I have been diagnosed with Graves’ disease ophthalmopathy. I have had double vision since March and am wearing a prism to correct the condition. I am going to see a Graves’ disease specialist. My question is can Graves’ disease go away? I met a woman who said that she had Graves’ disease and does not have it any longer. This has bothered me because my endocrinologist has led me to believe that I will always have Graves’ disease.
Graves’ disease is an autoimmune disorder with three manifestations: hyperthyroidism, that is an overactive and enlarged thyroid gland; ophthalmopathy, eye disease related to the autoimmune nature of Graves’ disease; and dermopathy, an unusual skin condition related to the autoimmune process. All three components of Graves’ disease are not seen in every case, and the skin component is actually fairly rare.
Although the cause of Graves’ disease is not known, it is believed that the autoimmune process involves the production of an antibody that attaches to and stimulates the thyroid exciting hormone (TSH) receptors in the thyroid gland.
The role of antibodies in Graves’ disease requires a bit more explanation. Antibodies are proteins that are produced by our immune system cells to fight infection or disease. In an autoimmune disease, for reasons unknown, the person’s immune system produces antibodies against the person’s own cells, or parts of cells. In Graves’ disease we find antibodies against the TSH receptors on the thyroid cells. A receptor is a special molecule on the surface of a cell that reacts to a hormone, chemical, virus or other molecule outside the cell, allowing the molecule to influence the cell. In the case of Graves’ disease, the antibody attaches to the TSH receptor and stimulates it, thereby mimicking the effect of an increase in TSH hormone.
This stimulation causes the thyroid cells to proliferate, making the gland larger and creating a goiter. The cells are also pushed to produce more of the thyroid hormones which in turn cause the various symptoms of hyperthyroidism.
Graves’ disease symptoms may include: tremors, rapid heartbeat or arrhythmias, weight loss, excessive sweating, frequent bowel movements, weakness, and reduced or absent menstrual cycles in women.
Graves’ ophthalmopathy is believed to be due to attachment of the same antibody to structures in the eye socket. It is characterized by swelling of the tissues behind the eyes, causing the eyes to be pushed forward, and deterioration of the muscles controlling the eyes, causing the double vision mentioned by our second writer. Medical treatments including cortisone-type drugs are generally successful in reducing this swelling, but occasionally surgery is necessary. Most people with Graves’ disease do not experience ophthalmopathy severely enough to require treatment.
Many autoimmune diseases have spontaneous remissions, and Graves’ disease is no exception. Therefore, many doctors will choose to treat it initially with anti-thyroid drugs, which reduce the over production of thyroid hormones and will usually shrink the goiter. Hopefully a spontaneous remission will occur and prevent a rebound of the hyperthyroidism when the pills are stopped. Treatment is usually given for one or two years. A prolonged remission is seen in one third to one half of cases treated this way. This obviously means that in one half to two thirds of cases, the hyperthyroidism will return at some point after the treatment is stopped.