Graves’ disease

At a glance

  • Graves' disease is an autoimmune disease that causes hyperthyroidism (an overactive thyroid).
  • 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.

Introduction

Photo of a patient having her thyroid examined by a doctor

Graves’ disease is the most common cause of an overactive thyroid. It is caused by a malfunction in the person’s immune system. Their body produces antibodies that cause the thyroid to make too many . This sends the body’s metabolism into overdrive, making lots of processes speed up unnecessarily. One thing that can be affected by this is the heartbeat.

Symptoms

The increased amount of causes symptoms typical of an overactive thyroid:

  • A pounding heart (palpitations) and rapid heartbeat, and sometimes an irregular heartbeat too
  • High blood pressure
  • Weight loss despite an increased appetite
  • Diarrhea
  • Tremor (shaking), nervous restlessness, irritability, sleep problems
  • Weakness, tiredness
  • Sweating and warm, moist skin
  • Hair loss

Sometimes the antibodies also stop the thyroid from working properly. In rare cases that may lead to 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. If the tissue behind the eyeballs becomes severely inflamed (a condition known as “Graves' ophthalmopathy”), the eyeballs tend to bulge. Sometimes they 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

Bulging eyes in 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.

Prevalence

Graves’ disease is the most common cause of an overactive thyroid, especially in women. Around 30 out of 1,000 women get Graves’ disease at some point in their life, compared to only about 5 out of 1,000 men. The disease usually starts between the ages of 30 and 60, and less often in children or elderly people.

Effects

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.

Diagnosis

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.

Treatment

Graves’ disease rarely goes away by itself. It is usually treated with anti-thyroid drugs for 1 to 1.5 years. These tablets reduce the production of thyroid . If the person has a rapid or irregular heartbeat, beta blockers can also be taken at the beginning.

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 swallowing radioactive iodine that is absorbed by the thyroid gland and destroys the overactive cells there. This releases more antigens, which can cause a stronger autoimmune response to start with. Sometimes this can make existing eye problems worse or cause new ones. 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 , which means that the person has to take tablets to replace them.

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. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

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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. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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Created on January 6, 2022
Next planned update: 2025

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

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