How Graves' Disease Is Diagnosed

Graves' disease is an autoimmune disorder that can cause hyperthyroidism (an overactive thyroid). The thyroid is a butterfly-shaped organ that produces too many hormones, which can cause many uncomfortable symptoms like night sweats, eye pressure, and unintentional weight loss. Graves' disease is the most common cause of hyperthyroidism in the United States.

Therapies include anti-thyroid medications, radioactive iodine therapy, and, on rare occasions, surgery.

This article will explain how Graves' disease is diagnosed, including self-checks, physical exams, and lab and blood tests. Your healthcare provider may also recommend imaging tests or a biopsy to rule out other conditions.

Self Checks/at-Home Testing

Keeping a journal of symptoms, what you eat, how you're feeling, and your sleep habits can help you assess your health. Other checks you can do at home include:

• Measuring blood pressure: Most pharmacies carry a digital blood pressure monitor that makes it easy to monitor hypertension (high blood pressure), a symptom of Graves' disease.
• Measure your pulse: Most smartwatches have the option to measure your pulse, or you can check your pulse manually. Pulses that are constantly on the upper limit of normal or resting (above 100 pulses per minute) might indicate Graves' disease.
• Weighing yourself weekly: Weigh yourself at the same time, under the same conditions (e.g., before you have breakfast). Losing weight without trying is one symptom that you should be aware of.
  

Physical Exam

Your healthcare provider will perform a physical exam to help confirm or rule out Graves' disease. These may be some of the things they are looking out for:

• Bulging eyes: Graves' disease is commonly characterized by swelling around the eyes that make them look like they are bulging out of the eye socket. People may also have dry eyes, puffy eyelids, eyelid retraction, inflammation, redness, pain, and general eye irritation. This is the most common symptom.
• Goiter: This is an abnormal enlargement of the thyroid gland sometimes caused by Graves' disease or iodine deficiency.
• Heat intolerance: Clammy skin caused by heat sensitivity is a common symptom of Graves' disease.
• Fast and irregular heartbeat (arrhythmia)
• High blood pressure
• Skin rashes
• Unintentional weight loss
• Anxiety
• Insomnia

Although many of these symptoms are also signs of hyperthyroidism, having or exhibiting signs of hyperthyroidism does not automatically confirm that you have Graves' disease. 

Lab and Tests for Graves' Disease

Your medical provider may recommend blood tests to measure an antibody called thyroid-stimulating immunoglobulin (TSI). In those with Grave's disease, TSI attaches to thyroid cells, causing your thyroid to make too many hormones.

Blood tests are also used to check amounts of thyroid-stimulating hormones (TSH). A low TSH level alerts you that the thyroid gland is producing too much hormone, which causes the pituitary gland (which plays a role in hormone production) to make less TSH.

Your healthcare providers may recommend a thyroid ultrasound to rule out thyroid cancer (an unlikely occurrence).

Imaging

Another test you might have is the radioactive iodine uptake (RAIU) test, which measures how much iodine the thyroid takes in. High levels of iodine absorption can be a sign of Graves' disease.

During the test, you will be asked to swallow a small amount of radioactive iodine. This is safe; this treatment targets thyroid cells only. A device measures the amount of iodine the thyroid gland absorbs and a scan will show how much iodine you have in your blood.

Differential Tests

Tests may be done to rule out other conditions. These are called differential tests. The differential tests will check for causes of thyrotoxicosis (overproduction of thyroid hormone), which can sometimes occur in the thyroid nodules. Other things your healthcare provider is looking for are thyrotoxicosis factitia (a hyperthyroid state due to the accidental or intentional ingestion of the hormone thyroxine) and thyroiditis (inflammation of the thyroid gland).

Pheochromocytoma, a neuroendocrine tumor that grows from cells in the kidneys, can mimic symptoms of thyrotoxicosis and must be ruled out. However, the occurrence of this tumor is extremely rare.

Summary

Graves' disease is an autoimmune disorder that can cause hyperthyroidism. This condition can cause a combination of uncomfortable symptoms, including bulging eyes, goiter, high blood pressure, and more.

Diagnosing Graves' disease may involve a physical exam and blood work to measure thyroid hormone production and check iodine levels. In some cases, albeit rare, your healthcare provider may recommend a biopsy to fully diagnose your condition.

Since some symptoms of Graves' disease are shared with many other conditions, your healthcare provider will need to rule out other possibilities.

A Word From Verywell

It's scary to experience new symptoms and not know what is causing them. If you are experiencing the symptoms of Graves' disease and think it may be the culprit, discuss your thoughts with your healthcare provider. Getting the appropriate tests and ruling out other conditions may give you peace of mind and get you on the path to healing. If you have Graves' disease, there are many treatments available to help you be comfortable and feel better.