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

Graves’ disease is an autoimmune disorder that causes hyperthyroidism, or the overproduction of thyroid hormones, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (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

According to the Mayo Clinic, it can also cause: (2)

• Anxiety
• Increase in sweating or warm, moist skin
• Changes in menstrual periods
• Erectile dysfunction or reduced libido

According to MedlinePlus, it can also cause: (3)

• 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, according to the Mayo Clinic: (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.

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Graves’ Disease and Pregnancy

Pregnancy Pregnancy or recently giving birth may increase your risk of Graves’ disease, particularly if you are genetically more susceptible to the condition.

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 NIDDK. (1) A blood test can confirm that you have hyperthyroidism and, in some cases, identify Graves’ disease as the cause.

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, according to MedlinePlus. (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.

The three treatment options for Graves’ disease are medicine, radioiodine therapy, and thyroid surgery, according to the NIDDK. (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. However, during the first three months of pregnancy, propylthiouracil is more commonly prescribed, because in rare cases, methimazole may harm the fetus (propylthiouracil may also affect the fetus in rare cases).

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.

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Healthy Living With Graves’ Disease

Alternative and Complementary Therapies

Certain lifestyle changes can also help improve Graves’ disease symptoms and boost general health, such as eating well and exercising, according to the Mayo Clinic. (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.

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Graves’ Disease Across the Life Span

Graves’ disease is the most common cause of hyperthyroidism in the United States, affecting about 1 out of every 200 people, according to the NIDDK. (1) 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.

People with other autoimmune disorders are more likely to develop Graves’ disease, according to the NIDDK. Conditions linked to Graves’ disease include (1)

• 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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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.

The 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.