An Overview of Graves' Disease

Graves' disease is one of the conditions that produce hyperthyroidism (overactive thyroid). It's caused by a malfunction of the thyroid gland that leads to the overproduction of thyroid hormones.

That malfunction is usually triggered by an autoimmune process, which is when your immune system mistakes a healthy part of your body for an infectious agent and attacks it.

Graves' disease is diagnosed based on symptoms, a physical examination, and blood tests. Imaging tests or a biopsy may be needed as well.

Several treatment approaches are common, including anti-thyroid medications, radioactive iodine therapy, and rarely, surgery. You may also have to manage symptoms of hyperthyroidism.

graves' disease symptoms edited
Illustration by Emily Roberts, Verywell

Symptoms

Graves' disease is associated with a number of symptoms. 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 a decrease, instead)
  • Thinning hair
  • Shortness of breath
  • Fertility problems
  • Menstrual-cycle changes
  • Dizziness
  • Hypertension (high blood pressure)

Graves' disease and other causes of hyperthyroidism are commonly associated with a goiter (enlargement of the thyroid gland).

However, 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 you have untreated Graves' disease, 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. Without immediate emergency medical treatment, this complication can be fatal. General anesthesia for surgery is a common trigger for thyroid storm in people with hyperthyroidism.

Causes

The autoimmune process behind Graves' disease is like any other in that the body mistakenly produces antibodies (infection-fighting proteins) against itself.

Several different thyroid antibodies exist, 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 production of thyroid hormone. TSHR-Ab acts like TSH, telling the thyroid gland to keep putting out TSH—even when it's not needed.

Risk Factors

Doctors don't understand why some people develop Graves' disease, but there are several risk factors.

Age is one: Graves' is more common in those under age 40. Women are also more likely to develop Grave's disease than men, and there is an increased risk of this condition during pregnancy.

If you have a family history of Graves' disease or if you have another autoimmune condition, such as lupus, you are at an increased risk of developing Grave's disease as well.

Smoking is a strong risk factor for developing 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

If you have symptoms of Graves' disease, your doctor will review your medical history for risk factors and then use a few methods to reach a diagnosis.

Typically, a physical examination and thyroid function blood tests can establish that you have hyperthyroidism, and they may also narrow the cause down to Graves' disease. Other times, an imaging study or a biopsy may also be needed to distinguish Grave's disease from other types of hyperthyroidism.

Physical Examination

Graves' disease shows up in a physical exam as 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.

If you have ophthalmopathy or dermopathy, your doctor may have a higher suspicion that you have Graves' disease, but these can occur with other types of hyperthyroidism as well. A goiter, similarly, suggests that you may have Graves' disease, but does not rule out another thyroid condition.

The combination of goiter, ophthalmopathy, and dermopathy (or acropathy) is more suggestive of Graves' disease.

Blood Tests

The most common thyroid tests include TSH, thyroxine (T4) and triiodothyronine (T3). A low TSH with a high T4 and/or high T3 is typical of hyperthyroidism. Your doctor 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. Imaging tests used in the evaluation of Graves' disease may include ultrasound, X-ray, a computerized tomography (CT) scan, and magnetic resonance imaging (MRI).

You might also receive radioactive iodine before an imaging test because iodine enters the thyroid and can help improve visualization of the gland.

Biopsy

If there is still uncertainty about your diagnosis, you may have a biopsy, which is when a sample of tissue is removed for examination under a microscope. A biopsy is especially useful if your doctor is concerned about thyroid cancer.

Treatment

You and your doctor have several different treatment methods to consider, either simultaneously or over time as your condition evolves.

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 decrease excessive 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.

Treating Symptoms

If you continue to have hypertension and a rapid heart rate even after taking adequate antithyroid medication, RAI, or surgery, you may need to use medications such as beta blockers, which 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 isn't needed for ophthalmopathy, but oral steroids or surgery can relieve swelling, if needed.

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

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

Coping

Graves' disease requires modification of some lifestyle issues to help you cope.

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 your doctor or a dietitian to help you come up with a dietary plan to maintain a healthy weight.

If you increase your food intake, be sure to maintain a balanced diet and to eat foods that are rich in vitamins, minerals, carbohydrates, and protein, rather than consuming processed or deep-fried foods. 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, as consuming too much of these foods can reduce your thyroid hormone levels, especially if your condition is adequately treated.

Stress

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

Graves' disease is the most common cause of hyperthyroidism. It causes a variety of symptoms and, without treatment, can produce notable complications. The condition can be managed, and special considerations should be kept in mind if you become pregnant or need to have any type of surgery.

After your treatment for Graves' disease, you may experience long-term hypothyroidism, which produces many symptoms that are distinct from those of hyperthyroidism. Lifelong treatment with thyroid replacement medications may, then, be necessary.

Was this page helpful?

Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. EndocrineWeb. Hyperthyroidism Symptoms. Updated May 7, 2019.

  2. Sugiura T, Yamanaka S, Takeuchi H, Morimoto N, Kamioka M, Matsumura Y. Autoimmunity and pulmonary hypertension in patients with Graves' disease. Heart Vessels. 2015;30(5):642–646. doi:10.1007/s00380-014-0518-3

  3. Bahn RS. Graves' ophthalmopathy. N Engl J Med. 2010;362(8):726–738. doi:10.1056/NEJMra0905750

  4. Kraus CN, Sodha P, Vaidyanathan P, Kirkorian AY. Thyroid dermopathy and acropachy in pediatric patients. Pediatr Dermatol. 2018 Nov;35(6):e371-e374. doi:10.1111/pde.13670

  5. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Hyperthyroidism (Overactive Thyroid). Updated August 2016.

  6. Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99:39-51. doi:10.1093/bmb/ldr030

  7. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Graves' Disease. Updated September 2017.

  8. Harvard Medical School, Harvard Health Publishing. Graves' Disease. Published July 2019.

  9. Sawicka-Gutaj N, Gutaj P, Sowiński J, et al. Influence of cigarette smoking on thyroid gland--an update. Endokrynol Pol. 2014;65(1):54–62. doi:10.5603/EP.2014.0008

  10. Falgarone G, Heshmati HM, Cohen R, Reach G. Mechanisms in endocrinology. Role of emotional stress in the pathophysiology of Graves' disease. Eur J Endocrinol. 2012;168(1):R13–R18. Published 2012 Dec 10. doi:10.1530/EJE-12-0539

  11. Abdel Razek AAK, Abd Allah SS, El-Said AAE. Role of Diffusion-Weighted Magnetic Resonance (MR) Imaging in Differentiation Between Graves' Disease and Painless Thyroiditis. Pol J Radiol. 2017 Sep 15;82:536-541. eCollection 2017. doi:10.12659/PJR.902416

  12. American Thyroid Association. Hyperthyroidism (Overactive).

  13. American Cancer Society. Test for Thyroid Cancer. Updated March 14, 2019.

  14. Oza R, Garcellano M. Nonpharmacologic management of hypertension: what works? Am Fam Physician. 2015;91(11):772–776.

  15. Reddy SV, Gupta SK, Jain M. Dermopathy of Graves' disease: Clinico-pathological correlation. Indian J Endocrinol Metab. 2012;16(3):460–462. doi:10.4103/2230-8210.95714

  16. Rizos CV, Elisaf MS, Liberopoulos EN. Effects of thyroid dysfunction on lipid profile. Open Cardiovasc Med J. 2011;5:76–84. doi:10.2174/1874192401105010076

  17. Bajaj JK, Salwan P, Salwan S. Various Possible Toxicants Involved in Thyroid Dysfunction: A Review. J Clin Diagn Res. 2016;10(1):FE01–FE3. doi:10.7860/JCDR/2016/15195.7092

Additional Reading