An overview of Graves’ disease

Graves’ disease is an autoimmune disease in which your immune system attacks healthy tissue in your thyroid gland for unknown reasons. It’s the most common cause of hyperthyroidism, a condition in which your thyroid gland makes too much thyroid hormone.

Your thyroid is a small, butterfly-shaped endocrine gland located at the front of your neck under your skin. Your thyroid’s main job is to control the speed of your metabolism (metabolic rate), which is the process of how your body transforms the food you consume into energy, by releasing certain hormones.

Your immune system usually produces proteins known as antibodies in order to fight against foreign invaders like viruses and bacteria.

If you have an autoimmune disease like Graves’ disease, though, your immune system begins to fight against healthy tissues and cells in your body.

With Graves’ disease, instead of producing antibodies to target a specific invader, your immune system mistakenly produces thyroid-stimulating immunoglobulins. These antibodies then target your own healthy thyroid cells.

Scientists know that people can inherit the ability to make antibodies against their own healthy cells. But they have yet to find a clear cause of Graves’ disease or determine who will develop it.

Experts believe it’s possible that your genes and a virus or other external trigger both play a part in its development.

Common signs and symptoms of Graves' disease include:

1. Thick, red skin usually on the shins or tops of the feet (Graves' dermopathy)

2. Rapid or irregular heartbeat (palpitations)

3. Anxiety and irritability

4. A fine tremor of the hands or fingers

5. Heat sensitivity and an increase in perspiration or warm, moist skin

6. Weight loss, despite normal eating habits

7. Enlargement of the thyroid gland (goiter)

8. Change in menstrual cycles

9. Erectile dysfunction or reduced libido

10. Frequent bowel movements

11. Bulging eyes (Graves' ophthalmopathy)

12. Fatigue and sleep disturbance

About 30% of people with Graves' disease show some signs and symptoms of Graves' ophthalmopathy. In Graves' ophthalmopathy, inflammation and other immune system events affect muscles and other tissues around your eyes. Signs and symptoms may include:

1. Vision loss

2. Double vision

3. Light sensitivity

4. Reddened or inflamed eyes

5. Puffy or retracted eyelids

6. Pressure or pain in the eyes

7. Gritty sensation in the eyes

8. Bulging eyes

Some people with Graves’ disease will experience Graves’ dermopathy.

With this condition, you’ll notice reddened, thickened skin around your shins or on the tops of your feet. While Graves’ dermopathy is often mild, it can potentially cause some pain and discomfort.

Your healthcare provider will ask about your symptoms and medical history, including your family history of thyroid disease, and perform a physical exam. They may also order the following tests to confirm a Graves’ disease diagnosis:

Thyroid blood tests: These blood tests check the level of thyroid hormone in your blood and amounts of thyroid-stimulating hormone (TSH). A low TSH level indicates that your thyroid gland is producing too much hormone. The overproduction causes your pituitary gland to make less TSH.

Thyroid antibody blood tests: These tests help identify different types of autoimmune thyroid conditions. The two types of antibodies linked with Graves’ disease include TSI (thyroid-stimulating antibodies) and TBII (thyrotropin binding inhibitory immunoglobulins).

Thyroid uptake and scan: In this test, you take a small amount of radioactive iodine orally. Your provider will check to see how much of the radioactive iodine your thyroid absorbs. High levels of iodine absorption can be a sign of Graves’ disease.

Doppler blood flow measurement (Doppler ultrasound): This test uses sound waves to detect increased blood flow in your thyroid due to Graves’ disease. Your provider may order this test if radioactive iodine uptake is not a good option for you, such as during pregnancy or breastfeeding.

Graves’ disease is a lifelong (chronic) condition. However, treatments can keep your thyroid hormone levels in check. Medical care may even make the disease temporarily go away (remission).

Treatments for Graves’ disease include:

1. Beta-blockers: Beta-blockers, such as propranolol and metoprolol, are often the first line of treatment for Graves’ disease. These medications regulate your heart rate and protect your heart until other hyperthyroidism treatments take effect. These medications don’t stop thyroid hormone production.

2. Antithyroid medications: Antithyroid medications, such as methimazole (Tapazole®) and propylthiouracil, block your thyroid’s production of thyroid hormone. In a small percentage of people, these medications cause skin rashes and low white blood cell count, which may increase your risk of infection. Rarely, liver disease develops.

3. Radioiodine therapy: This therapy involves taking one dose of radioactive iodine in pill or liquid form. Over two to three months, radiation slowly destroys thyroid gland cells. (The rest of your body isn’t exposed to radiation.) As your thyroid gland shrinks, hormone levels return to normal. People who are pregnant or breastfeeding shouldn’t get this treatment. If you have this treatment, you’ll likely eventually develop hypothyroidism (underactive thyroid), which requires medication. But hypothyroidism is easier to treat than hyperthyroidism and it causes fewer long-term health problems.

4. Surgery: A thyroidectomy involves surgically removing all or part of your thyroid gland. After surgery, some people produce too little thyroid hormone (hypothyroidism). If you develop this condition, you may need to take thyroid replacement hormone medications, such as levothyroxine (Synthroid®), for the rest of your life.

Experts still aren’t certain what causes autoimmune diseases like Graves’ disease. Currently, there’s no known way to prevent the condition.

Complications of Graves' disease can include:

Pregnancy issues : Possible complications of Graves' disease during pregnancy include miscarriage, preterm birth, fetal thyroid dysfunction, poor fetal growth, maternal heart failure and preeclampsia. Preeclampsia is a maternal condition that results in high blood pressure and other serious signs and symptoms.

Heart disorders : If left untreated, Graves' disease can lead to heart rhythm disorders, changes in the structure and function of the heart muscles, and the inability of the heart to pump enough blood to the body (heart failure).

Thyroid storm : A rare but life-threatening complication of Graves' disease is thyroid storm, also known as accelerated hyperthyroidism or thyrotoxic crisis. It's more likely when severe hyperthyroidism is untreated or treated inadequately. The sudden and drastic increase in thyroid hormones can produce many effects, including fever, sweating, vomiting, diarrhea, delirium, severe weakness, seizures, irregular heartbeat, yellow skin and eyes (jaundice), severe low blood pressure, and coma. Thyroid storm requires immediate emergency care.

Brittle bones : Untreated hyperthyroidism also can lead to weak, brittle bones (osteoporosis). The strength of your bones depends, in part, on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with your body's ability to incorporate calcium into your bones.