Graves' disease

Gravesova bolest, u starijim literaturama poznata kao Basedowljeva bolest je poremećaj obilježen hiperfunkcijom štitnjače smještene u prednjem, donjem dijelu vrata. Ova bolest je najčešći uzrok hipertireoze, a može se pojaviti u bilo kojoj dobi, najčešće u dvadesetim i tridesetim godinama života. Češće zahvaća žene i osobe koje imaju humani leukocitni antigen HLA-DR3. Radi se o autoimunom poremećaju u kojem imunološki sustav ne prepoznaje vlastitu strukturu, odnosno tkivo štitnjače, te počinje stvarati protutijela dovodeći do povećane proizvodnje hormona štitnjače. Povišena razina hormona štitnjače dovodi do simptoma hipermetabolizma poput pojačanog znojenja, nemira, lupanja srca, tremora ruku, nervoze, razdražljivosti, ispadanja kose, pojačanog apetita uz gubitak tjelesne mase i mišićne snage. Stolice su učestale i rijetke konzistencije, koža je topla i vlažna, a kod žena u generativnoj dobi često dolazi do poremećaja menstrualnog ciklusa. Često je hipertireoza praćena i očnim simptomima, najčešće u formi retrakcije vjeđe, crvenila, pečenja, ali i izbočenja očnh jabučica. Česta je tahikardija, a fizikalnim pregledom se otkriva simetrično povećanje štitnjače uz ranije navedene simptome. Dijagnoza je očita u bolesnika s tzv. Gravesovim trijasom kojeg čine tireotoksikoza, oftalmopatija i pretibijalni edem, a sigurna uz laboratorijske nalaze sniženog (suprimiranog) TSH uz povišene vrijednosti hormona štitnjače te povišenu vrijednost akumulacije radioaktivnog joda u štitnjači. Nakon postavljanja dijagnoze uobičajeno slijedi medikamentna terapija antitireoidnim lijekovima koji koče stvaranje hormona štitnjače. U obzir dolaze i lijekovi perklorati koji blokiraju ulazak joda u štitnjaču, litij koji blokira izlazak hormona iz štitnjače te beta-blokatori za ublažavanje simptoma hipermetabolizma. Vrlo je popularno liječenje radioaktivnom jodom zbog jednostavnosti, neinvazivnosti i ekonomičnosti, dok se kirurška ablacija ostavlja kao zadnja opcija liječenja. Kod zadnje dvije metode liječenja (radiojodna terapija i kirurško liječenje) velika je vjerojatnost razvoja hipotireoze koja zahtijeva daljnje praćenje i primjenu hormonske nadomjesne terapije levotiroksinom.Graves' disease, known as Basedow's disease, is a thyroid disease characterized by secretion of excessive amount of thyroid hormones. It is the most common cause of hyperthyroidism and it can appear at any age, most often in the twenties and thirties. The disease more often affects women and people who have a positive human leukocyte antigen HLA-DR3 (HLA D3 antigen). It is an autoimmune disorder in which the immune system does not recognize its own structure and begins to create antibodies against thyroid tissue leading to an increased production of thyroid hormones. An elevated level of thyroid hormone leads to a state of hypermetabolism with symptoms such as thinning hair that falls out more, exophthalmos, increased sweating and appetite, loss of muscle and body mass, menstrual and digestive system disorders like diarrhoea. Patients are also restless, nervous, irritated and tired, and the skin is warm and moist. Tachycardia, palpitations and tremors are also possible. For the diagnosis, it is necessary to begin with the medical history and physical examination, which reveals a symmetrical enlargement of the thyroid along with certain previously mentioned symptoms. Otherwise, the diagnosis is obvious in patients with the so-called Graves' triad, consisting of thyrotoxicosis, ophthalmopathy and pretibial myxoedema, and definitive with laboratory findings of lowered (supressed) TSH with elevated values of thyroid hormone and elevated value of radioactive iodine accumulation. The diagnosis is followed by therapy that begins with medications, i.e. antithyroid drugs that block the production of thyroid hormones. Perchlorate drugs that block the entry of iodine into the thyroid gland, lithium that blocks the release of hormones from the thyroid gland, and beta-blockers to calm more severe forms of hyperthyroidism are also considered. Radioactive iodine treatment is very popular due to its simplicity, non-invasiveness and economy, while surgical ablation is left as the last treatment option. It is important to emphasize that with the last two treatment methods (radioiodine therapy and surgical treatment) there is a high probability of hypothyroidism, which requires further monitoring and the use of hormone replacement therapy