Graves’ Disease | Graves' Disease and Thyroid Foundation

Graves’ Disease

Fast Facts: Graves' Disease

Graves' disease is named for Sir Robert Graves, an Irish physician who lived in the early 19th century.
The preferred usage is Graves' with an apostrophe - although medical geneticists refer to the condition as Graves disease without the apostrophe.
In Graves’ disease, antibodies are produced against certain proteins on the surface of cells. These targets may include the TSH receptors on the thyroid gland, the connective tissue cells surrounding the eyes, and the pretibial skin located on the front of the shin.
When the thyroid gland is stimulated to overproduce thyroid hormones, this results in hyperthyroidism.
Symptoms can develop gradually and may initially be mistaken for anxiety or stress. However, hyperthyroidism can become serious and must be treated to avoid complications such as bone/muscle wasting, heart problems, and thyroid storm – a very serious, life-threatening event.
Graves' disease is typically diagnosed via blood tests including thyroid function tests (TSH, Free T4, and T3) and antibody tests (TRAb or TSI). Your doctor might also order an ultrasound or a radioactive iodine uptake test (RAIU) and thyroid scan.
See below for more detailed information, including signs and symptoms, treatment options, eye involvement, and skin involvement.

Signs and Symptoms (every patient is unique, so you might not experience all of these):

Rapid heartbeat
Heart palpitations
Unexplained weight loss
Increased appetite
Restlessness
Decreased attention span
Shortness of breath
Muscle weakness

Insomnia
Heat intolerance
Increased perspiration
Frequent bowel movements
Lighter menstrual periods
Unexplained Fatigue
Unexplained anxiety
Unexplained mood changes

Treatment Options

While there are currently no cures for the autoimmune component of Graves’ disease, treatment focuses on correcting the hyperthyroid state and restoring thyroid levels to normal. Three different approaches are available. They include Anti-Thyroid Drugs (ATDs), Radioactive Iodine (RAI), and Surgery to remove the thyroid gland. A final decision should be made in conjunction with an endocrinologist or other qualified medical professionals. Although practices like good nutrition, stress reduction, adequate sleep, and exercise* are good for overall health, there are currently no "alternative" treatment options that have been proven to be effective in Graves' disease.

*Check with your doctor before starting a new exercise routine, particularly if you have uncontrolled hyperthyroidism.

Anti-thyroid drugs (ATDs)

Radioactive iodine (RAI)

RAI treatment is administered by mouth, usually in a small capsule or a drink of water. This treatment slowly destroys the thyroid gland and renders it incapable of overproducing thyroid hormone. Following RAI treatment, patients eventually end up with an underactive thyroid (hypothyroidism), which is treated with a thyroid hormone supplement once a day. A small percentage of patients with eye involvement will experience a worsening (usually transient) of symptoms following RAI treatment. The use of RAI in patients with existing serious eye disease is usually contraindicated.

Surgical Thyroidectomy

During a surgical thyroidectomy, the thyroid gland is removed. As with RAI, surgery often results in hypothyroidism, which is treated with a daily thyroid hormone supplement. The most common complications with this type of surgery can be damage to the nerves around the vocal cords and parathyroid glands, although these risks can be greatly minimized in the hands of an experienced surgeon.

Eye and Skin Involvement

Patients with Graves’ disease may experience some level of eye involvement, requiring consultation with an experienced ophthalmologist. Symptoms can include dry eyes, swelling, redness, eyelid retraction, and a “gritty” sensation. Less common complications include bulging (proptosis), double vision, and compression of the optic nerve. Symptoms typically progress and then stabilize over a period of 2-3 years. For more serious complications, surgical options are available to restore eye function and appearance.

Very occasionally, Graves’ patients develop a lumpy reddish thickening of the skin in front of the shins known as pretibial myxedema. This condition is usually diagnosed and treated by a dermatologist. Even rarer is a condition called acropachy, a clubbing and swelling of the fingers or toes.