20 May 2019 Graves' disease is an autoimmune disease characterised by production of auto-antibodies that stimulate the thyroid . It is estimated that its prevalence is about: 1 to 2% in women; 0.1 to 0.2% in men. The risk of developing Graves' disease is greater: In the post-partum period; In emotionally difficult phases of life. The typical clinical condition results from excessive production and secretion of T3 and T4 thyroid hormones, which is called hyperthyroidism . Hyperthyroidism in Graves' disease is often accompanied by a diffuse enlargement of the thyroid gland, called diffuse goitre . Symptoms of hyperthyroidism Typically hyperthyroidism is reflected by: Weight lose; Tachycardia (increased heart rate); Tremors; Heat intolerance; Diarrhoea; Anxiety, a result of metabolic hyperactivity associated with the disease. In the medium / long term, when control is insufficient or the diagnosis is late, there may be: Severe cardiac alterations; Disabling muscle weakness; Loss of bone mass, with increased risk of fracture. It is therefore a clinical condition that requires effective, specialised treatment. Causes of orbitopathy in Graves' disease In addition to hyperthyroidism and diffuse goitre, about 25% of people with Graves’ disease have signs or symptoms of orbitopathy . Orbitopathy of Graves' disease is a consequence of inflammation of the intra-orbital soft tissue , of autoimmune cause. The first phase of the disease, in which the inflammatory process is very active, is called the active phase of orbitopathy. In some cases, with the passage of time and reduction in the inflammation, scars are formed in the affected tissues , resulting in sequelae that tend to be chronic. The probability of orbitopathy and its negative prognosis increases significantly with smoking . In most cases, both orbits are affected and the orbitopathy is considered mild . In these situations, the dominant symptoms are: Retraction of the upper eyelid; Feeling of a foreign body in the eye; Reddening of the eye; Swelling of the eyelids; Slight protrusion of the eyeball. There are, however, cases with a substantial functional compromise, such as: Double vision: Colour perception; Decreased visual acuity, usually associated with significant; protrusion of the eyeball. The absence of hyperthyroidism does not preclude the development of orbitopathy . In fact, about 15% of these patients have euthyroidism or hypothyroidism at the time of diagnosis. Treatment by different specialisms Graves' disease is an uncommon condition. A clinical evaluation is required to identify the stage and severity of the disease and establish an appropriate treatment plan. Involvement of an ophthalmologist specialising in orbit conditions is therefore vital. Progression of the orbitopathy of Graves' disease depends decisively on: Timely control of thyroid function; The suitability of the treatment to each patient’s ophthalmic condition. It is therefore extremely important to have good articulation between the ophthalmologists and endocrinologists treating the condition. This article was written with the support of physicians and other clinical professionals from the Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
