What Is Graves’ Disease? Symptoms, Causes, Diagnosis, and Treatment
Graves’ disease is an autoimmune disorder that causes hyperthyroidism, or the overproduction of thyroid hormones. (1) The condition occurs when your immune system makes an antibody called thyroid-stimulating immunoglobulin (TSI), which causes the thyroid to make more thyroid hormone than your body requires. Without treatment, Graves’ disease can cause serious problems with the heart, bones, muscles, menstrual cycle, and fertility, among other complications.
A variety of symptoms can signal Graves’ disease, including: (1)
As with most autoimmune diseases (in which the immune system attacks the body’s own cells), researchers aren’t sure exactly what causes Graves’ disease. (1) They suspect it is a combination of genes and some other trigger, such as a virus.
The following factors can increase your risk of developing Graves’ disease: (2)
Family History Graves’ disease is more common when other family members have the condition.
Sex Women are far more likely to develop Graves’ disease.
Younger Age Graves’ disease usually develops in people under the age of 40.
Other Autoimmune Disorders People with other autoimmune disorders, such as type 1 diabetes or rheumatoid arthritis, have a greater risk of developing Graves’ disease.
Emotional or Physical Stress If you are genetically more susceptible to developing Graves’ disease, stressful life events or illnesses may trigger the condition.
Pregnancy Graves’ disease is the most common cause of hyperthyroidism during pregnancy, affecting 0.2 percent of people who are pregnant, particularly during the first trimester; pregnancy can also worsen existing Graves’ disease. Be sure to discuss your symptoms with your doctor, as there is a different condition, called postpartum thyroiditis, that also causes thyroid issues.
Smoking Cigarette smoking can affect the immune system, and it increases the risk of Graves’ disease. People who smoke and have Graves’ disease also have a greater risk of developing Graves’ ophthalmopathy.
A diagnosis of Graves’ disease is generally made based on symptoms and a physical exam, according to the Endocrine Society. A blood test can confirm that you have hyperthyroidism and, in some cases, identify Graves’ disease as the cause; the presence of antibodies can help in the diagnosis of Graves’.
Your doctor may also order further blood or imaging tests such as a CT scan or MRI to confirm Graves’ disease. These tests may include: (1)
Graves’ disease frequently responds well to treatment. (3) However, thyroid surgery or radioactive iodine often lead to hypothyroidism, or an underactive thyroid. If Graves’ disease is not treated, it can lead to complications, some of which can be serious or life-threatening.
If you are treating Graves’ disease with antithyroid medicine, your thyroid hormone levels may take several weeks or months to move into the normal range. (1) The total average treatment time is about 12 to 18 months, but treatment can continue for many years.
About 20 to 30 percent of people with Graves’ disease who take antithyroid drugs for 12 to 18 months experience a prolonged remission of their disease. (4)
The three treatment options for Graves’ disease are medicine, radioiodine therapy, and thyroid surgery. (1) Your doctor will help you decide which treatment is best for you based on your age, whether you are pregnant, or whether you have other medical conditions.
Radioiodine therapy is the most common treatment for Graves’ disease in the United States, and it entails taking radioactive iodine-131 (I-131) orally as a capsule or liquid. I-131 slowly destroys the cells of the thyroid gland that produce thyroid hormone. In some cases, you may need more than one radioiodine treatment to bring your thyroid hormone levels into the normal range, but it’s not likely.
Most people who have radioactive iodine treatment later develop hypothyroidism, because the thyroid hormone–producing cells have been destroyed. However, hypothyroidism is easier to treat (it can be controlled with medication) and causes fewer long-term health problems than hyperthyroidism.
Medications to treat Graves’ disease include:
Beta Blockers Beta blockers don’t stop your thyroid from producing thyroid hormone, but they can quickly improve symptoms until other treatments begin working.
Antithyroid Medicines Antithyroid medicines cause your thyroid to make less thyroid hormone. They usually don’t cure Graves’ disease, but in some cases, the effects last for a long time, even after you are no longer taking the medication. Methimazole is the most commonly prescribed antithyroid medicine.
Antithyroid medicines can cause the following side effects:
Surgery to remove the thyroid gland is another treatment for Graves’ disease, but it is used less frequently than radioiodine therapy and medication. It may be used to treat people with large goiters, or pregnant women who are allergic to or have side effects from antithyroid medicines.
If you have thyroid surgery, you will develop hypothyroidism and need to take thyroid hormone medicine every day for the rest of your life.
Certain lifestyle changes can also help improve Graves’ disease symptoms and boost general health, such as eating well and exercising. (2) Weight gain may occur when hyperthyroidism is successfully treated, because the thyroid controls the metabolism, so eating healthfully and exercising are important. Graves’ disease can also cause brittle bones, and weight-bearing exercises can help maintain bone density.
Stress may trigger Graves’ disease or make it worse, so stress-relieving practices can help, such as listening to music, taking a warm bath, or walking.
Complications of Graves’ disease can include: (2)
Pregnancy Issues Possible complications include miscarriage, preterm birth, fetal thyroid dysfunction, poor fetal growth, maternal heart failure, and preeclampsia (high blood pressure during pregnancy).
Heart Disorders Without treatment, Graves’ disease can lead to heart rhythm disorders, changes in the structure and function of the heart muscles, and heart failure.
Thyroid Storm Thyroid storm, also known as accelerated hyperthyroidism or thyrotoxic crisis, is a rare but potentially fatal complication of Graves’ disease. In thyroid storm, a sudden, drastic increase in thyroid hormones can cause fever, sweating, vomiting, diarrhea, delirium, severe weakness, seizures, irregular heartbeat, yellow skin and eyes (jaundice), severe low blood pressure, and coma. It’s more likely to happen when severe hyperthyroidism isn’t treated at all or isn’t treated properly. Thyroid storm can also occur when people with hyperthyroidism have general anesthesia, so it’s important to take antithyroid medicines before thyroid surgery.
Brittle Bones Untreated hyperthyroidism also can cause osteoporosis, because too much thyroid hormone interferes with your body's ability to incorporate calcium into your bones.
According to the Cleveland Clinic, Graves’ disease is the most common cause of hyperthyroidism, accounting for 60 to 80 percent of cases. But it’s still a relatively rare condition, considering that just 1.2 percent of Americans have hyperthyroidism. Women are 7 to 8 times more likely to have Graves’ disease than men.
Graves’ disease usually affects people between ages 30 and 50, but it can develop at any age.
Studies have found that Graves’ disease is more common in certain BIPOC (Black, Indigenous, and People of Color) populations.
A study of active duty U.S. military personnel found that the incidence rate ratio of Graves’ disease was significantly higher among Black people and Asian/Pacific Islanders compared with white people. (5) This may be due to environmental exposures, genetics, or a combination of both, according to the study authors.
People with other autoimmune disorders are more likely to develop Graves’ disease, according to the NIDDK. Conditions linked to Graves’ disease include:
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