Graves’ disease encompasses the toxic features that accompany an overactive thyroid gland. The symptoms and signs of the condition commonly occur due to the excess production of the thyroid hormones – thyroxine (T4) and triiodothyronine (T3). These hormones act by regulating various metabolic, physical, emotional, weight and energy functions of the body.
The features of Graves’ disease is separated as features of hyperthyroidism, features affecting the eyes and the features affecting the skin. 1-6
Features of hyperthyroidism
These are clinical features or symptoms that affect the whole body. The common symptoms that the patient experiences include:
- Intolerance to heat. Patient tends to feel hotter than the surroundings actually are. This may be accompanied by sweating.
- Palpitations and increased heart rate
- Itching
- Breathlessness - especially on exertion. There may be an aggravation and worsening of asthma
- Weight loss. This is often accompanied by an increased appetite.
- Rarely weight gain may be seen
- Increased bowel motions
- Tremors of the hands and the patient may complain of feeling shaky.
- Fatigue and weaknesss
- Increased frequency of urination particularly at night
- Increased thirst
- Increased anxiety and being emotionally unstable and labile. Many of the patients may be irritable and may complain that they cannot keep their emotions under control.
- Lack of sleep
- Lack of concentration and inability to focus
- Women may have less menstrual bleeding or may have no periods at all
- Men may suffer from erectile dysfunction, gynecomastia or enlargement of male breasts.
- Gastrointestinal upsets like nausea, vomiting (rare) and indigestion
- Goiter - which is an enlarged thyroid that may cause the neck to look swollen
Signs that are detected on examination of the patient include:
- Warm, smooth, moist skin
- Loosening of nails from the nailbeds called Plummer’s nails
- Reddening of the palms
- Thinning of hair
- Bright, shiny eyes
- Staring look and inability of the eye lid to cover the eyes completely
- Increased heart rate and abnormal rhythms of heart beat like atrial fibrillation
- High intensity of the pulse with loud beats
- Tremors in the fingers
- Increased muscle reflexes and jerkiness and weakness of muscles (proximal myopathy).
Features of eye affliction of Graves’ ophthalmopathy
Eye symptoms begin about six months before or after the diagnosis of Graves’ disease. Eye problems rarely occur long after the disease has been treated. In some patients with eye symptoms, hyperthyroidism never develops and, rarely, patients may be hypothyroid.
The severity of the eye symptoms is not related to the severity of the hyperthyroidism. These are clinical features or symptoms that affect one or both eyes. The common symptoms that the patient experiences include:
- Eye irritation
- There may be dryness or excessive tearing of eyes
- Blurring of vision
- Double vision
- Pain on eye movement and pain and discomfort behind the eyes
- Loss of vision
Signs that are detected on examination of the patient include:
- Swelling around the eyes (periorbital edema)
- Redness of eyes called conjunctival erythema and also swelling of the conjunctiva (conjunctival edema)
- Bulging eyes
- Lack of eye muscle movements
- loss of colour vision due to damage to the optic nerves (optic neuropathy)
- Swelling of the retina and retinal damage
Features of skin affliction of Graves’ disease
These are clinical features or symptoms that affect the skin. The common symptoms that the patient experiences include:
- Lumpy reddish thickening of the skin. This commonly occurs in front of the shins known as pretibial myxedema. This is painless and mild but may be painful
- Skin problems do not necessarily begin precisely when the hyperthyroidism starts
- Severity of skin problems are not related to the level of thyroid hormone
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