Graves’ disease

At a glance

  • Grave's disease is an autoimmune disease.
  • It causes hyperthyroidism: The thyroid gland then makes too many hormones
  • It can result in weight loss, nervousness and a rapid heartbeat.
  • Eye problems and swelling of the thyroid gland (known as a “goiter”) are also possible.
  • Graves’ disease is usually treated with medication.
  • If this treatment isn’t enough, other possible options are surgery or radioiodine therapy.


Photo of a patient having her thyroid examined by a doctor

Your thyroid gland is located at the front of your neck. It produces that are involved in many of the processes happening throughout the body. Some people develop an overactive thyroid. Graves’ disease is the most common cause. The then allows the thyroid to produce too many because antibodies are no longer regulated properly. This sends the body’s metabolism into overdrive, making lots of processes (such as the heartbeat) speed up unnecessarily.


Because Grave's disease makes the thyroid produce more than the body needs, it results in the following typical symptoms of an overactive thyroid:

  • A pounding heart (palpitations) and rapid heartbeat, and sometimes an irregular heartbeat too
  • High blood pressure
  • Weight loss despite food cravings
  • Diarrhea
  • Tremor (shaking), nervous restlessness, irritability, sleep problems
  • Weakness, tiredness
  • Sweating and warm, moist skin
  • Hair loss
Illustration: Possible symptoms of an overactive thyroid

In rare cases, the antibodies can block the functioning of the thyroid. That results in an underactive thyroid.

People with Graves’ disease often have a noticeably enlarged thyroid and a swollen neck (this is known as a “goiter”). Some people have problems with their eyes too. The eyes may then feel gritty, sting or water, or the person’s vision may be blurred. Sometimes the eyes bulge so much that the eyelids cover less of the eye. Then you can see the whites of the person’s eyes and all of their iris (the colored part of the eye). This bulging of the eyes and swelling of the muscles around the eye can cause problems with the person’s vision. For example, they might start seeing double. In rare cases, Graves’ disease also leads to swelling in the lower legs, or in the hands and feet.

Illustration: Bulging eyes in a person with Graves’ disease

Causes and risk factors

Graves’ disease is caused by an autoimmune response. The body’s own produces antibodies that then stick to the thyroid cells. This makes the cells reproduce and release too many into the bloodstream. The body functions that are controlled by thyroid are then thrown out of balance.

It is not quite clear why people develop Graves’ disease. It seems that genes probably play a role because the disease often occurs in people who are related to one another. Smoking increases both the risk of developing the disease and of having severe symptoms.


Graves’ disease is the most common cause of an overactive thyroid, especially in women. Around 300 out of 100,000 women get Graves’ disease at some point in their life, compared to only about 50 out of 100,000 men. Each year about 3 out of 100,000 women and 1 out of 100,000 men develop the eye problems that are typical of Grave's disease. The disease usually starts between the ages of 30 and 60, and less often in children or elderly people.


If Graves’ disease goes untreated, there’s an increased risk of the type of long-term effects that occur with an overactive thyroid. They include cardiovascular (heart and blood vessel) diseases like and frequent bone fractures caused by osteoporosis.

In rare cases, the person’s thyroid hormone levels suddenly increase drastically in what is known as a thyrotoxic crisis or a “thyroid storm.” Warning signs include a very high temperature, vomiting, restlessness and anxiety. If someone has a thyroid storm, they need to get hospital treatment quickly because of the possible complications. These include an irregular heartbeat, loss of consciousness and cardiovascular collapse (where not enough blood flows around the body). Thyroid storms can be triggered by things like extreme stress or substances that contain iodine.


The doctor begins by discussing your symptoms with you in detail and giving you a general physical examination. They then usually check the thyroid by feeling your neck to see whether the gland is bigger than usual. This is often followed by an ultrasound scan to take a closer look at the thyroid tissue.

In most cases, a blood test is used to confirm the . The results of the test show whether the thyroid is producing too many hormones and whether antibodies are responsible. Your eyes are also examined because Grave's disease can cause eye problems.

Good to know:

Graves' disease and other thyroid conditions can be diagnosed using various tests. They are all explained briefly in the "Understanding thyroid tests" information.


Graves’ disease rarely goes away by itself. It is usually treated with anti-thyroid drugs for 1 to 1.5 years. If you have a racing heart or an irregular heartbeat, you can also take beta blockers at the start.

The anti-thyroid drugs can make the level of thyroid return to normal. But about half of the people affected have increased hormone levels again when they stop taking the tablets – even if they’ve taken them for long enough. Then it can make sense to remove the thyroid gland surgically or treat it using radioiodine. Radioiodine therapy involves taking radioactive iodine. It is deposited in the thyroid and releases radioactivity there, which destroys the overactive cells. That may increase the autoimmune response at the start. Sometimes it can make existing eye problems worse or cause new ones. But backing the treatment up with steroids can usually prevent that from happening. Ultimately, both the surgical procedure and the radioiodine therapy permanently stop the thyroid from making thyroid . These then have to be taken in tablet form (L-thyroxine).

Steroid tablets or drips are also often used to treat the eye problems. Radiotherapy is another possible option. Sometimes a surgical procedure is performed to make space in the eye socket. This can involve removing some of the bone tissue, for instance.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

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Azizi F, Malboosbaf R. Long-Term Antithyroid Drug Treatment: A Systematic Review and Meta-Analysis. Thyroid 2017; 27(10): 1223-1231.

Bartalena L, Kahaly GJ, Baldeschi L et al. The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy. Eur J Endocrinol 2021; 185(4): G43-G67.

De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet 2016; 388(10047): 906-918.

Deutsche Gesellschaft für Nuklearmedizin (DGN). Radioiodtherapie bei benignen Schilddrüsenerkrankungen (Version 5). DGN-Handlungsempfehlung (S1 Leitlinie). AWMF-Registernr.: 031-003. 2015.

Jameson JL, Mandel SJ, Weetmann AP. Disorders of the Thyreoid Gland. In: D. L. Kaspers, S. L. Hauser, J. L. Jameson et al. (Ed). Harrison's Principles of Internal Medicine. McGraw-Hill Education; 2015.

Kahaly GJ, Bartalena L, Hegedüs L et al. 2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism. Eur Thyroid J 2018; 7(4): 167-186.

Liu X, Gao C, Liu X et al. Efficacy and safety of tripterygium glycosides for Graves ophthalmopathy: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98(50): e18242.

Liu ZW, Masterson L, Fish B et al. Thyroid surgery for Graves' disease and Graves' ophthalmopathy. Cochrane Database Syst Rev 2015; (11): CD010576.

Ma C, Xie J, Wang H et al. Radioiodine therapy versus antithyroid medications for Graves' disease. Cochrane Database Syst Rev 2016; (2): CD010094.

National Institute for Health and Care Excellence (NICE). Thyroid disease: assessment and management (NICE Guidelines; Band NG145). 2019.

Ross DS, Burch HB, Cooper DS et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26(10): 1343-1421.

Tsetsos N, Daskalakis D, Tzakri D et al. Endoscopic transnasal orbital decompression for Graves. Rhinology 2020; 58(1): 2-9.

Tu X, Dong Y, Zhang H et al. Corticosteroids for Graves' Ophthalmopathy: Systematic Review and Meta-Analysis. Biomed Res Int 2018: 4845894.

Vestergaard P. Smoking and thyroid disorders - a meta-analysis. Eur J Endocrinol 2002; 146(2): 153-161.

Viszeralchirurgie DGfA-u, (DGAV). S2k-Leitlinie Operative Behandlung benigner Schilddrüsenerkrankungen. 2021.

Walter MA, Briel M, Christ-Crain M et al. Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials. BMJ 2007; 334(7592): 514.

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Zhao LQ, Yu DY, Cheng JW. Intravenous glucocorticoids therapy in the treatment of Graves' ophthalmopathy: a systematic review and Meta-analysis. Int J Ophthalmol 2019; 12(7): 1177-1186.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on April 17, 2024

Next planned update: 2027


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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