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Whats the rush in treating Graves disease? Elaine Moore

This article explains the reasons why Graves’ patients should not be rushed into having aggressive permanent treatment. Patients newly diagnosed with Graves disease (GD) are frequently rushed into having aggressive treatment to destroy their thyroid glands. The reasons for this, theyre told, are to prevent the condition from worsening and to ward off conditions of thyroid storm. The reasons I have been telling patients not to rush into treatment are similar.

Aggressive treatment tends to worsen the existing autoimmune disorder, increasing thyroid antibody production and causing a transient increase in hyperthyroidism and perpetuating the autoimmune process. In addition, thyroid storm is often triggered by radioiodine because of the increase in thyroid hormone levels and thyroid antibodies and occasionally it is triggered by surgery. Finally, unlike some other diseases, Graves disease is not typically progressive. Its natural course is a waxing and waning of symptoms and periods of remission alternating with periods of variable symptoms. Only rarely does the disease progress although over time the effects of extended untreated hyperthyroidism can eventually damage other systems. Treatment, whether with medications or herbal remedies, is usually needed to lower thyroid hormone levels until the natural disease course winds down.

Autoimmune Nature of Graves Disease

Another very important reason I object to rushing into aggressive therapy is that Graves disease is an autoimmune disorder. The thyroid gland is the victim, not the cause in GD. The disease process in Graves disease is fascinating and fairly straightforward. The immune system, sensing that our thyroid tissue is foreign, is triggered or stimulated to launch an immune response directed at thyroid tissue. Normally, the immune system protects us from foreign substances and infectious agents, and it prevents cancerous cells from developing. In autoimmune diseases, the immune system is hyper-vigilant and confuses our bodys cells with foreign substances.

In the autoimmune response responsible for GD, the immune system produces various destructive immune system chemicals as well as autoantibodies that react with a specific protein known as the TSH receptor. This protein is like a lock sitting on the edge of thyroid and other cells. Normally, the pituitary hormone TSH, which is thyroidstimulating hormone or thyrotropin, is the only substance that can open or react with this lock. When it opens the lock, TSH enters and tells thyroid cells to produce thyroid hormone. Normally, small pulses or bursts of TSH activate the lock all day long, picking up speed at night. By doing so, the pituitary ensures that thyroid cells are producing adequate hormone for the bodys needs.

TSH Receptor Antibodies

In Graves disease, the immune system produces stimulating TSH receptor antibodies, which are also known as thyroid stimulating immunoglobulin (antibodies) or TSI. As their name implies, they too, like TSH, stimulate or activate the TSH receptor. In doing so, they also cause increased production of thyroid hormone. Even when the pituitary gland tries to fix the problem and stops secreting TSH, TSI keep ordering thyroid cells to produce excess hormone. When this happens, the thyroid gland is no longer under pituitary control. The amount of hormone it produces is dependent on levels of TSI. TSI are the direct cause of hyperthyroidism in Graves disease and various immune system chemicals known as cytokines also contribute to the symptoms that occur in this disorder.

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