Hyperthyroidism and Graves Disease: When Things Go Wrong
A beautifully balanced biochemical mechanism can maintain us in perfect health all our lives. Sadly, however, it may go out of kilter sometimes quite abruptly, and sometimes insidiously slowly, causing a slow decline in health and vigour, which will inexorably destroy peoples lives. On the one hand, the thyroid gland can become overactive, bringing with it a variety of unpleasant, even life threatening symptoms, or it may become under active causing a bewildering number of problems, varying from mere loss of energy and vigour to chronic invalidism and sudden death.
First regarding over activity.
There are two groups of problems, which can move the thyroid into an overactive state. First, there may be a control problem. This can originate right at the top of the chain of command. The hypothalamus may produce too much of the thyrotrophin release hormone (TRH), thus causing over activity in thyroid stimulating hormone (TSH) production, and hence, over activity of the thyroid itself. For example, the cells responsible for TRH production may overwork, as in the case of a hormone producing cancer, called an adenoma.
Fortunately, not very common. But there may be over stimulation of these cells from the brain itself. High levels of stress from major life events can be responsible. Young adults, especially women may be subject to this. Or the TRH producing cells may become insensitive to circulating thyroid hormone and over produced to compensate.
More commonly, the pituitary itself may start producing more TSH. This can occur as a result of a pituitary adenoma, the growth producing the hormone in an uncontrolled fashion. There may be a genetic problem with these cells, which may escape from the proper controls and start doing their own thing. Or, they can become over sensitive to hypothalamic TRH with the same results. Whatever the cause, the thyroid becomes over stimulated and more thyroid hormone is produced than is required.
Most causes of over production of thyroid hormone however, occur in the gland itself. The receptors which respond to TSH may over respond and react by over producing thyroid hormones. The body itself makes antibodies to the thyroid tissue, which initially may cause over production of thyroid hormone, but in time, this effect may burn itself out and then the receptors become insensitive and thyroid production starts to become affected the other way, resulting eventually in under production of thyroid hormones. This problem of antibodies as a cause of illness, applies not just to the thyroid, but to other organs and tissues as well.
For reasons that may not be clear, but again, are sometimes the result of major traumatic life events, the thyroid producing cells simply over produce. The thyroid may become subject to an inflammatory process thyroiditis which may run its course to leave the thyroid normal again, or subject perhaps, to an instability between over and under activity.
The overactive thyroid, HYPERTHYROIDISM, was first described as far back as 1835, by an Irish Physician, Robert Graves; and a German physician, Karl Von Basedow, hastened to write a paper about it in 1840. Hence in the UK, we call it Graves Disease and the Europeans Basedows Disease. The thyroid gland is usually enlarged and clearly visible, a condition most often seen in young women. As a whole, woman are more often affected than men, usually in the younger age groups; but it may occur at any age and at either sex. It is known to be the result of autoimmune antibody attack and it is also for this reason also known as autoimmune thyroiditis. In general it is diagnosed without difficulty. The treatment of Graves disease however, is often not at all satisfactory.