Heart Disease: Risk Factors, Prevention, and More

Ask The Advocate: Practicing Self-Care With Graves' Disease

If you have Graves' disease, your doctor may prescribe medication, radioiodine therapy, or thyroid surgery to treat it. They can help you understand the benefits and risks of different treatment approaches and support you in making treatment decisions.

In addition to following your treatment plan, practicing self-care — including healthy lifestyle habits and stress management — may help you feel better physically and mentally. Reaching out for social support may also help you manage the condition.

Healthline spoke with Nancy Hord Patterson to learn more about self-care with Graves' disease. Patterson is the founder of the National Graves' Disease Foundation, which is now known as the Graves' Disease & Thyroid Foundation.

Here's what she had to say.

One was to learn to say no — to not cram so much in. It took me years to do that because I'm kind of type A, so I'd say, "Yeah, I can do that, I'll do that, I can squeeze that in." And it didn't help to be trying to do so much.

I learned to manage my time a whole lot better.

I learned to make myself go to bed — because I used to be a night person that would study until midnight and then get up at 6:00 to go to work, and I couldn't do that anymore.

I understood healthy eating, so I didn't have to make a lot of changes there.

I did gain a lot of weight because I was on so many steroids to try to keep my thyroid eye disease from getting worse. Over the years, I weighed 100 pounds more than I weigh now — and I credit 98 of those pounds to steroids.

I also learned that you need to exercise, but you absolutely don't need to push it. I've talked to a lot of people that are trying to push it, and their heart's just going, "I can't do this."

I learned the hard way not to do that. Exercise, but don't overdo it.

My master's degree was in psychology, my PhD was in counseling, and my dissertation was on stress mastery, so that knowledge has helped a lot.

One strategy is to keep doing things that give you peace or joy, because it feels like you're only able to do the things you have to do, and you hate doing those. So make some time to do the things you like to do.

Learn to relax or meditate. Meditating is not necessarily a spiritual thing — it's just going within yourself and letting go, and it becomes a learned behavioral response. You learn that if you take a deep breath and blow it out really slow, things calm down about 1 degree. You get more in control, and the stress gets less in control.

I've also found journaling helpful. Or if you're the type that likes to draw, you can doodle or just take crayons and scribble all over a piece of paper.

Do something that physically helps you let out negative energy. Let out some anger.

Psychiatrist Elisabeth Kübler-Ross told me about camps that she would do with people who were going through cancer. She said they had rubber hoses, and they would take a telephone book, and they would beat the #@*& out of it. So, I've beaten a few phone books.

Also, learn about the illness and get a doctor that listens, because this is your illness, and you need to become your own advocate. That's the most important thing: Become an advocate.

Talking to people that know what you're going through is good, which is why it's good to have a support group. It's good to have their phone numbers, so you can call them up and say, "Susan, can you talk for a few minutes?"

When I got my diagnosis, there was nobody to talk to. Most people had not even heard of Graves' disease, so people were really isolated.

I asked my surgeon, "Are there any support groups?" He said, "No." And I said, "There will be."

Within about a week, I had the National Graves' Disease Foundation founded.

We had our first support group in Jacksonville, Florida. That's where I lived. Then we started more support groups in different cities, pretty much all over the country.

We also made an internet page with what we called the forum. People could write a message, and it was monitored. We'd read it, we'd answer it, other people would answer it.

It gave people a place to share with each other what was going on. They'd go, "Wow, you have that too?" It gave them a place to get what they couldn't get anywhere else, which was support and acknowledgment.

Nancy Hord Patterson, PhD, is the founder of the Graves' Disease and Thyroid Foundation, formerly known as the National Graves' Disease Foundation. She's a nationally certified counselor and clinical specialist in psychiatric/mental health nursing. She lives with Graves' disease and thyroid eye disease.

Graves Disease

You can lose weight due to diabetes or hyperthyroidism. But drastic weight loss coupled with excessive sweating and hair loss can also be due to Graves' disease. It is an autoimmune disorder that affects the thyroid gland leading to overproduction of the thyroid hormones (T3 and T4) leading to hyperthyroidism. Our expert Dr. Girish Parmar, Consultant Endocrinologist and Metabolic Physician, Kokilaben Dhirubhai Ambani Hospital, Mumbai explains in detail about everything you should know about this disease.

What is Graves disease?

In this condition, autoimmune antibodies are produced in the body which are similar to endogenous TSH (thyroid stimulating hormones) released from the brain. As these abnormal proteins are similar to the TSH hormone, they stimulate the thyroid gland. This in turn causes overproduction of T3 and T4 hormones leading to hyperthyroidism.

Symptoms

As blood levels of T3 and T4 hormones are increased, the overall metabolic rate is increased. This in turn increases the energy in the body and functioning of the metabolic processes leading to increased activity. Hence, the symptoms of Graves disease include –

 

Palpitation or increased heart rate

Excessive sweating

Tremors

Excessive hair fall

Frequent loose stools

High fever (as excess heat is produced due to increased metabolic rate)

Weight loss

Irregular periods

Eye problems

 

In 30 – 40 % of cases, the abnormal proteins present in the body increases the pressure on the muscles of the eye and thus, lead to frequent eye problems. These include swelling of the eyes (due to the pressure exerted behind the eyes), redness, bulging of the eyes and double vision.

Causes & Risk Factors

Graves disease is an autoimmune disorder in which your body cells produce antibodies. Although the exact cause of this is not known, there are several factors that increase your risk of suffering from the condition. These are –

Gender – Females are at a high risk of Graves disease as compared to men.

Age – Although people in their 40s and 50s are at high risk due to their age and low immunity, young people can also suffer from this disease.

Pregnant women

Stress

Excessive exposure to iodine

Diagnosis

The diagnosis of Graves disease is usually based on the symptoms. You doctor might recommend a blood test to detect levels of thyroid hormones in the body. These tests usually include –

T3 and T4 test – High levels of T3 and T4 hormone sin the body might indicate Graves disease.

TSH test – Low blood levels of TSH (thyroid stimulating hormone) signify hyperthyroidism due to Graves disease.

TSH receptor antibodies – If you suffer from Graves disease, your blood levels of TSH receptor antibodies are high.

Thyroid technetium scan – In this, a radioisotope (technetium) is injected into the body. If you have Graves disease, the gland takes up the isotopes and thus shows excess radioactivity in the region, when viewed on a display.

Treatment

The treatment of Graves disease is usually classified into 3 stages –

1st line of treatment: Medications

The medications that are prescribed to treat this disease include carbimazole and propylthiourasil (PTU). As the risk of liver dysfunction is high in case of carbimazole, propylthiourasil is usually recommended during the first three months of pregnancy.

Advantages: It is effective, cheap and has fewer side-effects as compared to other modes of treatment.

Disadvantages: You have to take these medications for around one and half years to two. And with this treatment the chances of remission (cure) is 30 – 40% and recurrence is 50 – 60%. In case the blood levels of TSH receptor is high, the chances of remission is less and thus, medication therapy is effective in such cases.

2nd line of treatment: Radioactive iodine therapy

If the patient is not responding to the medical therapy, your doctor might go for radioactive iodine therapy. In this, radioactive iodine either in the form of capsule or liquid (injection) is given only once.

Advantages: It is cheap and also effective. One dose provides remission in 70 – 80 % of cases.

Disadvantages: With this treatment, there is a high chance of the person suffering from hypothyroidism (shrinking of the thyroid gland). And in such case, the patient has to be on hormones (as the body does not produce hormones) for the rest of his/her life.

3rd line of treatment: Surgery

In rare cases, your doctor might recommend thyroidectomy (surgical removal of the thyroid gland) to treat the condition.

Prevention

As there is no known cause of the disease, Graves disease cannot be prevented. However, If you are at a high risk of suffering from this disease, make sure your diet is low in iodine. Also, avoid seafood and cough syrup (as they contain high levels of iodine).

The content has been verified by Dr Girish Parmar, Consultant Endocrinologist and Metabolic Physician, Kokilaben Dhirubhai Ambani Hospital, Mumbai.

More From Graves disease

Chronic Illness

Coronavirus death rate is higher for those with chronic illnesses

Monday's report by Centers for Disease Control and Prevention highlights the dangers posed by these conditions. They include heart disease, diabetes and chronic lung ailments, such as asthma or emphysema.

By Lindsey Tanner, Associated Press

---