Graves’ Disease: Causes, Symptoms & Treatment

Graves’ disease affects about 1 in every 200 people, making it one of the most common thyroid disorders. 

The disorder is caused by a malfunctioning immune system, but the reason this occurs is unknown. Symptoms include rapid heartbeat, weight loss, intestinal issues, sweatiness, anxiety, and shakiness.

While Graves’ disease has no cure, it can be managed with medications, radioiodine therapy, and surgery.

What Is Graves’ Disease?

According to the National Institute of Diabetes and Digestive and Kidney Diseases, Graves’ disease is a disorder caused due to hyperactivity of the thyroid gland. The name comes from Sir Robert Graves, the Irish physician who first described the condition in 1835.

This condition is an autoimmune disorder where the body’s immune system produces antibodies that attack the thyroid. The thyroid regulates your metabolism (the rate at which your body converts food into energy) and is a crucial player in overall well-being. 

With Graves’ disease, antibodies stimulate the thyroid to produce too much hormone, which then floods the body with extra thyroid hormones and causes symptoms such as fatigue, weight loss, rapid heartbeat, and tremors.

Graves’ disease is not contagious, but it may involve heritable or genetic factors.

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Graves’ Disease & Hyperthyroidism

Graves’ disease causes the immune system to produce antibodies that attack and destroy the thyroid gland, leading to hyperthyroidism. The immune system normally produces antibodies to protect us from foreign substances in our bodies, such as bacteria and viruses. 

In people with Graves’ disease, however, these antibodies attack an important part of the thyroid gland called thyroid peroxidase (TPO). The destruction of this part leads to underactivity of the thyroid gland and results in symptoms of hyperthyroidism.

Graves’ disease is the most common cause of hyperthyroidism in the U.S., but it’s not the only one. Other conditions, such as inflammation and tumors, can also cause hyperthyroidism.

Symptoms of Graves’ Disease

The symptoms of Graves’ disease are very similar to those of other types of hyperthyroidism, so diagnosing this condition may require some tests. However, some of the more common symptoms include the following:

• Heat intolerance
• Insomnia
• Weight loss
• Excessive sweating
• Dry skin
• Irritability
• Eye proptosis (bulging eyes)
• Hyperactivity
• Excessive hunger

The symptoms of Graves’ disease can be difficult to deal with, but they’re also very manageable and treatable. See your doctor for a proper diagnosis if you’re experiencing any of these symptoms for more than two weeks.

Graves’ Ophthalmopathy

Graves’ ophthalmopathy (GO) is a common side effect of hyperthyroidism. It occurs in about 25 percent of patients with Graves’ disease. It causes inflammation in the muscles that control your eye movements, leading to double vision, bulging eyes, and drooping eyelids.

While Graves’ ophthalmopathy is not life-threatening, it can be very painful and debilitating for patients. It often causes problems with vision and can be difficult to manage if left untreated.

The symptoms of GO usually develop within 2 years of the onset of Graves’ disease, but they can take up to 10 years to appear. For this reason, people with Graves’ disease need regular eye exams so they can be treated early.

If you have Graves’ ophthalmopathy, your doctor may refer you to an eye specialist (ophthalmologist) for topical or oral steroid treatment. The condition usually improves after treatment for Graves’ disease has been started.

Causes of Graves’ Disease

The cause of Graves’ disease is unknown, but doctors believe it may be a combination of genetics and environmental factors.

The most common cause of Graves’ disease is an inherited genetic mutation that makes you more likely to develop the disease. If you have a family history of Graves’ disease, it’s a good idea to get tested for this genetic mutation.

Other factors that may contribute to its onset include the following:

• Smoking
• Sex, as women are more likely than men to develop the condition
• Vitamin D deficiency
• Iodine excess

Occupational exposure to Agent Orange

Risk Factors

Graves’ disease usually develops in people between 30 and 60 years old, although it can occur earlier or later in life. Women are also more likely than men to develop Graves’ disease, especially if they have other autoimmune diseases like lupus or rheumatoid arthritis. 

The disease may run in families, and it may be linked to a genetic predisposition to the overproduction of thyroid hormones.

Complications of Graves’ Disease

Although the disease can be easily treated with medication, it can lead to serious complications if left untreated. These are some of the main complications:

• Permanent vision loss if untreated
• Goiters (swollen neck)
• Thyroid eye disease (TED)
• Heart failure
• Problems with fertility

Diagnosis

The first step in diagnosing Graves’ disease is to rule out other thyroid disorders. To do this, your doctor will perform several blood tests and examinations. These include the following:

• Blood tests: Blood tests can detect the presence of antibodies that attack the thyroid gland. Blood tests may also be performed to check for other conditions causing symptoms similar to Graves’ disease.
• Radioactive iodine uptake test: A radioactive iodine uptake test measures how much radioactive iodine is taken into your thyroid gland after being given a small amount of radioactive iodine by mouth or injection. If your thyroid gland is overactive, it will take up more than usual amounts of radioactive iodine.
  
  This can help confirm the diagnosis of Graves’ disease, but it cannot tell your doctor if there is any damage or scarring in your thyroid gland.
• Thyroid scans: A thyroid scan is an imaging test that allows doctors to see how much your thyroid gland is working. It involves injecting radioactive iodine into your bloodstream and then taking pictures of your thyroid using a special camera. This helps determine if you have hyperthyroidism or hypothyroidism.

Doppler blood flow measurement: This test measures how well blood flows through certain areas of your body using ultrasound waves and sound waves. A doctor can use this information to determine if there are any abnormalities in your thyroid gland and how much it is affecting your body.

Treatments for Graves’ Disease

Because Graves’ disease is an autoimmune disorder, it’s important to know the triggers that can contribute to flare. Avoiding these triggers will help keep your symptoms under control and prevent complications from occurring.

Graves’ disease can be treated with a combination of medical, lifestyle, and home remedies:

Medical Treatments

Medical treatment for Graves’ disease is usually a combination of drugs that reduce the activity of the thyroid gland and drugs that decrease the production of thyroid hormone. The goal is to reduce the symptoms caused by Graves’ disease without damaging your thyroid gland. 

Medication can help manage symptoms like irritability, trouble sleeping, and weight gain. Doctors may also recommend radiation therapy as part of your treatment plan if they think it would benefit you.

These medications include:

• Beta-blockers 
• Antithyroid drugs 
• Lithium carbonate

Surgery may be necessary to remove all or part of your thyroid gland if medications aren’t effective at controlling your symptoms or if they cause side effects that aren’t tolerable.

Lifestyle Changes

You can also try making small lifestyle changes to help manage Graves’ disease symptoms. 

Lifestyle changes may improve your symptoms if you don’t want to take medication or have already tried it without success. These include losing weight and reducing stressors like caffeine or alcohol consumption. Avoid smoking since it can worsen your symptoms further.

Home Remedies

The following home remedies can help relieve symptoms of Graves’ disease:

• Ice chips: Ice chips are an easy way to reduce swelling in your face, throat, and neck.
• Aspirin: Taking aspirin helps to reduce inflammation and pain.
• Epsom salts: Epsom salts are a natural diuretic that can help relieve bloating and water retention caused by Graves’ disease.
• Apple cider vinegar: Apple cider vinegar helps balance your body’s pH levels, which can help reduce inflammation caused by Graves’ disease.

Stay hydrated: Drink plenty of water to stay hydrated.

Graves’ Ophthalmopathy Treatment

Treatment of Graves’ ophthalmopathy depends on its severity. Mild cases may require no specific treatment, while severe cases may need a combination of medications and surgery.

Here is a breakdown of the different types of treatments:

Medical Treatments

If your Graves’ ophthalmopathy is severe, your doctor may prescribe medications such as prednisone or levothyroxine. These medications help suppress your immune system and reduce inflammation in your eyes. They can also help improve vision and prevent eye damage from occurring.

Work with your doctor to find the right dose for you.

Lifestyle Changes

Some people find lifestyle changes to be an effective way to manage Graves’ ophthalmopathy symptoms. These are some common strategies:

• Reduce stress levels through meditation or other relaxation techniques.
• Get enough sleep.
• Cut down on caffeine consumption.
• Eat healthy food.
• Stay hydrated by drinking plenty of water. This will help to keep your eyes moist.
• Wear sunglasses when outdoors to protect your eyes from ultraviolet rays.

Home Remedies

These home remedies might help to relieve symptoms:

• Cool compress: For temporary relief from itching and swelling, place a cool compress (such as a wet washcloth) on your eyes for 5 to 10 minutes.
• Moisturizers: Use artificial tears (preferably lubricating ones) to keep your eyes moist during the day and overnight. To moisturize your eyelid skin, you can also use natural oil products, like olive oil or coconut oil.
• Lid scrubs: A gentle scrub of the eyelids with a soft toothbrush can exfoliate dry skin, reducing irritation and itchiness. Use this twice a day, once in the morning and once at night.

Elevation: Keeping your head elevated can ease inflammation associated with Graves’ ophthalmopathy. Prop an extra pillow or two under your head when you lie down.

Managing Severity

Left untreated, Graves’ disease can lead to heart problems and vision loss, which is why it’s recommended to act quickly in the early stages of the disease.

The first step to preventing Graves’ disease progression is to stay healthy by eating well and exercising regularly. As part of a healthy lifestyle, it’s important to get regular medical checkups, including routine blood work.

Clinical Trials

As with any other medical condition or treatment protocol, there’s always room for improvements in diagnosis and treatment. This is where clinical trials come in.

As a patient diagnosed with Graves’ disease, you could be an important member of any ongoing clinical trial. Your participation can help medical professionals piece together the information they wouldn’t have been able to otherwise. You can find more information on ongoing Graves’ disease clinical trials at ClinicalTrials.gov.

When to See a Doctor

It’s important to see your doctor if you think you might have Graves’ disease. The earlier the condition is diagnosed and treated, the better your chances of getting relief from symptoms and avoiding serious consequences.

References

1. Endocrine Diseases, Grave’s Disease. (November 2021). The National Institute of Diabetes and Digestive and Kidney Diseases.

2. The Pathology of Hyperthyroidism. (December 2018). Frontiers in Endocrinology.

3. Current Concepts in Graves’ Disease. (June 2011). Endocrinology & Metabolism.

4. The Genetic Basis of Graves’ Disease. (December 2011). Current Genomics.

5. Agent Orange Exposure Linked to Graves’ Disease in Vietnam Veterans, UB Study Finds. (June 2010). University at Buffalo.

6. Graves’ Disease. Office on Women’s Health, U.S. Department of Health and Human Services.

7. Graves’ Disease: Epidemiology, Genetic and Environmental Risk Factors, and Viruses. (January 2020). Best Practice & Research Clinical Endocrinology & Metabolism.

8. Grave’s Disease. (October 2016). The New England Journal of Medicine.

9. Causes of Overactive Thyroid (Hyperthyroidism). (September 2019). The National Health Service.

10. Graves’ Eye Disease (Graves’ Ophthalmopathy). (March 2022). Harvard Health Publishing.

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12. Thyroid Tests. (May 2017). National Institute of Diabetes and Digestive and Kidney Diseases.

13. Rare Disease Database: Graves’ Disease. National Organization for Rare Disorders.

14. Laboratory Testing in Thyroid Conditions – Pitfalls and Clinical Utility. (January 2019). Annals of Laboratory Medicine.

15. Radioiodine Therapy of Graves’ Disease and the Uptake Paradox. (January–March 2020). Indian Journal of Nuclear Medicine.

16. Corticosteroids in Moderate-To-Severe Graves’ Ophthalmopathy: Oral or Intravenous Therapy? (January 2019). International Journal of Environmental Research and Public Health.

17. Review of the Treatment of Graves’ Ophthalmopathy: The Role of the New Radiation Techniques. (April–June 2018). Saudi Journal of Ophthalmology.

18. Use of Color Doppler Ultrasonography to Measure Thyroid Blood Flow and Differentiate Graves’ Disease from Painless Thyroiditis. (June 2013). European Thyroid Journal.

19. Graves’ Eye Disease. (May 2022). National Eye Institute.

20. Management of Graves Disease: A Review. (December 2015). JAMA.

21. Preferences of Patients and Clinicians for Treatment of Graves’ Disease: A Discrete Choice Experiment. (May 2021). European Journal of Endocrinology.

22. Outline  Images  Download  Cite  Share  Favorites  Permissions ORIGINAL ARTICLES Outcomes of Graves’ Disease Patients Following Antithyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-line Treatment. (June 2021). Annals of Surgery.