What Do Missy Elliott and George Bush Have In Common?


You have probably heard of Missy Elliott and George HW Bush, both are American; while the former is a musician, the latter had been the President of USA. But did you know these two individuals have something more in common, apart from their nationalities? Read on to find out!

The answer to this question above is "Graves' Disease". Well, you never thought that such great personalities might have something so grave? Well, they do. And Graves' disease does not discriminate colour or race or rich and poor. Anyone can get affected by it. Wondering what this disease is all about? Imagine this scenario - What if someday, your long time best friend turns his back on you? Well, this is what happens in Graves’ disease, where the antibodies in your body (the good guy) turn into the bad guy at random age and attack your own immune system! *with a little less feeling of betrayal, of course!This is the so-called autoimmune disorder. The “soldiers” who are supposed to protect you from your “enemy” suddenly change their direction and thrust towards you with the command “ATTACKKKK!”.It is just a metaphor, but this is what happens in reality. The soldiers are the antibodies, and the enemy could be any harmful organism. Graves’ disease can happen at any age,but it is quite unusual before puberty, in fact, it is most common among women at the age between 30-50.


Point to remember about Graves' Disease:

  • Thyrotoxicosis

  • Eye problems

  • skin problems


So let’s begin!




Due to the attack of the “soldiers” on the body itself, a few pathways are activated and this stimulates the extra production of thyroid hormone, leading to the manifestation of symptoms of hyperthyroidism, with or without a swelling in the neck (goitre). From the name itself, you can see the word “toxic” in it, so obviously too much of thyroid hormone can cause you harm. This is a more serious form of hyperthyroidism as the level of thyroid hormone is much higher. To read further about high thyroid hormone, please refer to this post.


Eye problems

Lid retraction is a condition where the eyelids are slightly pulled back which exposes more of the white areas of the eyeballs. Next, lid lag is when a person looks down, the upper eyelids do not follow the speed of the eyeballs, instead, the movement is delayed. Apart from lid retraction and lid lag due to high thyroid hormone in the body, Graves’ disease has a particular condition known as Graves’ ophthalmopathy. The increase in fluid content around the eyeballs causes the rise of the pressure behind the eyeballs, which ultimately makes the eyes look protruding. In some people, the nerve could be compressed, thus he/she will complain of visual blurness. The picture below depicts the typical signs of  this condition perfectly.

graves disease

Image Source: Davidson’s Principles and Practice of Medicine

It is shown that there is swelling and obvious protrusion of both sides of the eyeballs. White area of eyeballs (sclera) is exposed more.

Studies suggest that this is more commonly seen in smokers and people who do not control their thyroid function properly. Besides, the eyes might even get teary easily when exposed to bright lights or wind. In other words, the eyes are more sensitive now. Also, with inflammation of the eyes, it comes with pain.


Skin problems (Graves’ dermopathy)


Pretibial myxoedema - This has the same mechanism with the eye problems but it manifests as raised pink-colored or purplish plaques on the anterior aspect of the legs. It might cause itchiness and the surface looks like the surface of your orange peel, which explains the fancy name of this description “peau d’orange”, literally means ‘orange skin’ in French. In a more severe case, this skin condition may extend to the arms, upper body, neck, and even face!



How is Graves' Disease diagnosed?

  • Physical examination

  • Blood test

  • Ultrasound

  • Radioactive iodine uptake

  • Imaging tests like CT scan, X-ray, MRI


Well, is Graves' Disease treatable?


Of course it is! Graves’ disease does not bring long-term harm to the body if the person receives prompt treatment . Here is how the disease can be managed.

Management of thyrotoxicosis

With palpitation, tremor, shortness of breath, diarrhea and so on as the clinical features of thyrotoxicosis, treating the symptoms is the first thing to do. After stabilizing the condition, the thyroid hormone secretion should be halted next! The root of the problem is the overproduction of thyroid hormone, thus anti-thyroid medication is the first choice of drug. Thyroid surgery is another option which will permanently stop the production but might need long term dependence of thyroid replacement drug.


What about the eyes?

No treatment is actually needed but eyedrops can be applied. Do wear your cooling glasses if you are out on a street in a sunny or windy day.  Since smoking is related to the development of ophthalmopathy, cessation of smoking is indeed helpful! Besides this, there are oral medications too, to improve the condition.


And… the orange skin?

Application of steroidal medication on the surface can help relieve the condition.


Finally, diet and exercise are two most important factors to improve your general well-being. Take care of yourself first, then only you are able to take care of others.


Think about getting your health checked to find out if you are healthy by choosing this.





Angie Loh

by Angie Loh

A medical student with nothing but passion and a pen. Poems and novels never fail to make me feel alive. I'm inspired to make the world a better place and fill it with a little bit more love. But first, where's my coffee? View all articles by Angie Loh.


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