Graves' disease: Symptoms, Causes, Diagnosis & Treatment

 

Your thyroid gland is impacted by Graves' disease, an autoimmune disease. Hyperthyroidism is a disorder in which the gland overproduces thyroid hormone. Your heart and bones suffer when your thyroid is overactive. Treatments can be helpful.

Graves' disease is a disorder of the immune system that affects the thyroid gland. The body produces an excessive amount of thyroid hormone as a result. We refer to that condition as hyperthyroidism.

Thyroid hormones impact numerous body organs. Thus, those organs may also be impacted by the symptoms of Graves' disease. Graves' disease can strike anyone. However, women and those over 30 are more likely to experience it.

The symptoms of Graves' disease are lessened, and the body produces less thyroid hormone when the condition is treated.

Also Read: Goiter: Symptoms, Causes, Diagnosis, Risk factors & Treatment

What is Graves' Disease?

Your thyroid produces too much thyroid hormone if you have Graves' disease, a chronic autoimmune condition that lasts a lifetime. Your body produces antibodies against your thyroid gland, which is why it occurs.

It's one of the most common causes of hyperthyroidism, or an overactive thyroid, particularly if thyroid issues run in your family. Your thyroid is the primary organ affected by Graves' disease. However, it can also impact your skin and eyes.

Graves' disease causes your metabolism to speed up. Several aspects of your health may be impacted by this. It's possible that you don't feel like yourself or that your body is out of control. If you experience any symptoms of this condition, you must get treatment.

Symptoms:

The following are typical signs of Graves' disease:

• Feeling agitated and anxious

• Having a mild hand or finger tremor

• Being heat-sensitive, as evidenced by increased perspiration or warm, moistened skin

• Losing weight even though you want to eat more

• Possessing a goiter, or an enlarged thyroid gland

• Experiencing variations in menstrual cycles

• Having less desire for sex or experiencing erectile dysfunction, which is the inability to obtain or maintain an erection.

• Often bowel movements

• Having bulging eyes, also known as Graves' ophthalmopathy or thyroid eye disease.

• Being tired

• Having Graves' dermopathy, which is characterized by thick, discolored skin that is primarily found on the shins or tops of the feet.

• Experiencing palpitations, which are rapid or irregular heartbeats

• Not getting enough sleep.

Disease of the thyroid eye

Another name for thyroid eye disease is Graves' ophthalmopathy. Eye symptoms are present in about 25% of Graves' disease patients. The muscles and other tissues surrounding the eyes are impacted by thyroid eye disease. Symptoms could consist of:

• Eyes that bulge

• The eyes have a grainy texture

• Discomfort or pressure in the eyes

• Eyelids that are puffy or partially obscure the eyeball. We refer to this as retracting eyelids.

• Furious or red eyes

• Sensitivity to light

• Double or blurred vision

• Vision loss.

Dermophathy graves

Rarely, skin thickening and darkening are symptoms of Graves' disease. It usually shows up on the tops of the feet or the shins. The skin feels like the peel of an orange.

We refer to this as Graves' dermopathy. It is caused by an accumulation of protein in the skin. Most of the time, it is painless and mild.

Causes:

The body's immune system, which fights disease, malfunctions in Graves' disease. Why this occurs is unknown to experts.

Antibodies produced by the immune system target bacteria, viruses, and other foreign substances. The immune system produces an antibody against a specific subset of cells in the thyroid gland, which produces hormones in the neck, in Graves' disease.

The pituitary gland, a small gland at the base of the brain, produces the hormone that regulates the thyroid gland. The thyrotropin receptor antibody (TRAb) is the antibody associated with Graves' disease. The pituitary hormone is replaced by TRAb. As a result, the body produces more thyroid hormone than it requires. Hyperthyroidism is the term for that condition.

Thyroid eye disease causes
Graves' ophthalmopathy, another name for thyroid eye disease, is caused by an accumulation of specific carbohydrates in the muscles and tissues behind the eyes. There is no known cause. It might be related to the same antibody that can lead to thyroid dysfunction.

Thyroid eye disease frequently manifests months later or concurrently with hyperthyroidism. However, signs of thyroid eye disease may manifest years before or after the onset of hyperthyroidism. Additionally, thyroid eye disease can occur without hyperthyroidism.

Risk factors:

Graves' disease risk factors include the following:

• Family history. Individuals with Graves' disease frequently have a family history of autoimmune diseases or thyroid disorders.

• Intercourse. Graves' disease is far more common in women than in men.

• Age. Most cases of Graves' disease occur in people between the ages of thirty and sixty.

• Another autoimmune disease. Individuals who suffer from other immune system disorders, like rheumatoid arthritis or type 1 diabetes, are at an increased risk.

• Smoking. Smoking increases the risk of Graves' disease because it can impact the immune system. Smokers with Graves' disease are more likely to develop thyroid eye disease.

Complications:

Graves' disease complications can include:

• Health issues during pregnancy. Pregnancy-related Graves' disease can result in early birth, miscarriage, thyroid problems, and stunted fetal growth. Additionally, it may result in preeclampsia and heart failure in the expectant mother. High blood pressure and other severe symptoms are caused by preeclampsia.

• Heart conditions. If Graves' disease is left untreated, it can cause abnormal heart rhythms and alter the way the heart functions. The body may not receive enough blood from the heart. We refer to that condition as heart failure.

• Thyroid storm. This uncommon but fatal Graves' disease complication is also known as accelerated hyperthyroidism or thyrotoxic crisis. It is more likely to occur if severe hyperthyroidism is not adequately treated. A sudden and severe increase in thyroid hormones can result in a thyroid storm, which has several negative effects on the body. Fever, perspiration, disorientation, delirium, extreme weakness, tremors, irregular heartbeat, extreme hypotension, and coma are some of these symptoms. Thyroid storm requires immediate medical attention.

• Brittle bones. Untreated hyperthyroidism can cause osteoporosis, which is characterized by weak, brittle bones. The amount of calcium and other minerals that the bones contain determines how strong they are. The body finds it difficult to get calcium into the bones when thyroid hormone levels are too high.

Diagnosis:

Your healthcare provider may perform a physical examination and inquire about your medical and family history to diagnose Graves' disease. Tests could consist of:

• Blood tests. Thyroid-stimulating hormone (TSH) and thyroid hormone levels are measured by blood tests. The pituitary hormone that stimulates the thyroid gland is called TSH. TSH levels are typically lower, and thyroid hormone levels are higher in people with Graves' disease. The levels of the antibody known to cause Graves' disease are measured by another laboratory test. If antibodies are not found in the results, hyperthyroidism may have another cause.

• Uptake of radioactive iodine. Iodine is necessary for the body to produce thyroid hormones. For this test, a tiny quantity of radioactive iodine must be taken. The amount of iodine that enters the thyroid gland is later shown by a specialized scanning camera. The thyroid gland's rate of iodine absorption can be determined by this test. The thyroid gland's absorption of radioactive iodine can be used to determine whether hyperthyroidism is due to Graves' disease or another illness. To display an image of the uptake pattern, this test can be combined with a radioactive iodine scan.

What is the treatment for Graves' disease?

Graves' disease is a chronic illness that lasts a lifetime. However, there are ways to control your thyroid hormone levels. Even a temporary remission of the disease may result from medical treatment.

Graves' disease can be treated with the following:

• Beta-blockers: For Graves' disease, beta-blockers such as propranolol and atenolol are frequently the initial course of treatment. Until additional treatments for hyperthyroidism take effect, these medications regulate your heart rate.

• Antithyroid medications: Antithyroid medications, such as propylthiouracil and methimazole, prevent the thyroid from producing thyroid hormones.

•  Thyroid gland cells are gradually destroyed by radioiodine therapy.  Your hormone levels return to normal as your thyroid gland shrinks.  However, hypothyroidism is likely to develop in the future.

•  Surgery: During a thyroidectomy, your thyroid gland may be surgically removed entirely or in part.

• Thyroidectomy and radioiodine therapy typically result in hypothyroidism, or an underactive thyroid. You will require lifelong thyroid replacement hormone medication if you develop this condition. However, compared to hyperthyroidism, hypothyroidism is simpler to treat. It results in fewer chronic health issues.

Every treatment option for Graves' disease has benefits as well as risks. Furthermore, the medical community cannot agree on the best course of action. Making the best decision for you requires a thorough discussion of all the options with your provider.

Antigen-specific immunotherapy is presently being investigated by researchers as a potential treatment for Graves' disease. Ask your doctor about the possibility of participating in a clinical trial.

References:

• Loscalzo J, et al., eds. Hyperthyroidism and other causes of thyrotoxicosis. In: Harrison's Principles of Internal Medicine. 21st ed. McGraw Hill; 2022. https://accessmedicine.mhmedical.com. Accessed Feb. 7, 2024.

• American Thyroid Association. Graves’ Disease (https://www.thyroid.org/graves-disease/). Accessed 5/14/2025.

• Ross DS. Graves' hyperthyroidism in nonpregnant adults: Overview of treatment. https://www.uptodate.com/contents/search. Accessed Feb. 7, 2024.

• Lanzolla G, Marinò M, Menconi F. Graves disease: latest understanding of pathogenesis and treatment options (https://pubmed.ncbi.nlm.nih.gov/39039206/). Nat Rev Endocrinol. 2024;20(11):647-660. Accessed 5/14/2025.

• Ferri FF. Graves disease. In: Ferri's Clinical Advisor 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed Feb. 8, 2024.

• Graves' disease. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease. Accessed Feb. 7, 2024.