Teresa Maldonado Emily Asbell

Case Study: Graves Disease

Description of the case (signs and symptoms): Jackie, a 25 year old pregnant female is presented to her OB/GYN with the following symptoms, irritability, fatigue, rapid/ irregular heart, tremor of the hand, muscle weakness, sensitivity to heat, and no weight gain, enlargement of thyroid gland (goiter), frequent bowel movements and diarrhea. The medical examination revealed that she had an autoimmune disease classified as Graves Disease. List of all the tissues or systems that are involved and description of how they are affected: In Graves disease, your immune system creates auto-antibodies that cause the thyroid to grow and make more thyroid hormone than your body needs. These auto-antibodies are called thyroid-stimulating immunoglobulins or TSIs. The TSIs bind to thyroid cell receptors, which are normally TSH receptor for thyroid-stimulating hormone or TSH. In a normal thyroid cell TSH is the hormone responsible for telling the thyroid to produce hormones. In an unregulated thyroid the TSIs trick the thyroid into growing and producing too much thyroid hormone, leading to hyperthyroidism. Sometimes in Graves' disease inflammation and swelling can occure in the soft tissues and muscles that surround the eyes, often causing the eyeballs to bulge from their sockets. Skin can also be affected by Graves' disease. The skin covering the lower legs and feet can become thick, reddened, and bumpy because of profound swelling known as pretibial myxedema. When we have hyperthyroidism, the electrical impulses to the heart can go wild and create irregular heart rhythms that can lead to a heart attack or death. List of all the diagnostic tests that are available: There are two tests that can be used to diagnose this woman; they are thyroid function test and the antibody test. The thyroid function test is done by taking a blood sample from the individual and sending it off to the lab to test for thyroid hormone (T4) and TSH. The Antibody test is done by also taking a blood sample and looking for antibodies that suggest Graves disease. Due to the patient being pregnant they cannot perform a Radioactive Iodine Uptake on her. If the patient wasnt pregnant the RAIU could be done by injecting iodine into the pa tient to see how much iodine the thyroid takes up. A high uptake suggests Graves disease. List of the most current medical treatments: There are 3 treatments of Graves disease. One is Antithyroid medications known as Methimazole and Propylithiouracil. These drugs keep the thyroid from making too much thyroid hormone. MMIs are not usually preferred in pregnant individuals. The second treatment is Radioactive Iodine, where you swallow a pill that contains RAI which damages the

Teresa Maldonado Emily Asbell

thyroid by giving it radiation. By destroying the thyroid cells less thyroid hormone is made. With this treatment you must continue taking medication for the rest of your life. Last but not least there is surgery, where most or the entire thyroid is removed. With removing the thyroid you will also have to take a thyroid hormone to replace what your body can no longer make. Your doctor may also suggest Beta-Blockers, which serves as a temporary treatment while waiting for a primary treatment. They block the action of the thyroid hormone on the body and relieve symptoms quickly. Women who become pregnant with Graves disease are at risk of preeclampsia, preterm birth, placental abruption, miscarriage, and heart failure. So before getting pregnant make sure your Graves disease is well under control.

References http://www.endocrine.niddk.nih.gov/pubs/graves/ http://www.medicinenet.com/graves_disease/article.htm http://www.mayoclinic.com/health/graves-disease/DS00181/DSECTION=symptoms