Diagnosis and Treatment
Determining whether you have Graves' disease involves a physical exam and a discussion of your symptoms. While the symptoms you reveal to your doctor may immediately suggest hyperthyroidism, changes in your eyes and an enlargement of your thyroid are usually the telltale signs that indicate you have Graves' disease and not a form of thyroiditis, which is an inflammation of the thyroid.
To confirm that you have Graves' disease, however, your doctor will want to order blood tests. Low levels of TSH, combined with high levels of free T4 and free T3, will indicate that you do, indeed, have hyperthyroidism.
Tracing the cause of hyperthyroidism to Graves' disease, however, requires other tests. Often, diagnosis also involves an RAIU test that can help confirm Graves' disease. This test involves ingesting a small amount of RAI. Hours later, a camera is placed in front of your neck to see where the iodine is concentrated. In people with Graves' disease, the RAIU test will reveal that the thyroid is absorbing a lot of iodine to produce thyroid hormone. The scan will show diffuse uptake of iodine over the whole gland.
Sometimes, doctors will check the blood for specific autoantibodies. The most telling substances in the blood are the TSIs. These are sometimes referred to as thyroid-stimulating antibodies (TSAs) or thyroid receptor antibodies (TRAb). These antibodies behave like TSH and will bind to TSH receptors in the thyroid gland, prompting them to produce thyroid hormone. But unlike TSH, TSIs do not stop the production of thyroid hormone once the levels get too high. TSIs are also responsible for thyroid eye disease.
People who have Graves' disease also have other autoantibodies in their blood, namely TPOAb and TgAb. Both these autoantibodies are also present in people with Hashimoto's disease, which makes them less conclusive than the TSI antibodies. TPOAb affects the thyroid by attacking the enzyme involved in iodine uptake. TgAb destroys thyroglobulin, the protein that stores thyroid hormone. Experts believe that these antibodies are present in low levels in about 10 percent of the population but do not cause any signs or symptoms.
Treating Graves' disease typically involves the options outlined in the previous chapter. The goal is simple: to restore thyroid hormone levels to normal. You may have RAI treatment to destroy the diseased thyroid tissue or take antithyroid drugs in the hopes of inducing a remission. Surgery is usually a last resort.
Some people with Graves' disease may describe manic behavior. But unlike true mania, which causes a real increase in your energy levels, hyperthyroidism in Graves' disease tends to bring on exhaustion.
Some people with Graves' disease will go into remission without medication. But this is extremely rare and occurs primarily in cases where the disease is mild.
Any course of treatment has advantages and disadvantages. Finding the perfect amount of RAI, for example, is often very difficult. High doses of RAI are more likely to be successful but almost guarantee that you'll be hypothyroid in the end. But giving patients a more conservative amount of RAI often doesn't work. Too little treatment, and you wind up still battling hyperthyroidism.
If you opt to take antithyroid medication, you may be able to avoid hypothyroidism, but you may continue having symptoms of hyperthyroidism. To help you decide, you should review your options carefully with your doctor and weigh the advantages and disadvantages of each treatment. Your decision will also be influenced by several other factors, including personal preference, allergies to medications, previous health conditions, and whether you are pregnant.