remedies are also applicable in some cases. If an individual, especially a female, has a risk of thyroid disorders running through the family, they must get tested for Graves' disease.

Frequently Asked Questions

1. What Are The Long-Term Effects Of Graves' Disease?

The long-term effects of Graves' disease, if left untreated, are heart failure, heart rhythm disorders, eye disease, and skin problems. If treated, there are high chances of relapse within one year. But after four years of treatment without relapse, the prognosis is good.

2. Can Graves' Disease Be Cured?

It is possible to treat Graves' disease with conventional medication therapy, such as antithyroid drugs and radioactive iodine. Surgery through a minimally-invasive procedure may be advisable in some cases. However, while the advanced research in the clinical field helps us manage the symptoms, the underlying autoimmune condition remains.

3. Is Graves' Disease Hereditary?

The causes of Graves' disease can be both hereditary (79% chance) and environmental (21% chance), according to studies. It is a multi-factorial disease caused by a combination of both genetic and non-genetic reasons.

4. What Should I Do If I Suspect I Have Graves' Disease?

If one notices the symptoms of Graves' disease, it is best to consult the concerned healthcare provider and get tested clinically. After a proper diagnosis, an endocrinologist can assess and treat the condition better.