What Is Graves' Disease?

Graves' Disease Symptoms

Graves' disease is associated with many symptoms that are the same as symptoms of any type of hyperthyroidism. And there are also symptoms specific to Graves' disease.

The symptoms of hyperthyroidism (due to any cause) include:

• Weight loss
• Heart palpitations
• Fatigue
• Muscle weakness
• Agitation
• Irritability
• Insomnia
• Increased sweating/heat intolerance
• Shaking hands
• Diarrhea or frequent bowel movements
• Increased appetite (sometimes decreased appetite)
• Thinning hair
• Shortness of breath
• Fertility problems
• Menstrual-cycle changes
• Dizziness
• Hypertension (high blood pressure)

Additional symptoms commonly occur with Graves' disease but not other types of hyperthyroidism:

• Graves' ophthalmopathy: Also called Graves' orbitopathy, this often causes "bulging eyes." Graves' ophthalmopathy can cause pressure around the eyes, sensitive eyes, and decreased vision. This affects about one-third of people with Graves', and it results from swelling due to the autoimmune process behind the disease.
• Skin lesions: Thyroid dermopathy, also known as Graves' dermopathy, can produce thickening of the skin, swelling, and severe itching. In rare cases, thyroid dermopathy can progress to a condition called acropachy, which is characterized by deformities of the fingers and toes.

Complications

If your Graves' disease is not adequately treated, osteoporosis (thinning of the bones) and heart disease can develop over time.

Thyroid storm is a rare and dangerous complication characterized by a rapid heartbeat, high blood pressure, and high fever. This complication can be fatal, but immediate medical treatment can alleviate the condition. General anesthesia for surgery is a common trigger for a thyroid storm in people with hyperthyroidism.

Causes

An autoimmune process is when the immune system mistakenly targets a person's own body. With Graves' disease, the body produces antibodies (infection-fighting proteins) against the thyroid gland.

There are several different thyroid antibodies, each resulting in a different thyroid condition. TSH receptor antibody (TSHR-Ab) is the antibody associated with Graves' disease.

Thyroid-stimulating hormone (TSH) is released by the pituitary gland in the brain. It binds to TSH receptors on the thyroid gland to trigger the production of thyroid hormones. TSHR-Ab acts like TSH, signaling the thyroid gland to keep putting out TSH—even when it's not needed.

Risk Factors

There are several risk factors associated with Graves' disease:

• It is more common in people under age 40.
• Women are more likely to develop Grave's disease than men.
• There is an increased risk during pregnancy.
• A family history of Graves' disease is a risk factor.
• If you have another autoimmune condition, such as lupus, you have a higher chance of developing Grave's disease.
• Smoking is a strong risk factor for this condition.

There has been some suggestion that stress could play a role, but the evidence is not consistent and a causative relationship remains uncertain.

Diagnosis

A physical examination and thyroid function blood tests can establish whether you have hyperthyroidism. This may narrow the cause down to Graves' disease.

Sometimes an imaging study or a biopsy may also be needed to distinguish Grave's disease from other types of hyperthyroidism.

Physical Examination

Graves' disease can cause an enlarged thyroid gland, rapid heart rate, agitation, tremor, fast reflexes, and possibly moist, smooth skin. These are all signs of hyperthyroidism, but they do not confirm that you have Graves' disease.

A goiter suggests that you may have Graves' disease, but does not rule out another thyroid condition. Ophthalmopathy or dermopathy are more common with Graves' disease than with other causes of hyperthyroidism.

Blood Tests

The most common thyroid tests include TSH, free thyroxine (free T4), and triiodothyronine (T3). A low TSH with a high free T4 and/or high T3 is typical of hyperthyroidism. Your healthcare provider may also request that you have thyroid antibody tests.

Imaging Tests

Graves' disease can produce a change in the appearance of the thyroid gland that may be distinguished from a normal thyroid gland or from other thyroid conditions. This is usually visualized with a thyroid ultrasound.

Treatment

Thyroid Management

Treatments that can help reduce your thyroid gland's overactivity include:

• Anti-thyroid medication: Several anti-thyroid medications are available. They work by preventing the thyroid gland from using iodine to produce thyroid hormones. The most common antithyroid medications include Tapazole (methimazole), carbimazole (which converts to methimazole), and Propylthiouracil (PTU). Methimazole, which is also called thiamazole, is also available in generic form.
• Radioactive iodine: Destruction of all or part of your thyroid gland using radioactive iodine (RAI) can reduce thyroid hormone production. Sometimes, the destruction of the thyroid gland results in hypothyroidism (underactive thyroid).
• Surgery: Removal of all or part of the thyroid gland may be necessary if you cannot be treated with medication or RAI. However, this is not the typical treatment approach for Graves' disease. Removal of the thyroid gland results in hypothyroidism.

Symptomatic Treatment

You might also need treatment to manage the effects of hyperthyroidism.

Medications such as beta-blockers reduce heart rate and lower blood pressure. Other methods for managing hypertension include exercise, decreasing salt in your diet, weight loss, and relaxation techniques.

Treatment usually is not needed for mild thyroid eye disease, but for moderate to severe cases, intravenous steroids, a high dose of oral steroids, or Tepezza (teprotumumab) can relieve symptoms of double vision, swelling, and irritation.

If a thyroid eye disease is in the chronic stage, tissues can become fibrotic. This may be sight-threatening, and surgery may relieve symptoms.

Thyroid dermopathy is treated with topical (on the surface of the skin) steroids.

You may also need medication to manage diarrhea, as well as dietary adjustments or calorie supplements to prevent weight loss.

Lifestyle Coping Strategies

Weight Management

Hyperthyroidism may cause weight loss and an increased appetite. To avoid losing too much weight, you may need to increase your caloric intake. It is best to talk to your healthcare provider or a dietitian to help you come up with a dietary plan to maintain a healthy weight.

Be sure to maintain a balanced diet and to eat foods that are rich in vitamins, minerals, carbohydrates, and protein. Even though they are high in calories, avoid processed or deep-fried foods, because they contain unhealthy ingredients that can negatively affect your health.

Hyperthyroidism can reduce your cholesterol, so your dietician may give you permission to eat a higher proportion of fat-containing foods than what is normally recommended in a healthy diet.

Diet

Some foods are known to be goitrogens, which interfere with the body's ability to use iodine. This causes hypothyroidism. If you have Graves' disease, you need to maintain moderation when it comes to goitrogens. Consuming too much of these foods can reduce your thyroid hormone levels.

Stress

Hyperthyroidism can cause anxiety, irritability, and restlessness. If you experience these issues, be sure to talk with your healthcare provider. Often, antithyroid medications are enough to reduce these symptoms, but sometimes, other coping mechanisms, such as meditation, biofeedback, exercise, and counseling are needed.