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Essay on Graves' Disease

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Graves' Disease

The disease was first noted in 1786 by Caleb Hillier Parry 1755- 1822, physician from General Hospital, Bath, England. His account was published posthumously in 1825.
However Graves' disease is named after the Irish physician who described several cases in London Medical Journal in 1835. Graves' disease is also known as Parry's disease. In Europe, the disease is known as Basedow's disease. It is the most common cause of thyrotoxicosis (the morbid condition due to over activity of the thyroid gland).

The disorder has three major manifestations:
Hyperthyroidism with diffuse goiter
Ophthalmopathy
and Dermopathy

The three manifestations need not appear together. Indeed one or two never appear, and moreover, …show more content…

TSH not only stimulates the thyroid gland to churn out more hormones. If in excess, can cause overwhelming cell growth and division to result in goiter.

Most T3 and T4 released into the bloodstream are bound to proteins. Only the "free" component is biologically active and it is this component which decides the manifestations of thyrotoxicosis. The hormones exert their effects mainly by binding to nuclear receptors in cells to affect expression of genes.

In the presence of excess T3 and T4, an increase in number as well as affinity of beta-adrenergic receptors in the heart is noted. These receptors facilitate the action of "fight, flight and fright" hormones ( epinephrine, norepinephrine) which are positively chronotropic ( beat faster) and inotropic ( pump harder) to the heart. This may then lead to cardiac failure in older patients.

In fact, mild hyperthyroidism may produce severe disability in patients with underlying heart disease. Hence, all patients with unexplained cardiac failure or atrial arrhythmias should be examined for thyrotoxicosis.
Hyperthyroidism also increases the basal metabolic rate, heat production and oxygen consumption (calorigenic action) of many tissues. Body temperature increases slightly and the patient experiences intolerance to heat. Flushing and sweating are just compensatory

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