Graves Disease

Graves disease is an autoimmune disorder that leads to overactivity of the thyroid gland (hyperthyroidism).

An autoimmune disorder is a condition that occurs when the immune system mistakenly attacks healthy tissue.

Scientists cannot predict who will develop Graves’ disease. However, factors such as age, sex, heredity, and emotional and environmental stress are likely involved.

Graves’ disease usually occurs in people younger than age 40 and is seven to eight times more common in women than men. Women are most often affected between ages 30 and 60.  And a person’s chance of developing Graves’ disease increases if other family members have the disease.

Researchers have not been able to find a specific gene that causes the disease to be passed from parent to child.  While scientists know some people inherit an immune system that can make antibodies against healthy cells, predicting who will be affected is difficult.

People with other autoimmune diseases have an increased chance of developing Graves’ disease.  Conditions associated with Graves’ disease include type 1 diabetes, rheumatoid arthritis, and vitiligo—a disorder in which some parts of the skin are not pigmented.

The thyroid gland is an important organ of the endocrine system. The gland is located at the front of the neck above where the collarbones meet. This gland releases the hormones that control body metabolism. Controlling metabolism is important for regulating mood, weight, and mental and physical energy levels.

When the body makes too much thyroid hormone, the condition is called hyperthyroidism. 

Graves disease is the most common cause of hyperthyroidism. It is due to an abnormal immune system response that causes the thyroid gland to produce too much thyroid hormone. Graves disease is most common in women over age 20. But the disorder can occur at any age and can affect men as well.

Younger patients may have these symptoms:
  • Anxiety
  • Breast enlargement in men (possible)
  • Difficulty concentrating
  • Double vision
  • Eyeballs that bulge (exophthalmos)
  • Eye irritation and tearing
  • Fatigue
  • Frequent bowel movements
  • Goiter (possible)
  • Heat intolerance
  • Increased appetite
  • Increased sweating
  • Irregular menstrual periods in women
  • Muscle weakness of the hips and shoulders
  • Moodiness
  • Nervousness
  • Rapid or irregular heartbeat (palpitations or arrhythmia)
  • Restlessness and difficulty sleeping
  • Shortness of breath with activity
  • Tremor
  • Weight loss (weight gain in some cases)
Older patients may have these symptoms:
  • Rapid or irregular heartbeat
  • Chest pain
  • Memory loss
  • Weakness and fatigue

The health care provider will do a physical exam and may find that you have an increased heart rate. An exam of your neck may find that your thyroid gland is enlarged.

Other tests include:
  • Blood tests
  • Radioactive iodine uptake and scan
This disease may also affect the following test results:
  • Orbit CT scan or ultrasound
  • Thyroid stimulating immunoglobulin (TSI)
  • Thyroid peroxidase (TPO) antibody
  • Anti-TSH receptor antibody

Treatment is aimed at controlling your overactive thyroid. Medicines called beta-blockers are often used to treat symptoms of rapid heart rate, sweating, and anxiety until the hyperthyroidism is controlled.

Hyperthyroidism is treated with one or more of the following:
  • Antithyroid medications
  • Radioactive iodine
  • Surgery

If you have had radioactive iodine treatment or surgery, you will need to take replacement thyroid hormones for the rest of your life. This is because these treatments destroy or remove the gland.

Some of the eye problems related to Graves disease usually improve when hyperthyroidism is treated with medications, radiation, or surgery. Radioactive iodine can sometimes make eye problems worse. Eye problems are worse in people who smoke, even after the hyperthyroidism is treated.

Sometimes prednisone (a steroid medication that suppresses the immune system) is needed to reduce eye irritation and swelling.

You may need to tape your eyes closed at night to prevent drying. Sunglasses and eye drops may reduce eye irritation. In rare cases, surgery or radiation therapy (different from radioactive iodine) may be needed to prevent further damage to the eye and loss of vision.

Graves disease often responds well to treatment. Treatments such as radioactive iodine treatment or surgery destroy or remove the thyroid gland. If you have these treatments, you will have an underactive thyroid (hypothyroidism). You will need to take replacement thyroid hormones for the rest of your life.

If you do not get the correct dosage of thyroid hormone replacement, hypothyroidism can lead to:
  • Depression
  • Mental and physical sluggishness
  • Weight gain