What to know about Graves’ disease and the immune system

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Hyperthyroidism has different causes. However, the most frequent is an autoimmune condition called Graves’ disease. It causes the immune system to attack the thyroid gland, which results in the production of higher-than-usual levels of thyroid hormones.

The National Institute of Diabetes and Digestive and Kidney Diseases states the condition affects nearly 1% of people in the United States and is the cause of approximately 80% of hyperthyroidism cases. It is more common in females and individuals over the age of 30 years.

Other risk factors include:

• smoking and the use of other nicotine products
• a family history of Graves’ disease or Hashimoto’s disease, an autoimmune condition that can cause low production of thyroid hormones
• other autoimmune diseases, such as rheumatoid arthritis

An autoimmune condition is the most common cause of hyperthyroidism. Autoimmune means the body’s natural defense system cannot distinguish between a person’s own cells and foreign cells, so it mistakenly attacks healthy cells and tissues.

If someone has an autoimmune condition, it does not mean they are immunocompromised. Another term for immunocompromised is immunodeficiency, which means a weakened immune system. When an individual has a condition that weakens their immunity, they have difficulty responding to infections.

To date, there is no evidence that people with an autoimmune thyroid condition are immunodeficient.

They should not be more susceptible to infections or be more prone to serious illnesses than people without autoimmune conditions.

However, if a person has a thyroid autoimmune condition, they are more likely to have another autoimmune condition. For example, if a person has another condition affecting a vulnerable part of the body, such as the lungs, they may be more prone to developing lung infections.

However, the increased risk stems from the other autoimmune disease rather than a thyroid autoimmune condition.

Symptoms can vary but may include:

• shaky hands and muscle weakness
• irregular or fast heartbeat
• frequent bowel movements
• weight loss
• difficulty sleeping, irritability, tiredness, and nervousness
• issues tolerating heat or excessive sweating
• an enlargement in the neck called a goiter

If a person does not receive treatment, they may develop:

• osteoporosis and muscle issues
• an irregular heartbeat that results in:
  • heart failure
  • stroke
  • blood clots
  • other heart issues
• an eye disease called Graves’ ophthalmopathy, which involves bulging eyes and retracting eyelids
• fertility and menstrual cycle issues

Learn more about Graves’ disease.

There is no one-size-fits-all treatment, as it depends on various factors, such as:

• age
• other medical conditions
• the type and severity of the hyperthyroidism

Treatment options include medications, radioactive iodine, and surgery.

Medications

Medications include beta-blockers and antithyroid drugs:

Beta-blockers

These block the action of thyroid hormones in the body. They can help a person feel better quickly, but they do not reduce thyroid hormone levels.

Due to their quick action, doctors may prescribe one of these regardless of whether they prescribe one of the other treatment options, which require more time to take effect. One example is atenolol (Tenormin).

Antithyroid hormones

These block the thyroid gland’s capacity to make thyroid hormones. They control the gland’s hyperactivity without permanently damaging it. One example of this class of drugs is methimazole (Tapazole).

Radioactive iodine

This therapy damages or destroys thyroid cells that produce thyroid hormones. It reduces the size of the thyroid gland or nodules, decreasing thyroid hormone levels. As it is such an effective treatment, it is a very common option.

However, radioactive iodine may often cause hypothyroidism, which is the production of lower-than-usual thyroid hormone levels. This condition is treatable with a daily dose of thyroid hormones.

Surgery

Surgery involves the removal of all or most of the thyroid gland. One side effect of the surgery is hypothyroidism, but, as with radioactive iodine, it is not difficult to manage.

This option can be a risk if a person’s hyperthyroidism is not managed before the operation. Doctors typically only choose this treatment method if other options are ineffective.

Any person with symptoms of hyperthyroidism should contact a doctor. This is particularly important if a person is pregnant or planning to conceive.

Individuals who have undergone one of the treatments that result in hypothyroidism will need to take thyroid hormone medication daily. When this happens, it is sometimes necessary to adjust a dose, so they should consult a doctor periodically to check their thyroid levels.

Even if a person has an autoimmune condition called Graves’ disease, it is not the same as having an immunocompromised condition, which means weakened immunity. Hyperthyroidism should not make someone susceptible to more frequent or more severe infections.

It is important to get treatment for hyperthyroidism, so individuals with symptoms should contact a doctor.