Graves' disease is an immune system condition that affects the thyroid gland. It causes the body to make too much thyroid hormone. That condition is called hyperthyroidism.
Thyroid hormones affect many organs in the body. So Graves' disease symptoms also can affect those organs. Anyone can get Graves' disease. But it's more common in women and in people older than 30.
Treatment for Graves' disease helps lower the amount of thyroid hormone that the body makes and eases symptoms.
Common symptoms of Graves' disease include:
Thyroid eye disease also is called Graves' ophthalmopathy. About 25% of people with Graves' disease have eye symptoms. Thyroid eye disease affects muscles and other tissues around the eyes. Symptoms may include:
Rarely, people with Graves' disease have darkening and thickening of the skin. It most often appears on the shins or the tops of the feet. The skin has a texture like an orange peel.
This is called Graves' dermopathy. It comes from a buildup of protein in the skin. It's most often mild and painless.
Other medical conditions can cause symptoms like those of Graves' disease. See your healthcare professional if you have any symptoms of Graves' disease to get a prompt diagnosis.
Seek medical care right away if you have heart-related symptoms, such as a fast or irregular heartbeat, or if you have vision loss.
Graves' disease is caused by the body's disease-fighting immune system not working correctly. Experts don't know why this happens.
The immune system makes antibodies that target viruses, bacteria or other foreign substances. In Graves' disease, the immune system makes an antibody to one part of the cells in the hormone-making gland in the neck, called the thyroid gland.
A tiny gland at the base of the brain, called the pituitary gland, makes a hormone that controls the thyroid gland. The antibody linked with Graves' disease is called thyrotropin receptor antibody (TRAb). TRAb takes over the work of the pituitary hormone. That leads to more thyroid hormone in the body than the body needs. That condition is called hyperthyroidism.
Thyroid eye disease, also called Graves' ophthalmopathy, comes from a buildup of certain carbohydrates in the muscles and tissues behind the eyes. The cause isn't known. It may involve the same antibody that can cause the thyroid gland to not work correctly.
Thyroid eye disease often appears at the same time as hyperthyroidism or several months later. But symptoms of thyroid eye disease can appear years before or after hyperthyroidism starts. It's also possible to have thyroid eye disease without hyperthyroidism.
Factors that can increase the risk of Graves' disease include:
Complications of Graves' disease can include:
Thyroid storm. This rare but deadly complication of Graves' disease also is called accelerated hyperthyroidism or thyrotoxic crisis. It's more likely to happen when severe hyperthyroidism is not treated or not treated well enough.
Thyroid storm happens when a sudden and drastic rise in thyroid hormones causes a number of effects in the body. They include fever, sweating, confusion, delirium, severe weakness, tremors, irregular heartbeat, severe low blood pressure and coma. Thyroid storm needs medical attention right away.
To diagnose Graves' disease, your healthcare professional may do a physical exam and ask about your medical and family history. Tests might include:
Blood tests. Blood tests show the levels of thyroid-stimulating hormone (TSH) and thyroid hormones in the body. TSH is the pituitary hormone that spurs the thyroid gland. People with Graves' disease most often have lower than usual levels of TSH and higher levels of thyroid hormones.
Another lab test measures the levels of the antibody known to cause Graves' disease. If the results don't show antibodies, there might be another cause of hyperthyroidism.
Radioactive iodine uptake. The body needs iodine to make thyroid hormones. This test involves taking a small amount of radioactive iodine. Later, a special scanning camera shows how much of the iodine gets into the thyroid gland. This test can show how fast the thyroid gland takes up iodine.
The amount of radioactive iodine the thyroid gland takes up helps show whether Graves' disease or another condition is the cause of the hyperthyroidism. This test may be used with a radioactive iodine scan to show a picture of the uptake pattern.
Treatment for Graves' disease aims to stop the thyroid from making hormones. Treatment also blocks the effect of the hormones on the body.
With this therapy, you take radioactive iodine, called radioiodine, by mouth. The radioiodine goes into the thyroid cells. Over time, it destroys the cells that make thyroid hormone. This causes your thyroid gland to shrink. Symptoms ease little by little, most often over several weeks to several months.
Radioiodine therapy may raise the risk of thyroid eye disease or make its symptoms worse. This side effect most often is mild and doesn't last. But the therapy might not be for you if you have moderate to severe eye symptoms.
Other side effects may include a tender neck and a brief rise in thyroid hormones. Radioiodine therapy isn't used for treating pregnant people or those who are breastfeeding.
This treatment destroys cells that make thyroid hormone. After the treatment, you'll likely need to take daily hormone medicine to get the thyroid hormones your body needs.
Anti-thyroid medicines block the thyroid from using iodine to make hormones. These prescription medicines include propylthiouracil and methimazole.
Because the risk of liver failure is more common with propylthiouracil, methimazole is most often the first choice. But methimazole has a slight risk of birth defects. So propylthiouracil might be prescribed during the first trimester of pregnancy. Pregnant people typically take methimazole after the first trimester.
When either of these medicines are used without other treatments, hyperthyroidism may come back. These medicines may work better when they are taken for longer than a year. Anti-thyroid medicines may be used before or after radioiodine therapy as an added treatment.
Side effects of both medicines include rash, joint pain, liver failure or a decrease in disease-fighting white blood cells.
These medicines don't stop the body from making thyroid hormones. But they block the effect of hormones on the body. They may work quickly to ease irregular heartbeats, tremors, anxiety, irritability, heat intolerance, sweating, diarrhea and muscle weakness.
Beta blockers include:
Beta blockers aren't often given to people with asthma because they can cause an asthma attack. These medicines also might make it harder to manage diabetes.
Surgery to remove the thyroid, called thyroidectomy, can treat Graves' disease. You need to take thyroid medicine for the rest of your life after this surgery.
Risks of this surgery include damage to the nerve that controls the vocal cords and damage to the tiny glands that sit next to the thyroid gland, called the parathyroid glands. The parathyroid glands make a hormone that controls the level of calcium in the blood. Complications are rare with surgeons who have done a lot of thyroid surgeries.
For mild symptoms of thyroid eye disease, using artificial tears during the day may be helpful. You can buy artificial tears without a prescription. Use lubricating gels at night.
For symptoms of thyroid eye disease that are worse, treatment might include:
Orbital decompression surgery. In this surgery, a surgeon removes the bone between the eye socket, called the orbit, and the air spaces next to the orbit, called the sinuses. This gives the eyes room to move back to their usual place.
This treatment is mainly used if pressure on the optic nerve might cause loss of vision. Possible complications include double vision.
Thyroid eye disease doesn't always get better with treatment of Graves' disease. Symptoms of thyroid eye disease may even get worse for 3 to 6 months. After that, the symptoms of thyroid eye disease most often stay the same for a year or so. Then the symptoms begin to get better, often on their own.
If you have Graves' disease, it's important to take care of your mental and physical health. This includes:
Eating well and exercising. These can help ease some symptoms during treatment and help you feel better overall. Your thyroid controls how you burn calories. So you may gain weight when the hyperthyroidism is corrected.
Brittle bones also can happen with Graves' disease. Weight-bearing exercises can help keep bones strong.
Work with your healthcare team to design a plan that makes eating well, exercising and relaxing part of each day.
For thyroid eye disease, also called Graves' ophthalmopathy, these steps may help:
If Graves' disease affects your skin, use creams or ointments that have hydrocortisone. You can buy these without a prescription. The hydrocortisone can ease swelling. Using compression wraps on your legs also may help.
You likely will start by seeing your primary healthcare professional. You may then be sent to a specialist in hormones and the endocrine system, called an endocrinologist. If you have thyroid eye disease, you also might be sent to an eye specialist, called an ophthalmologist.
Here's some information to help you get ready for your appointment.
Make a list of:
For Graves' disease, questions might include:
Your healthcare team is likely to ask you questions, such as:
