Graves' disease: symptoms, eye problems, tests and treatment
Graves' disease is the most common cause of an overactive thyroid. This guide explains symptoms, eye and skin changes, tests, treatment options and pregnancy points.
Scientist and Chief Medical OfficerDr. Ambed MishraEducational information only, not medical advice. Always ask a qualified doctor about your own health. In an emergency call 112 (India) or 911 (US). Read the full disclaimer.
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Graves' disease is an autoimmune condition that makes the thyroid gland overactive. It is the most common cause of hyperthyroidism, and a doctor can arrange tests and discuss options. This article explains what the NIDDK and NHS say. It is general education and not a diagnosis.
What is Graves' disease?
The NIDDK explains that Graves' disease is an autoimmune disorder in which the immune system attacks the thyroid, which then makes more thyroid hormone than the body needs. The NIDDK says it affects nearly 1 in 100 Americans and causes about 4 in 5 cases of hyperthyroidism in the United States. The NHS also says Graves' disease accounts for about 4 in 5 cases of overactive thyroid.
What causes it?
The NIDDK says the exact cause is unknown. It likely involves a mix of genes and an outside trigger such as a virus. The immune system makes an antibody called thyroid-stimulating immunoglobulin, which mimics the thyroid-stimulating hormone and drives the thyroid to overproduce hormone.
Who is more at risk?
The NIDDK lists being female or over age 30, a family history of Graves' or Hashimoto's disease, other autoimmune conditions such as vitiligo, autoimmune gastritis, type 1 diabetes or rheumatoid arthritis, and nicotine use.
Symptoms
Symptoms of hyperthyroidism, according to the NIDDK, include weight loss despite increased appetite, a rapid or irregular heartbeat, nervousness, irritability, trouble sleeping, fatigue, tremors, muscle weakness, heat intolerance, sweating, frequent bowel movements and a goitre.
Eye changes
The NIDDK says Graves' eye disease affects more than 1 in 3 people with Graves' disease. Symptoms include bulging, gritty or puffy eyes, light sensitivity, eye pressure or pain, and blurred or double vision. Most cases are mild. Smoking worsens eye disease.
Skin changes
Rarely, thick reddish skin develops, usually on the shins. The NIDDK says it is typically mild and painless.
How is it diagnosed?
The NIDDK says doctors use a medical history and physical exam, plus tests that can include blood tests for thyroid hormone levels and the thyroid-stimulating immunoglobulin antibody, a radioactive iodine uptake test, a thyroid scan and a Doppler ultrasound. The ultrasound is often used when radioiodine is not appropriate, such as during pregnancy or breastfeeding.
Treatment options
A doctor, often an endocrinologist, decides the treatment. The NIDDK describes:
- Beta-blockers to relieve symptoms quickly. They do not reduce hormone production.
- Antithyroid medicines, described by the NIDDK as the simplest treatment.
- Radioiodine therapy, a common and effective treatment that gradually destroys thyroid cells. It is not used during pregnancy or breastfeeding, and it usually leads to hypothyroidism, which is treated with daily thyroid hormone.
- Thyroid surgery, used less often, for large goitres or for pregnant women who cannot take antithyroid medicines.
- For eye disease: mild cases can be managed with eye drops, sunglasses and similar measures. Severe cases may need steroids, surgery or, rarely, radiation.
Complications if untreated
The NIDDK lists irregular heartbeat with risk of blood clots, stroke and heart failure, thinning bones and muscle problems, menstrual, fertility and pregnancy problems, and eye discomfort or vision changes.
Iodine in the diet
The NIDDK says people with Graves' disease may be sensitive to too much iodine. Seaweed such as kelp or dulse and iodine supplements may worsen hyperthyroidism, so discuss your diet and any supplements, cough syrups or multivitamins with your clinician. Do not stop or change prescribed treatment without talking to your doctor.
When to see a doctor
See a doctor if you notice symptoms of an overactive thyroid, or changes in your eyes such as bulging, double vision or pain. Tell your doctor if you are pregnant or planning pregnancy.
Seek emergency help for sudden vision loss, a very fast or irregular heartbeat, chest pain, confusion or a sudden severe worsening of symptoms. In an emergency, call your local emergency number (112 in India, 911 in the United States).
This article is for education only and does not replace advice from your own doctor.
Common questions
What causes Graves' disease?
The NIDDK says the exact cause is unknown. It likely involves genes plus an outside trigger, and the immune system makes an antibody that drives the thyroid to overproduce hormone.
What is Graves' eye disease?
The NIDDK says it affects more than 1 in 3 people with Graves' disease and can cause bulging, gritty or puffy eyes, light sensitivity, pain and double vision. Most cases are mild.
Does smoking affect Graves' disease?
The NIDDK lists nicotine use as a risk factor and says smoking worsens eye disease.
Is Graves' disease treatable?
The NIDDK describes medicines, radioiodine therapy and surgery. A doctor chooses the approach based on the person.
Important: please read
- Educational information only. This article is general health education. It is not medical advice, diagnosis or treatment. Reading it does not create a doctor–patient relationship with MyDoctor or with anyone else.
- Ask a qualified doctor. Always talk to a qualified, registered doctor about your own health. In India, that means a doctor registered with the National Medical Commission (NMC) or a State Medical Council. In the United States, a licensed physician. Elsewhere, a doctor licensed where you live.
- Never ignore or delay professional advice because of something you read here. Do not start, stop or change any medicine or treatment without your doctor.
- Emergencies: call 112 in India, 911 in the United States, or your local emergency number. Do not wait for an online answer.
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- About the sources. This article summarises, in our own words, information from the public health bodies named under Sources. Health knowledge changes, and this summary may not reflect the latest research or your personal situation.
- Liability. To the extent permitted by law, MyDoctor (MODERNUS HEALTH TECHNOLOGIES PRIVATE LIMITED) accepts no liability for any decision made on the basis of this content.
Sources
- NIDDK (NIH). Graves' Disease www.niddk.nih.gov
- NIDDK (NIH). Hyperthyroidism (Overactive Thyroid) www.niddk.nih.gov
- NHS. Overactive thyroid (hyperthyroidism) www.nhs.uk
Dr. Ambed Mishra, PharmD, PhD
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Dr. Ambed Mishra is a clinical (patient care) scientist, author and former professor. He is Group CEO and Chief Medical Officer of MODERN US HEALTH (MODERN US GROUP), Austin, Texas, the group behind MyDoctor, and a senior consultant who teaches and trains MD/DO physicians, PharmD and PhD professionals, nurses and other healthcare professionals in patient care in the United States and India.
More about Dr. Ambed Mishra
- More than ten years of full-time leadership in United States healthcare, building patient care services that improve medication adherence and bring doctors, pharmacists and nurses together around each patient.
- Leads the MD and engineering teams behind MyDoctor: clinic and hospital management software, electronic health records and telehealth for hospitals and physician groups in the United States and India.
- Former Assistant Professor and Clinical Preceptor at Rajiv Gandhi University of Health Sciences, Bangalore, and senior researcher with hospitals, universities and patient care groups in India and the United States.
- More than 30 published research and review articles and case reports, and more than 15 international conference presentations in India, Australia, Canada, the United States, Spain and other countries.
- Chief Medical Officer and Global Program Head of a nonprofit mission that helps cover hospital and doctor visit bills for patients in need in India, Nepal, the United States and other countries.
The author's office answers questions about articles, research, speaking and collaboration. It cannot give personal medical advice.