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Your Guide to Thyroid Disease

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Graves' Disease

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What is Graves’ disease?

Graves’ disease is an autoimmune disease that leads to hyperthyroidism, or overactive thyroid. An overactive thyroid means thyroid hormone levels are too high. In the United States, Graves’ disease is the most common cause of hyperthyroidism.

Located in the front of your neck, the thyroid gland controls your body’s metabolism. It makes hormones that are vital to every cell in your body. These hormones tell your organs and body systems (such as your digestive system) how fast or slow to work. When the thyroid makes too much of these hormones, your body goes into overdrive. The symptoms of hyperthyroidism reflect this frantic metabolic pace. Symptoms are also wide and varied because the thyroid controls everything. They range from feeling too hot all the time, to feeling nervous or having frequent bowel movements.

In autoimmune diseases, a faulty immune system makes harmful antibodies. Normally, it produces antibodies in response to a threat, such as a virus. The antibodies help fight off the invader. However, autoimmune antibodies fight the body’s own cells. In Graves’ disease, these antibodies attach to the thyroid gland and continuously tell it to make thyroid hormones. The result is hyperthyroidism.

Graves’ disease is a fairly common condition. It affects about 1 in 200 Americans. However, it is 7 to 8 times more common in women than men. It typically develops during the young adult or middle-aged adult years.

Fortunately, Graves’ disease is highly treatable. Medications, radioactive iodine, and surgery are the main treatments. Most people effectively manage their disease and avoid complications. Left untreated, Graves’ disease can cause heart problems, pregnancy complications, and osteoporosis. In rare cases, it can lead to a life-threatening complication called thyroid storm. Seek immediate medical care (call 911) for symptoms of thyroid storm including:

  • Fever
  • Delirium, severe weakness, or loss of consciousness
  • Profuse sweating
  • Seizures
  • Vomiting or diarrhea
  • Yellow eyes or skin

What are the symptoms of Graves’ disease?

Graves’ disease symptoms are the result of too much thyroid hormone. An overactive thyroid causes your body’s systems to work at too fast a pace. This high metabolic rate can affect any body system. As a result, there are a wide variety of possible symptoms. For some people, the symptoms appear suddenly. However, they can also develop gradually over a period of time.

Common symptoms of Graves’ disease

One of the most common symptoms of Graves’ disease is Graves’ ophthalmopathy. About 30% of people with Graves’ disease suffer with this eye condition. It is the result of inflammation and other immune system effects on the eyes. It causes bulging eyes, redness, retracted eyelids, a feeling of grittiness, pain or pressure, and vision problems.

Sometimes, the thyroid gland will enlarge and you will be able to feel it in the front of your neck. It may also be visibly larger—a condition commonly called a goiter. Goiter also can be caused by other thyroid conditions and iodine deficiency.

Other common symptoms of Graves’ disease:

  • Frequent bowel movements or diarrhea

  • Heat intolerance

  • Racing or irregular heartbeat

  • Nervousness, irritability, anxiety

  • Sleep problems

  • Tremors or weakness

  • Weight loss

Women may also have menstrual irregularities. Men can experience erectile dysfunction or changes in sexual drive.

Serious symptoms that might indicate a life-threatening condition

In rare cases, Graves’ disease can cause thyroid storm, a potentially life-threatening condition. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Fever, delirium, severe weakness, or loss of consciousness

  • Heart-related symptoms

  • Profuse sweating, vomiting, or diarrhea

  • Vision loss

  • Yellow eyes or skin (jaundice)

Many other conditions share some of the common symptoms of Graves’ disease. See your doctor for any new or unusual symptoms for a diagnosis. Seeking a timely diagnosis will help you get back on the road to health.

What causes Graves’ disease?

Graves’ disease is an autoimmune disorder. This means the body’s immune system turns against the body’s own cells. Normally, the immune system makes antibodies to fight infections and other threats. Something happens in autoimmune diseases that triggers production of harmful antibodies. In Graves’ disease, the immune system makes antibodies that bind to cells within the thyroid gland. This stimulates the gland to continuously produce thyroid hormones.

Experts do not know exactly what triggers this fault in the immune system. It is likely a combination of genetic and environmental factors. For example, a virus may trigger it in someone who is already predisposed to developing an autoimmune disorder.

What are the risk factors for Graves’ disease?

Graves’ disease is most common in women between the age of 20 and 60 years. It is also tends to run in families. Other factors that increase the risk of developing Graves’ disease include:

  • Having another autoimmune disorder

  • Being pregnant

  • Smoking

  • Enduring trauma or stress, either emotional or physical

Reducing your risk of Graves’ disease

Most of the risk factors for Graves’ disease are beyond your control. However, you may be able to lower your risk of developing Graves’ disease by stopping smoking or never starting. Smokers have a higher risk of developing Graves’ disease and Graves’ ophthalmopathy. If you have other risk factors for Graves’ disease, talk with your doctor about your health and how to protect it.

How is Graves’ disease treated?

Graves’ disease treatment is highly successful. The goal is to lower thyroid hormone levels. Normal thyroid hormone levels will relieve symptoms and prevent complications. There are three main treatment options for accomplishing this goal:

  • Antithyroid medicines interfere with the thyroid’s ability to make hormones. This will not cure Graves’ disease, but it will lower thyroid hormone levels. Medicines may be the best option for people with mild disease who are likely to go into remission.

  • Radioactive iodine is a treatment you take by mouth as a capsule or liquid. It slowly destroys the thyroid gland to cure Graves’ disease. You may need to take a beta-blocker (which blocks epinephrine) to control your symptoms while the radioactive iodine works. Most people who get radioactive iodine treatment end up with hypothyroidism, or low thyroid hormone levels. It requires lifelong thyroid hormone replacement.

  • Surgery removes the thyroid gland to cure Graves’ disease. Lifelong thyroid hormone replacement will be necessary after surgery. Doctors usually reserve this option for people who are not candidates for either antithyroid medicines or radioactive iodine.

What are the potential complications of Graves’ disease?

Graves' disease is controllable with proper treatment. However, the following complications can develop if you do not treat the disease:

  • Heart problems including heart arrhythmias and congestive heart failure

  • Orbital swelling leading to chronic eye discomfort, eye motility, and vision-threatening compression of the optic nerve

  • Osteoporosis

  • Pregnancy complications including miscarriage, preterm birth, and problems with baby’s thyroid or growth. There are also risks for the mother including preeclampsia and heart failure.

A pregnant woman with Graves’ disease who is on antithyroid medicine will have more frequent thyroid hormone monitoring throughout pregnancy. The goal is to keep thyroid hormone levels down with the lowest amount of medicine possible. This helps prevent hypothyroidism in the baby. Beta-blockers may be an option for significant symptoms while on the lower dose of antithyroid medicine.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Feb 10
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Graves’ Disease. American Thyroid Association. https://www.thyroid.org/Graves'-disease/
  2. Graves’ Disease. Endocrine Society. http://www.hormone.org/questions-and-answers/2012/Graves'-disease
  3. Graves’ Disease. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/Graves'-disease/symptoms-causes/syc-20356240
  4. Graves’ Disease. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/Graves'-disease
  5. Graves’ Disease. Office on Women’s Health. https://www.womenshealth.gov/a-z-topics/Graves'-disease