Your Guide to Thyroid Disease

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Frequently Asked Questions About Graves' Disease

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Graves’ disease is the most common cause of hyperthyroidism in the United States, but most people don’t know much about this autoimmune disease. It’s named after Robert Graves, the Irish doctor who first described it. Graves’ disease is characterized by overactivity of the thyroid, a small gland located at the base of the neck. The thyroid produces hormones that affect every system of the body, so when the thyroid goes into overdrive, the entire body is affected.

Here are some common questions and answers about Graves’ disease.

What causes Graves’ disease?

Graves’ disease is an autoimmune disorder, which means that it’s caused by a misdirected attack of the immune system. Normally, the immune system produces antibodies that attack invading germs. In people with Graves’ disease, the immune system makes antibodies that attach to thyroid cells and cause them to produce excessive amounts of thyroid hormones.

No one knows exactly what causes the immune system to go after the thyroid. Because Graves’ disease can run in families, researchers suspect that inherited genetic changes may be related to the development of Graves’ disease. Infections may also trigger autoimmune diseases, and researchers have found a link between Graves’ disease and infection with the Epstein-Barr virus.

What are the symptoms of Graves’ disease?

Graves’ disease symptoms include:

  • Bulging eyes
  • Rapid or irregular heartbeat
  • Irritability
  • Hand tremors
  • Diarrhea
  • Heat intolerance
  • Insomnia
  • Unexpected weight loss
  • Thickening and reddening of the skin, especially on the lower legs and feet
  • Muscle weakness

The symptoms of Grave’s disease can come on suddenly or develop gradually. Symptoms can also change with time. Some people with Graves’ disease experience no noticeable symptoms.

How is Graves’ disease diagnosed?

Healthcare providers use physical exams and medical tests to diagnose Graves’ disease. If you have any of the symptoms of Graves’ disease, your healthcare provider will probably want to do a blood test to check the levels of thyroid hormone in your body. People with Graves’ disease typically have elevated levels of T4 and low levels of TSH. Blood tests can also reveal antibodies associated with Graves’ disease. A physician may also order a radioactive iodine uptake test, thyroid scan, or ultrasound. (The thyroid gland needs iodine to make thyroid hormone.) The results of these tests will help your healthcare provider make a diagnosis and establish a plan of care.

What health problems does Graves’ disease cause?

Without treatment, Graves’ disease can cause heart problems, osteoporosis, proptosis (bulging eyes) and visual problems, including double vision, light sensitivity, eye pain and, rarely, blindness. Graves’ disease can also cause fertility challenges; approximately half of women with Graves’ disease have trouble getting pregnant. Graves’ disease may cause problems during pregnancy too, including preeclampsia, placental abruption, miscarriage, birth defects, and preterm birth. Some evidence suggests that people who have Grave’s disease are also at increased risk of developing thyroid cancer. The good news is that treatment can prevent most of these health problems.

What is Graves’ disease treatment?

There are three main treatments for Graves’ disease:

  • Medication: There are two FDA-approved medications for Graves’ disease: methimazole (MMI) and propylthiouracil (PTU). These medicines keep the thyroid from making too much thyroid hormone. Healthcare providers also use a class of drugs called beta-blockers to ease patients’ symptoms. Beta blockers can provide some relief while other treatments reach full effectiveness.
  • Radioactive iodine: Usually administered via a small pill that’s taken by mouth, radioactive iodine delivers radiation directly to the thyroid gland. The radiation gradually destroys the thyroid , so it can no longer overproduce thyroid hormone. After radioactive iodine treatment, most people will need to take thyroid hormone pills daily to maintain healthy body function.
  • Surgery: Physicians can surgically remove the thyroid. After thyroid removal, you will have to take synthetic thyroid hormone (sometimes called “thyroid pills”) for the rest of your life.

Your healthcare provider will help you determine which treatment is best for you.

What is the prognosis for Graves’ disease?

With appropriate treatment, people with Graves’ disease can live long, healthy lives.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 12
Graves’ Disease. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease

Graves’ Disease. Office on Women’s Health. https://www.womenshealth.gov/a-z-topics/graves-disease

Pazaitou-Panayiotou K, Michalakis K, Paschke R. Thyroid Cancer in Patients with Hyperthyroidism. Horm Metab Res. 44(04), 255-262. doi:10.1055/s-0031-1299741. https://www.ncbi.nlm.nih.gov/pubmed/22334393

Graves’ Disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/graves-disease/diagnosis-treatment/drc-20356245

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