Graves’ Disease

What is Graves’ disease?

Graves’ disease is an autoimmune disease in which your immune system attacks healthy tissue in your thyroid gland for unknown reasons. It’s the most common cause of hyperthyroidism, a condition in which your thyroid gland makes too much thyroid hormone.

Your thyroid is a small, butterfly-shaped endocrine gland located at the front of your neck under your skin. Your thyroid’s main job is to regulate the speed of your metabolism (metabolic rate), which is the process of how your body transforms the food you consume into energy, by releasing certain hormones.

The condition gets its name from Robert Graves, an Irish doctor who first described the condition in the 1800s.

Who does Graves’ disease affect?

Graves’ disease affects women more than men. It typically occurs in people between the ages of 30 and 50, but it can affect children and older adults.

Your risk of developing Graves’ disease increases if you have a family history of thyroid disease and/or you smoke cigarettes.

You’re also more likely to get Graves’ disease if you have another autoimmune disease, such as:

• Rheumatoid arthritis.
• Lupus.
• Type 1 diabetes.
• Celiac disease.
• Vitiligo.

How common is Graves’ disease?

Even though Graves’ disease is the most common cause of hyperthyroidism, accounting for 60% to 80% of hyperthyroidism cases, it’s a relatively rare condition. Approximately 1.2% of people in the United States have hyperthyroidism.

How does Graves’ disease affect my body?

Thyroid hormone affects several parts of your body and bodily functions. Because of this, Graves’ disease/hyperthyroidism (excess thyroid hormone) can affect many parts of your body, including your:

• Heart.
• Skeletal muscle (the muscles that help you move).
• Eyes.
• Skin.
• Bones.
• Liver.

For example, excess thyroid hormone can cause rapid heartbeat and lead to more serious heart conditions and cause osteoporosis (weakened bones).

Because Graves’ disease affects several aspects of your health, it’s important to seek medical treatment for it.

What are the symptoms of Graves’ disease?

The onset of symptoms of Graves’ disease is usually gradual, often taking several weeks or months to develop.

Graves’ disease causes hyperthyroidism, which speeds up certain body functions. There are many symptoms of hyperthyroidism. You may experience some of these symptoms and not others, or many of them at the same time.

Symptoms of hyperthyroidism can include:

• Rapid heartbeat (palpitations).
• Feeling shaky and/or nervous.
• Weight loss.
• Increased appetite.
• Diarrhea and/or more frequent bowel movements.
• Thin, warm and moist skin.
• Intolerance to heat and excessive sweating.
• Difficulty sleeping, such as insomnia.
• Enlarged thyroid gland (goiter).
• Hair loss and change in hair texture (brittle).
• Menstrual changes.
• Muscle weakness.

If you’re experiencing these symptoms, see your healthcare provider.

Graves’ disease can also cause eye disease symptoms, including:

• Gritty, irritated eyes.
• Swelling of the tissues around your eyes (puffy eyes).
• Bulging eyes.
• Light sensitivity.
• Pressure or pain in your eyes.
• Blurred or double vision.

This is called Graves’ ophthalmopathy or orbitopathy or thyroid eye disease. Only about a third of people with Graves’ disease develop this condition. If you’re experiencing these symptoms, it’s important to see your eye doctor (optometrist or ophthalmologist).

Rarely, people with Graves’ disease develop a lumpy, reddish thickening of the skin on their shins known as pretibial myxedema (called Graves’ dermopathy). It’s usually painless and mild, but it can be painful for some people.

What causes Graves’ disease?

Researchers don’t know what causes autoimmune diseases like Graves’ disease. Something triggers your immune system to overproduce an antibody called thyroid-stimulating immunoglobulin (TSI). TSI attaches to healthy thyroid cells, causing your thyroid to overproduce thyroid hormones.

The trigger of the attack may be a combination of having a genetic predisposition and environmental factors, such as:

• Stress.
• Virus/infection.
• Pregnancy.

How is Graves’ disease diagnosed?

Your healthcare provider will ask about your symptoms and medical history, including your family history of thyroid disease, and perform a physical exam. They may also order the following tests to confirm a Graves’ disease diagnosis:

• Thyroid blood tests: These blood tests check the level of thyroid hormone in your blood and amounts of thyroid-stimulating hormone (TSH). A low TSH level indicates that your thyroid gland is producing too much hormone. The overproduction causes your pituitary gland to make less TSH.
• Thyroid antibody blood tests: These tests help identify different types of autoimmune thyroid conditions. The two types of antibodies linked with Graves’ disease include TSI (thyroid-stimulating antibodies) and TBII (thyrotropin binding inhibitory immunoglobulins).
• Thyroid uptake and scan: In this test, you take a small amount of radioactive iodine orally. Your provider will check to see how much of the radioactive iodine your thyroid absorbs. High levels of iodine absorption can be a sign of Graves’ disease.
• Doppler blood flow measurement (Doppler ultrasound): This test uses sound waves to detect increased blood flow in your thyroid due to Graves’ disease. Your provider may order this test if radioactive iodine uptake is not a good option for you, such as during pregnancy or breastfeeding.

How is Graves’ disease treated?

Graves’ disease is a lifelong (chronic) condition. However, treatments can keep your thyroid hormone levels in check. Medical care may even make the disease temporarily go away (remission).

Treatments for Graves’ disease include:

• Beta-blockers: Beta-blockers, such as propranolol and metoprolol, are often the first line of treatment for Graves’ disease. These medications regulate your heart rate and protect your heart until other hyperthyroidism treatments take effect. These medications don’t stop thyroid hormone production.
• Antithyroid medications: Antithyroid medications, such as methimazole (Tapazole®) and propylthiouracil, block your thyroid’s production of thyroid hormone. In a small percentage of people, these medications cause skin rashes and low white blood cell count, which may increase your risk of infection. Rarely, liver disease develops.
• Radioiodine therapy: This therapy involves taking one dose of radioactive iodine in pill or liquid form. Over two to three months, radiation slowly destroys thyroid gland cells. (The rest of your body isn’t exposed to radiation.) As your thyroid gland shrinks, hormone levels return to normal. You shouldn’t get this treatment if you’re pregnant or breastfeeding. If you have this treatment, you’ll likely eventually develop hypothyroidism (underactive thyroid), which requires medication. But hypothyroidism is easier to treat than hyperthyroidism and it causes fewer long-term health problems.
• Surgery: A thyroidectomy involves surgically removing all or part of your thyroid gland. After surgery, some people produce too little thyroid hormone (hypothyroidism). If you develop this condition, you may need to take thyroid replacement hormone medications, such as levothyroxine (Synthroid®), for the rest of your life.

Antithyroid medication, radioiodine therapy and surgery all have benefits and risks, and there’s no consensus in the medical community on which treatment is the best option. It’s important to discuss all three options in detail with your provider to make the best choice for you.

Can Graves’ disease be prevented?

Experts still aren’t certain what causes autoimmune diseases like Graves’ disease. Currently, there’s no known way to prevent the condition.

What is the prognosis (outlook) for Graves’ disease?

If Graves’ disease is properly treated, the prognosis (outlook) is generally good.

Treatment for Graves’ disease is lifelong. People who receive definitive treatment for Graves’ disease (radioactive iodine or thyroidectomy) will eventually develop hypothyroidism (underactive thyroid), which requires lifelong medication. People who take antithyroid drugs to treat Graves’ disease usually have to take them throughout their life.

What are the possible complications of Graves’ disease?

Untreated or poorly managed Graves’ disease increases your risk for these complications:

• Heart problems: Untreated or undertreated Graves’ disease can cause arrhythmia (irregular heartbeat). Arrhythmia increases your risk of stroke, heart failure and other heart conditions.
• Osteoporosis: Untreated or undertreated Graves’ disease can lead to osteoporosis (abnormal thinning and weakness of your bones), which can make you susceptible to repeated bone fractures.
• Thyroid storm: Thyroid storm (also called thyroid crisis and thyrotoxic crisis) happens when your thyroid gland releases a large amount of thyroid hormone in a short amount of time. It’s a rare complication of hyperthyroidism and Graves’ disease and can happen if you suddenly stop taking your antithyroid medication or experience trauma or an infection. Thyroid storm is a medical emergency and is life-threatening. Symptoms include high fever and a rapid heart rate.

If you have thyroid eye disease (Graves’ ophthalmopathy) that isn’t properly treated, it can cause severe swelling that can damage your optic nerve and lead to vision loss.

Graves’ disease and pregnancy

Thyroid hormones play a key role in the development of a fetus's brain and nervous system. Untreated hyperthyroidism and Graves’ disease during pregnancy can be harmful to you and the fetus.

Your healthcare provider may test your hormone levels monthly to ensure they stay within a safe range. Too much thyroid hormone during pregnancy can increase the risk of:

• Low birth weight.
• Miscarriage.
• Preeclampsia.
• Premature labor.
• Infant hyperthyroidism.
• Congestive heart failure.

When should I see my healthcare provider about Graves’ disease?

Since Graves’ disease is a chronic condition, you’ll need to see your healthcare provider regularly throughout your life to make sure your thyroid levels are in check and your treatment plan is working. If you develop any new symptoms, talk to your provider.

If you’re experiencing symptoms of thyroid storm, a rare complication of Graves’ disease, call 911 or get to the nearest emergency room (ER) as soon as possible. Thyroid storm is life-threatening.
Symptoms include:

• Having a high fever — a temperature between 104 degrees to 106 degrees Fahrenheit is common.
• Having a rapid heart rate (tachycardia) that can exceed 140 beats per minute.
• Feeling agitated, irritable and/or anxious.
• Delirium.
• Congestive heart failure.
• Loss of consciousness.