What is graves' disease?

Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although several disorders may result in hyperthyroidism, Graves' disease is a common cause.

Thyroid hormones affect many-body systems, so signs and symptoms of Graves' disease can be wide-ranging. Although Graves' disease may affect anyone, it's more common among women and in people younger than age 40.

Common signs and symptoms of Graves' disease include:

• Anxiety and irritability
• A fine tremor of the hands or fingers
• Heat sensitivity and an increase in perspiration or warm, moist skin
• Weight loss, despite normal eating habits
• Enlargement of the thyroid gland (goiter)
• Change in menstrual cycles
• Erectile dysfunction or reduced libido
• Frequent bowel movements
• Bulging eyes (Graves' ophthalmopathy)
• Fatigue
• Thick, red skin usually on the shins or tops of the feet (Graves' dermopathy)
• Rapid or irregular heartbeat (palpitations)
• Sleep disturbance

Graves' ophthalmopathy

Graves' ophthalmopathyOpen pop-up dialog box

About 30% of people with Graves' disease show some signs and symptoms of Graves' ophthalmopathy. In Graves' ophthalmopathy, inflammation and other immune system events affect muscles and other tissues around your eyes. Signs and symptoms may include:

• Bulging eyes
• Gritty sensation in the eyes
• Pressure or pain in the eyes
• Puffy or retracted eyelids
• Reddened or inflamed eyes
• Light sensitivity
• Double vision
• Vision loss

Graves' dermopathy

Graves' dermopathyOpen pop-up dialog box

An uncommon manifestation of Graves' disease, called Graves' dermopathy, is the reddening and thickening of the skin, most often on your shins or the tops of your feet.

When to see a doctor

Several medical conditions can cause the signs and symptoms associated with Graves' disease. See your doctor if you experience any potential problems related to Graves' disease to get a prompt and accurate diagnosis.

Seek emergency care if you're experiencing heart-related signs and symptoms, such as a rapid or irregular heartbeat, or if you develop vision loss.

There are a variety of treatments available for Graves’ disease. The majority aim to inhibit the overproduction of thyroid hormones by targeting the thyroid gland; others aim to reduce the symptoms.

Anti-thyroid medication

The most commonly utilized treatment for Graves’ disease is anti-thyroid medication.

Three common drugs that target the thyroid are propylthiouracil, methimazole, and carbimazole (which is converted to methimazole and is not available in the United States but is used in Europe); methimazole is most common in the United States.

Anti-thyroid medication helps prevent the thyroid gland from producing excess amounts of hormones by blocking the oxidation of iodine in the thyroid gland.

Symptoms normally improve within 4-6 weeks of starting medication. Anti-thyroid drugs can often be used in conjunction with other treatments such as radioactive iodine therapy or surgery.

Medication may continue for 12-18 months to make sure that the condition does not come back. In some cases, it may be prescribed longer.

Radioactive iodine therapy

Radioactive iodine therapy has been used to treat Graves’ disease since the 1940s. It is still popular because it is non-invasive and highly effective.

Iodine is used by the thyroid gland to make thyroid hormones. Radioactive iodine is taken orally and directly targets the thyroid gland. When medication is taken, the radioactive iodine soon builds up in the thyroid gland and slowly destroys any overactive thyroid cells.

This results in a reduction in the size of the thyroid gland and fewer thyroid hormones being produced. Although there have been concerns that the radiation might increase the risk of thyroid cancer, so far, no study has measured an increased danger. However, there is a minimal risk of secondary cancers that may result from this treatment.

Beta-blockers

Beta-blockers are traditionally prescribed to deal with heart problems and hypertension. They work by blocking the effects of adrenaline and other similar compounds. They can help reduce symptoms of Grave’s disease.

Graves’ disease patients may be more sensitive to adrenaline; this can result in symptoms such as sweating, shaking, increased heart rate, and anxiety. Beta-blockers can help alleviate these symptoms but do not address Graves’ disease itself.

Beta-blockers are often used alongside other treatments, meaning there is a risk that side effects can occur due to the different drugs interacting with one another.

Surgery

Because other treatments for Graves’ have steadily improved, surgery is now less common. However, it is still used if other treatments are unsuccessful.

Thyroidectomy is removing all or part of the thyroid gland – how much depends on the severity of the symptoms.

The biggest advantage of surgery is that it is arguably the fastest, most consistent, and most permanent way to restore normal thyroid hormone levels.

After surgery, patients may experience neck pain and a hoarse or weak voice; however, these should be temporary due to the breathing tube inserted into the windpipe.

A scar will be present after surgery; its severity will depend on how much of the thyroid is removed.

If only part of the thyroid is removed, the remaining portion can take over its functions.

If the whole thyroid is removed, the body will not produce enough thyroid hormones, a condition known as hypothyroidism. To treat this, a doctor will prescribe hormone pills, which replace the effect of the hormone.