What is Graves’ disease?
In Graves’ disease, antibodies made by the immune system stimulate the thyroid to produce extra hormone. This can speed up functions throughout the body.
Hyperthyroidism means an overactive thyroid. Graves’ is one cause, but nodules and other conditions can also cause excess thyroid hormone. Identifying the cause matters because the treatments differ.
What symptoms can Graves’ disease cause?
Symptoms can develop gradually and vary from person to person. They may include:
- A fast or irregular heartbeat, shaking hands, or feeling unusually hot and sweaty.
- Weight loss despite a normal or increased appetite, frequent bowel movements, or muscle weakness.
- Feeling restless or anxious, difficulty sleeping, or tiredness.
- An enlarged thyroid, which may cause swelling at the front of the neck.
Symptoms alone cannot confirm Graves’ disease. Tell your clinician what has changed and when it began. Eye symptoms are discussed below.
How is Graves’ disease diagnosed?
A clinician combines your symptoms and examination with test results. TSH, free T4 and sometimes T3 show how the thyroid is functioning. An overactive thyroid usually causes low TSH with raised thyroid hormone levels.
TSH receptor antibody tests, reported as TRAb or TSI, help identify Graves’ as the cause. A thyroid uptake test and scan may help if the cause remains unclear. Ultrasound is useful in selected situations. Not everyone needs all of these tests.
What are the treatment choices?
The main options reduce thyroid hormone production or remove the source of excess hormone. Your clinician should explain the benefits, risks and follow-up for each suitable option.
The choice depends on the severity of the overactive thyroid, thyroid size, eye disease, other health conditions, pregnancy plans and your preferences. Ask what each option means for possible recurrence and long-term thyroid hormone replacement.
A beta blocker may help with a racing heart or shaking while other treatment takes effect. It controls symptoms rather than stopping thyroid hormone production.
Antithyroid medicines
Medicines such as methimazole reduce hormone production. Blood tests guide adjustments. Some people enter remission, meaning thyroid function stays normal without antithyroid medicine. Others need longer treatment or a different option. Medicine should only be stopped under medical supervision.
If you take an antithyroid medicine and develop a fever or severe sore throat, seek medical care immediately for a blood count. Do not take further doses until your clinician clears you to restart. Yellowing skin or eyes, or dark urine, also needs immediate medical advice.
Radioactive iodine
This treatment reduces the thyroid’s ability to make hormone. It commonly leads to an underactive thyroid requiring replacement hormone. It is not used during pregnancy or breastfeeding. Eye disease can affect whether it is suitable.
Thyroid surgery
Removing the thyroid is another option. After total thyroid removal, lifelong thyroid hormone replacement is needed. Discuss an experienced thyroid surgeon, recovery, and risks to the voice and calcium control.
Can Graves’ disease affect the eyes?
Some people develop thyroid eye disease, with gritty or painful eyes, swelling, bulging or double vision. It can occur even when thyroid hormone levels are in range, so controlling the thyroid may not resolve every eye problem.
Report new eye symptoms to your care team. Smoking and secondhand smoke increase the risk of eye disease and can make it worse. Radioactive iodine can also worsen eye disease in some people, so discuss eye symptoms before choosing treatment.
Get urgent medical attention if your vision decreases, colors look different, part of your field of vision is missing, or your eyelids cannot close fully.
What happens after treatment?
Follow-up blood tests check whether hormone levels are improving, remain too high, or have become too low. Graves’ hyperthyroidism can return after a period of remission. Ask which tests you need and when, even if you feel better.
If treatment causes an underactive thyroid, thyroid hormone replacement may be needed. Tell your care team before pregnancy, or promptly if you become pregnant, because Graves’ and its treatments require a pregnancy-specific plan.
Questions to ask your care team
- Which findings confirm that Graves’ is causing my overactive thyroid?
- Which treatments are suitable for me, and what are their trade-offs?
- Do my eyes need specialist assessment before treatment?
- Which side effects mean I should stop medicine and seek care?
- When will my blood tests be repeated, and who will explain the results?
- How would pregnancy plans affect treatment and follow-up?
Sources and medical review
Medically reviewed by Richard B. Guttler, MD, FACP, FACE, ECNU