Diseases of the Auto Immune System

Hyperthyroidism or Graves' Disease

Hyperthyroidism is the over-production of thyroid hormones. 'Hyper-' means 'over' or 'above'. Its opposite is 'hypo-' as in hypothyroidism – insufficient production of thyroid hormones. The thyroid is situated in the neck. The hormones it produces regulate the digestive, nervous and reproductive systems. The skin, lungs, hair, muscles, eyes and bones are all affected by thyroid hormones.

The most common form of hyperthyroidism is Graves' disease. Robert Graves was an Irish physician who first described this form of over-activity of the thyroid gland well over a century ago. Graves' disease is a condition of the auto-immune system. For reasons not fully understood the body perceives one of its own organs as foreign and sets out to destroy it. There may be a genetic link. Those with Graves' disease have increased levels of iodine in their body.

Symptoms include swelling of the thyroid gland and often exophthalmos (goitre) of the eye (Graves' ophthalmopathy). Exophthalmos is a forward protrusion of the eye resulting in a disfiguring fixed stare. Other symptoms are an increase in appetite, weight loss, poor heat tolerance, arrhythmic heart beat and changes in the menstrual pattern.

Beta blockers often relieve symptoms but aren't a cure. Anti-thyroid medications will prevent production of excessive amounts of hormones but can cause serious liver damage. They are often used together with radioactive iodine treatment or surgery. If these measures are not viable, removal of the thyroid gland (thyroidectomy) may be considered.

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Mild cases of Graves' ophthalmopathy may be treated with prescription eye-drops and gels and oral steroids. Once the condition has stabilised, exophthalmos may be corrected by orbital decompression. This eye surgery removes bone from between the eye socket (orbit) and the sinuses, allowing more room for the swollen tissues and for the eye to fit back into the socket.

If the eye muscles are damaged causing double vision, surgery can be undertaken which will correct the problem. Finally blepharoplasty (surgical modification of the eyelid) can restore retracted eyelids.

Occasionally sufferers develop pretibial myxedoema (Graves' dermopathy), a skin condition usually limited to the lower leg. This is a rare condition occurring in only about 1-4% of patients. The skin covering the front of the shins and on top of the feet reddens. Scaly thickening of the skin forms an orange peel appearance. The lesions may burn and itch and in advanced cases may extend to the elbows, knees and other sites. It may take several months for the lesions to appear. They may then stabilise or spontaneously regress.

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Food choices play a role in managing the effects of hyperthyroidism. With the correct diet there may even be a reduction in the symptoms. Some foods have been found to interfere with the normal function of the thyroid. These are called goitrogens.

Iodine has already been mentioned. Foods with a high iodine content include kelp, shellfish, some other seafoods, beef liver, turkey, chicken and red meats. Soy products may inhibit the function of the thyroid. Vegetables of the Brassica family which includes broccoli, kohl rabi, Brussels sprouts and cauliflowers may be high in iodine, especially if eaten raw. Refined carbohydrates such as white sugar and white flour should be restricted. Caffeine and alcohol consumption should be limited.