8 Symptoms of Graves' Disease and How It's Treated

What is Graves’ disease?

Graves’ disease, is an autoimmune condition where the body produces antibodies that bind to receptors for thyroid hormones in different tissues and organs, leading to an overproduction of thyroid hormones. The thyroid, a small butterfly-shaped gland in your neck, regulates energy usage and the function of every organ, including your heart's rhythm. Graves' disease can also lead to thyroid enlargement, a swelling in the front lower part of the neck, just below the voice box.

Graves' disease can lead to hyperthyroidism, an overactive thyroid. Doctors diagnose Graves’ disease by checking thyroid levels or conducting a thyroid uptake and scan to evaluate thyroid function. People with Graves' disease-related hyperthyroidism typically have low thyroid-stimulating hormones.

Who can have Graves’ disease?

Graves’ disease is the most common cause of an overactive thyroid. Graves’ is more common in women. While Graves’ disease causes hyperthyroidism, it can also affect the eyes by causing thyroid eye disease, an autoimmune disease in which the eye muscles and fatty tissue behind the eye become inflamed, or a rarer condition called pretibial myxedema, which consists of swelling or scaling of the skin over the lower legs and top of the foot.

Not all people with Graves’ disease have hyperthyroidism at diagnosis. Some people with Graves’ disease can have normal thyroid function as defined by having a normal TSH blood level.

What are the risk factors?

Genetics

Stress: An initial episode of hyperthyroidism may be triggered by significant psychological stress or an infection.

Smoking: Smokers are two times more likely to get Graves’ hyperthyroidism. Smoking increases the risk of developing thyroid eye disease in patients with Graves’.

Medications: Amiodarone, which is used for heart arrhythmias, can worsen Graves’ disease.

What are the symptoms of an overactive thyroid?

Common hyperthyroid symptoms include:

Palpitations or rapid heartbeat
Hand tremors
Increased anxiousness
Excessive sweating
Diarrhea
Unintentional weight loss
Increased appetite
Hair loss

Most patients who show symptoms from hyperthyroidism have more than one of the above signs or symptoms. The exception to this may be older people, who may have apathetic hyperthyroidism, where they may have only a few symptoms like weight loss and palpitations.

Patients with Graves’ disease may have no symptoms of hyperthyroidism. Thyroid eye disease can present with bulging of the eyes, double vision, eyelid swelling, pain behind the eyes, blurred vision and redness. Most patients will have more than one symptom of eye disease.

How is hyperthyroidism diagnosed?

A doctor will evaluate patients who have one or more symptoms of hyperthyroidism. The first test usually performed is a TSH level to see if the patient has hyperthyroidism. If hyperthyroidism is confirmed, additional testing with either antibody levels or a nuclear medicine scan is performed to determine if the cause is Graves’ disease or another cause of hyperthyroidism. A doctor should also evaluate patients with signs or symptoms of Graves’ eye disease.

Are there treatment options?

Although Graves’ disease has no cure, there are three treatment options for overactive thyroid due to Graves' disease. The most common and first-line treatment is a medication called methimazole, also known as an anti-thyroid drug. Methimazole is taken once or twice daily. It works by blocking your thyroid’s ability to make thyroid hormones and normalizing thyroid blood tests. With continued use of methimazole, the levels of Graves’ antibodies can decrease over time and will sometimes become undetectable. This can lead to remission in some patients, at which point the methimazole can be stopped and the patient monitored without medication.

Another anti-thyroid drug is propylthiouracil. This medication is generally only used in hyperthyroid patients in special situations like the first trimester of pregnancy or hospitalized patients with the most severe form of hyperthyroidism, referred to as “thyroid storm.” Also, it may be used in select situations where a patient has an intolerance to methimazole.

Other treatment options are thyroidectomy, the surgical removal of the thyroid or radioactive iodine ablation. Radioactive iodine ablation consists of swallowing a small iodine pill with radiation attached. The thyroid then takes up the radioactive iodine, and the thyroid is treated. Patients who undergo thyroidectomy will be on lifelong thyroid hormone supplementation afterward. Most patients who get radioactive iodine will also be on lifelong thyroid hormone supplementation, and a smaller proportion may return to normal thyroid function.

Graves' disease itself is rarely fatal; however, untreated or poorly controlled cases can lead to complications that negatively affect overall health and life expectancy. These complications may include issues such as heart failure or stroke.