Graves’ disease is a thyroid disease that affects 1 in 100 Americans. It is an autoimmune disorder and is the underlying cause of hyperthyroidism (overactive thyroid gland) in 80% of cases. Please continue reading to learn more about this condition, including what causes it, how Graves’ disease affects you, its symptoms, and treatment for Graves’ disease.

What is the thyroid gland and thyroid stimulating hormone?

The thyroid gland is a small butterfly-shaped gland in the front of the neck. It secretes two thyroid hormones called T3 and T4 that control metabolism and many other body functions like digestion, heart function, muscle and bone function, and brain development. 

The signal that tells the thyroid gland to secrete hormones originates in the pituitary gland located at the base of the brain. The pituitary gland secretes a hormone known as thyroid stimulating hormone (TSH). The levels of TSH rise and fall in the body depending on how much thyroid hormone the body needs. 

TSH levels are high in people with hypothyroidism (underactive thyroid gland) because in this case the thyroid does not produce thyroid hormone in sufficient amounts. In contrast, TSH levels are low in hyperthyroidism (overactive thyroid gland) because there is too much thyroid hormone.

What is Graves’ disease?

Graves’ disease is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue in the thyroid gland, causing it to overproduce thyroid hormones. The exact cause of Graves’ hyperthyroidism is unclear but it appears to be a combination of genetics and environmental factors.

Who is at risk of Graves’ disease?

According to the National Institute of Digestive and Kidney Diseases and American Thyroid Association, anyone can develop Graves’ disease, but it is more common in women and people over the age of 30. Risk factors for Graves’ disease include a family history of Graves’ disease or Hashimoto’s thyroiditis (a type of thyroid gland inflammation). Also, people who have other autoimmune diseases such as autoimmune gastritis, vitiligo, type 1 diabetes, or rheumatoid arthritis are at higher risk of developing Graves’ disease. Use of nicotine products can also increase your risk of Graves.

What are the symptoms of Graves’ disease (too much thyroid hormone)?

Thyroid hormone affects many organ systems in the body. People with Graves’ disease develop hyperthyroidism (high thyroid hormone levels). Excess thyroid hormone can cause the following signs and symptoms:

• Rapid and irregular heartbeat
• Increased appetite 
• Unintended weight loss
• Irritability, nervousness, anxiety
• Trouble sleeping
• Muscle weakness
• Tremors or shaky hands
• Sweating and reduced ability to tolerate heat
• Frequent bowel movements
• Goiter (enlarged thyroid gland)

Thyroid eye disease

Approximately 30% of people with Graves’ disease develop thyroid eye disease called Graves’ ophthalmopathy (GO). Signs and symptoms of GO include bulging eyes, puffy eyes, gritty or irritated eyes, light sensitivity, pressure or pain in the eyes, blurred vision and double vision.

Skin problems

Rarely, people with a Graves’ disease diagnosis can develop skin problems called pretibial myxedema or Graves’ dermopathy. This is usually a mild disease consisting of red, thickened, and rough skin, usually on the shins and feet.

Is Graves’ disease serious?

Yes, Graves’ disease, is serious. Left untreated, it can lead to severe health complications such as blood clots, stroke, heart problems, congestive heart failure, osteoporosis (abnormal thinning of bones), problems with menstrual cycles, fertility, and pregnancy, as well as changes in vision and other eye problems.

How do doctors diagnose Graves’ disease?

Doctors diagnose Graves’ disease based on symptoms and physical exam as well as blood tests to measure thyroid hormone levels. A blood test for an antibody called thyroid stimulating immunoglobulin (TSI) is also done to diagnose Graves. Other tests for autoimmune disorders like Graves’ disease include radioactive iodine uptake test, thyroid scan, and Doppler to detect increased blood flow in the thyroid gland. 

What is the most common treatment for Graves disease?

Doctors treat Graves’ disease by treating symptoms of hyperthyroidism (overactive thyroid). This can be accomplished with:

Anti-thyroid medications and others

• Antithyroid drugs like methimazole and propylthiouracil cause the thyroid gland to make less thyroid hormone.
• Beta-blockers control symptoms like rapid heartbeat and nervousness.

Note: Taking iodine supplements can worsen Graves’ hyperthyroidism.

Radioiodine therapy

This method of treating Graves’ disease involves using a radioactive substance (iodine-131) to destroy thyroid cells and stop thyroid hormone production. Iodine-131 can be taken by mouth in the form of capsules or liquid. It does not affect other body tissues. 

Many people need to take other medications such as beta blockers to control Graves’ symptoms while on radioactive iodine therapy. Also, radioiodine therapy can worsen eye symptoms (Graves’ ophthalmopathy). 

Most people who receive radioactive iodine therapy eventually develop hypothyroidism (underactive thyroid), requiring lifelong thyroid replacement medicine. 

Note: Radioactive iodine therapy cannot be given to anyone who is pregnant or breastfeeding due to risk to the fetus or infant. 

Thyroid surgery

A surgeon can remove a part or all of the thyroid gland to treat hyperthyroidism caused by Graves’ disease. Thyroid surgery is usually done in people who have goiter (enlarged thyroid gland) or who are pregnant and cannot receive anti-thyroid medicine.

Doctors prescribe anti-thyroid medicine before thyroid surgery (this is done under general anesthesia). Without anti-thyroid medication, the surgery can precipitate a serious condition called thyroid storm or thyroid crisis.

If part of the thyroid gland is surgically removed, your doctor may prescribe thyroid replacement medicine for some time after your surgery. If your entire thyroid gland is removed, thyroid replacement medicine will be required lifelong to maintain thyroid function. 

Can you be cured of Graves?

Antithyroid medications can temporarily treat symptoms of Graves’ disease. However, they do not permanently cure Graves’ disease. It can take several weeks or even months for thyroid hormone levels to come back into the normal range. Most people need 1-2 years of treatment for Graves’ disease, some even longer.

References:

1. https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease
2. https://www.uptodate.com/contents/iodine-in-the-treatment-of-hyperthyroidism