From Mary Shomon,
Your Guide to Thyroid Disease.
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by Elaine Moore

1. Graves' disease is an autoimmune disorder. In GD, the immune system produces thyroid autoantibodies that react with a protein known as the TSH receptor. TSH receptor protein is found on thyroid cells, eye muscle cells and also the dermal cells of skin tissue.
2. Antibodies known as stimulating TSH receptor antibodies or thyroid stimulating immunoglobulins (TSI) are responsible for GD, thyroid eye disease (Graves' ophthalmopathy) and also the skin condition known as pretibial myxedema. In GD, TSI react with the TSH receptor on thyroid cells, acting in place of the pituitary hormone TSH. This causes thyroid cells to produce and release excess thyroid hormone, causing a condition of hyperthyroidism. The TSI test is used to diagnose GD. According to Dr. Joseph Fisher, in a recent Medscape article, the RAI-U test is no longer necessary or desirable for diagnosis.
3. GD is unique to everyone. Patients may have only one major symptom or they may have several different symptoms. Predominant symptoms can change over time, and their severity can vary, increasing during times of stress. GD may spontaneously resolve, follow a lengthy course with variable periods of waxing and waning, or it may progress rapidly.
4. Graves' disease is caused by a combination of genetic and environmental factors. Patients with GD have a certain combination of genes that make them susceptible to disease development when they're exposed to certain environmental triggers.
5. According to the College of American Pathologists, stress is the major trigger for GD. Other triggers include excess iodine, estrogens, and certain chemicals, such as aspartame. Dietary iodine in excess of 150 mcg daily can trigger GD in susceptible people. The average American diet provides 300-700 mcg of iodine daily, and fast food diets provide more than 1,000 mcg of iodine daily.
6. People with autoimmune thyroid disease (AITD) may have either hypothyroidism or hyperthyroidism depending on the specific thyroid antibodies that are predominant at the time. People with AITD generally have several different thyroid antibodies. When TSI predominate, patients become hyperthyroid. When blocking TSH receptor antibodies predominate, patients become hypothyroid. Most people with GD have an initial period of hypothyroidism, which may be subtle or overt. And 20% of GD patients move into hypothyroidism, even without treatment.
7. Treatment for GD is designed to reduce blood levels of thyroid hormone. Surgery and Radioiodine accomplish this by reducing thyroid tissue and causing hypothyroidism. Anti-thyroid drugs (ATDs) and alternative medicine work by blocking iodine absorption and reducing thyroid hormone production; in addition, they help the immune system heal and inhibit thyroid antibody production.
8. Remission is both possible and predictable. Remission occurs when the immune system stops producing TSI. Before patients are weaned off anti-thyroid drugs, they should have TSI levels near [2% activity. Factors known to cause a relapse after remission include high TSI titers, large goiter and cigarette smoking.
9. People using ATDs must be monitored with FT4 and FT3 levels. TSH can take many months to rise and can be misleading. While patients can achieve remission within several weeks, most people achieve remission within 12-18 months. For a small number of people remission remains elusive and patients remain on low doses of ATDs for many years, a common practice in Europe.
10. Diet and Lifestyle changes do make a difference. Studies show that reducing dietary iodine, adding goitrogens to block iodine absorption, incorporating stress reduction techniques, and avoiding chemical triggers all promote remission. Patients with GD must also avoid novocaine, antihistamines and ephedrine.

Elaine Moore is a medical technologist with more than 30 years experience working in clinical chemistry and the author of Graves' Disease, A Practical Guide, Autoimmune Diseases & Their Environmental Triggers, The Encyclopedia of Alzheimer's Disease and the upcoming Thyroid Eye Disease (SaraHealth Press, spring 2003). She works as a laboratory manager and is writing a book on HIV and STDs. Join Elaine at the Graves' Disease/Hyperthyroidism Forum where she answers questions in the "Ask Elaine Moore" section.

Find out more information on Graves' Disease, A Practical Guide and read an interview with Elaine Moore at http://thyroid.about.com/library/books/aafprgravesbook.htm