What Is Graves’ Disease? Symptoms, Causes, Diagnosis, and Treatment

Graves’ disease is an autoimmune disorder that causes hyperthyroidism, or the overproduction of thyroid hormones. (1) The condition occurs when your immune system makes an antibody called thyroid-stimulating immunoglobulin (TSI), which causes the thyroid to make more thyroid hormone than your body requires. Without treatment, Graves’ disease can cause serious problems with the heart, bones, muscles, menstrual cycle, and fertility, among other complications.

A variety of symptoms can signal Graves’ disease, including: (1)

• Weight loss
• Nervousness or irritability
• Trembling hands
• Sensitivity to heat
• Enlargement of the thyroid gland (a goiter)
• Frequent bowel movements or diarrhea
• Rapid or irregular heartbeat
• Trouble sleeping
• Tiredness or muscle weakness
• Graves’ ophthalmopathy (GO, also known as thyroid eye disease), which can cause retracted eyelids, bulging eyes, double vision, and swelling around the eyes. About 30 percent of people with Graves’ disease develop mild GO, and about 5 percent develop severe GO. The condition usually lasts for 1 to 2 years and commonly gets better on its own
  
• In rare cases, a reddish thickening of the skin on the shins, known as pretibial myxedema or Graves’ dermopathy

It can also cause: (2,3)

• Anxiety
• Increase in sweating or warm, moist skin
• Changes in menstrual periods
• Erectile dysfunction or reduced libido
• Breast enlargement in men
• Difficulty concentrating
• Hair loss
• Shortness of breath during activity

As with most autoimmune diseases (in which the immune system attacks the body’s own cells), researchers aren’t sure exactly what causes Graves’ disease. (1) They suspect it is a combination of genes and some other trigger, such as a virus.

Risk Factors

The following factors can increase your risk of developing Graves’ disease: (2)

Family History Graves’ disease is more common when other family members have the condition.

Sex Women are far more likely to develop Graves’ disease.

Younger Age Graves’ disease usually develops in people under the age of 40.

Other Autoimmune Disorders People with other autoimmune disorders, such as type 1 diabetes or rheumatoid arthritis, have a greater risk of developing Graves’ disease.

Emotional or Physical Stress If you are genetically more susceptible to developing Graves’ disease, stressful life events or illnesses may trigger the condition.

Pregnancy Graves’ disease is the most common cause of hyperthyroidism during pregnancy, affecting 0.2 percent of people who are pregnant, particularly during the first trimester; pregnancy can also worsen existing Graves’ disease. Be sure to discuss your symptoms with your doctor, as there is a different condition, called postpartum thyroiditis, that also causes thyroid issues.

Smoking Cigarette smoking can affect the immune system, and it increases the risk of Graves’ disease. People who smoke and have Graves’ disease also have a greater risk of developing Graves’ ophthalmopathy.

A diagnosis of Graves’ disease is generally made based on symptoms and a physical exam, according to the Endocrine Society. A blood test can confirm that you have hyperthyroidism and, in some cases, identify Graves’ disease as the cause; the presence of antibodies can help in the diagnosis of Graves’.

Your doctor may also order further blood or imaging tests such as a CT scan or MRI to confirm Graves’ disease. These tests may include: (1)

• Radioactive iodine uptake test, which measures the amount of iodine the thyroid collects from the bloodstream. If the test shows that your thyroid collects large amounts of iodine, you may have Graves’ disease.
• Thyroid scan, which shows how and where iodine is distributed in the thyroid. If you have Graves’ disease, iodine will show up throughout the thyroid.
• Ultrasound, which can reveal whether the thyroid gland is enlarged. (2)

Prognosis of Graves’ Disease

Graves’ disease frequently responds well to treatment. (3) However, thyroid surgery or radioactive iodine often lead to hypothyroidism, or an underactive thyroid. If Graves’ disease is not treated, it can lead to complications, some of which can be serious or life-threatening.

If you are treating Graves’ disease with antithyroid medicine, your thyroid hormone levels may take several weeks or months to move into the normal range. (1) The total average treatment time is about 12 to 18 months, but treatment can continue for many years.

About 20 to 30 percent of people with Graves’ disease who take antithyroid drugs for 12 to 18 months experience a prolonged remission of their disease. (4)

The three treatment options for Graves’ disease are medicine, radioiodine therapy, and thyroid surgery. (1) Your doctor will help you decide which treatment is best for you based on your age, whether you are pregnant, or whether you have other medical conditions.

Radioiodine Therapy

Radioiodine therapy is the most common treatment for Graves’ disease in the United States, and it entails taking radioactive iodine-131 (I-131) orally as a capsule or liquid. I-131 slowly destroys the cells of the thyroid gland that produce thyroid hormone. In some cases, you may need more than one radioiodine treatment to bring your thyroid hormone levels into the normal range, but it’s not likely.

Most people who have radioactive iodine treatment later develop hypothyroidism, because the thyroid hormone–producing cells have been destroyed. However, hypothyroidism is easier to treat (it can be controlled with medication) and causes fewer long-term health problems than hyperthyroidism.

Medication Options

Medications to treat Graves’ disease include:

Beta Blockers Beta blockers don’t stop your thyroid from producing thyroid hormone, but they can quickly improve symptoms until other treatments begin working.

Antithyroid Medicines Antithyroid medicines cause your thyroid to make less thyroid hormone. They usually don’t cure Graves’ disease, but in some cases, the effects last for a long time, even after you are no longer taking the medication. Methimazole is the most commonly prescribed antithyroid medicine.

Antithyroid medicines can cause the following side effects:

• Allergic reactions, including rashes and itching
• A decrease in the number of white blood cells in your body, which can lower resistance to infection
• Rarely, liver failure

Thyroid Surgery

Surgery to remove the thyroid gland is another treatment for Graves’ disease, but it is used less frequently than radioiodine therapy and medication. It may be used to treat people with large goiters, or pregnant women who are allergic to or have side effects from antithyroid medicines.

If you have thyroid surgery, you will develop hypothyroidism and need to take thyroid hormone medicine every day for the rest of your life.

Alternative and Complementary Therapies

Certain lifestyle changes can also help improve Graves’ disease symptoms and boost general health, such as eating well and exercising. (2) Weight gain may occur when hyperthyroidism is successfully treated, because the thyroid controls the metabolism, so eating healthfully and exercising are important. Graves’ disease can also cause brittle bones, and weight-bearing exercises can help maintain bone density.

Stress may trigger Graves’ disease or make it worse, so stress-relieving practices can help, such as listening to music, taking a warm bath, or walking.

Complications of Graves’ disease can include: (2)

Pregnancy Issues Possible complications include miscarriage, preterm birth, fetal thyroid dysfunction, poor fetal growth, maternal heart failure, and preeclampsia (high blood pressure during pregnancy).

Heart Disorders Without treatment, Graves’ disease can lead to heart rhythm disorders, changes in the structure and function of the heart muscles, and heart failure.

Thyroid Storm Thyroid storm, also known as accelerated hyperthyroidism or thyrotoxic crisis, is a rare but potentially fatal complication of Graves’ disease. In thyroid storm, a sudden, drastic increase in thyroid hormones can cause fever, sweating, vomiting, diarrhea, delirium, severe weakness, seizures, irregular heartbeat, yellow skin and eyes (jaundice), severe low blood pressure, and coma. It’s more likely to happen when severe hyperthyroidism isn’t treated at all or isn’t treated properly. Thyroid storm can also occur when people with hyperthyroidism have general anesthesia, so it’s important to take antithyroid medicines before thyroid surgery.

Brittle Bones Untreated hyperthyroidism also can cause osteoporosis, because too much thyroid hormone interferes with your body's ability to incorporate calcium into your bones.

According to the Cleveland Clinic, Graves’ disease is the most common cause of hyperthyroidism, accounting for 60 to 80 percent of cases. But it’s still a relatively rare condition, considering that just 1.2 percent of Americans have hyperthyroidism. Women are 7 to 8 times more likely to have Graves’ disease than men.

Graves’ disease usually affects people between ages 30 and 50, but it can develop at any age.

Studies have found that Graves’ disease is more common in certain BIPOC (Black, Indigenous, and People of Color) populations.

A study of active duty U.S. military personnel found that the incidence rate ratio of Graves’ disease was significantly higher among Black people and Asian/Pacific Islanders compared with white people. (5) This may be due to environmental exposures, genetics, or a combination of both, according to the study authors.

People with other autoimmune disorders are more likely to develop Graves’ disease, according to the NIDDK. Conditions linked to Graves’ disease include:

• Rheumatoid arthritis, a chronic inflammatory disorder of the joints
• Type 1 diabetes, an autoimmune disorder in which your immune system attacks and destroys the beta cells in the pancreas that make insulin
• Lupus, an autoimmune disease that affects multiple organs throughout the body
• Celiac disease, an autoimmune condition that prevents nutrient absorption and the digestion of gluten
• Pernicious anemia, a condition caused by a vitamin B12 deficiency
• Addison’s disease, a hormonal disorder
• Vitiligo, a disorder in which some parts of the skin are not pigmented

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Endocrine Society

A global community of 18,000 endocrine scientists and clinical practitioners who collaborate to accelerate scientific breakthroughs to help us better understand and treat hormone disorders.

National Institute of Diabetes and Digestive and Kidney Diseases

The mission of the NIDDK is to conduct and support medical research and to disseminate science-based information to improve people’s health and quality of life. Its website offers information about symptoms, causes, diagnosis, treatment, and complications of Graves’ disease.

Mayo Clinic

The Mayo Clinic is a nonprofit organization that specializes in clinical practice, education, and research. Its website offers information about symptoms, causes, risk factors, complications, diagnosis, and treatment of Graves’ disease.

MedlinePlus

MedlinePlus is a service of the U.S. National Library of Medicine (NLM), the world’s largest medical library, which is part of the National Institutes of Health (NIH). It offers information about the causes, symptoms, diagnosis, treatment, and prognosis of Graves’ disease.