Graves disease

Graves disease, a form of overactive thyroid disease, can cause insomnia, hyperactivity and weight loss. Women are affected up to eight times more often than men.

Graves disease Overview

Reviewed: September 12, 2014

Graves' disease is an autoimmune disease that affects the thyroid, causing hyperthyroidism. The immune system makes antibodies that trigger the thyroid to make more thyroid hormone than your body needs. An overactive thyroid increases the body's metabolic rate,

Common symptoms of an overactive thyroid include goiter (an enlarged thyroid), trouble sleeping, nervousness, irritability, heat sensitivity, and unexplained weight loss.

With Graves' disease, the immune system makes antibodies that act like TSH, which triggers the thyroid to make more thyroid hormone than your body needs. This is called an overactive thyroid or hyperthyroidism. An overactive thyroid causes every function of the body to speed up, such as heart rate and the rate your body turns food into energy. Many factors are thought to play a role in getting Graves' disease including genetics, gender or sex hormones, severe emotional stress or trauma, pregnancy, and infection.

Graves' disease treatments include medications, radioactive iodine therapy, and surgery. Methimazole and Propylthiouracil act on the thyroid from making too much thyroid hormone. Radioactive iodine destroys thyroid cells so that less thyroid hormone is made. Surgical removal of the thyroid is another treatment option. 

Graves disease Symptoms

Most people with Graves' disease have symptoms of an overactive thyroid, such as:

  • Goiter (enlarged thyroid)
  • Trouble sleeping
  • Irritability or nervousness
  • Heat sensitivity, increased sweating
  • Hand tremors
  • Rapid heartbeat
  • Thinning of skin or fine, brittle hair
  • Frequent bowel movements
  • Weight loss without dieting
  • Fatigue or muscle weakness
  • Lighter menstrual flow and less frequent periods
  • Problems getting pregnant

Unlike other causes of an overactive thyroid, Graves' disease also can cause:

  • Eye changes. For some people with Graves' disease, the tissue behind the eyes becomes inflamed and swells. This can cause bulging or discomfort in one or both eyes. Sometimes it affects vision. Eye symptoms can occur before, at the same time, or after other symptoms of Graves' disease begin. It may rarely occur in people with normal thyroid function. We do not know why these eye problems occur. They are more common in people who smoke, and smoking makes eye symptoms worse. Eye problems often get better without treatment.
  • Reddening and thickening of the skin, often on the shins and tops of the feet. This rare skin problem is not serious and is usually painless. Most people with this skin problem also have eye problems from Graves' disease.

Symptoms of Graves' disease can occur slowly or very suddenly and are sometimes confused with other health problems. Some people with Graves' disease do not have any symptoms.

Graves disease Diagnosis

Most people with Graves' disease have symptoms that are bothersome. Tests used to diagnose Graves' disease include:

  • Thyroid function tests. A blood sample is sent to a lab to see if your body has the right amount of thyroid hormone (T4) and TSH. A high level of thyroid hormone in the blood plus a low level of TSH is a sign of overactive thyroid. Sometimes, routine screening of thyroid function reveals mild overactive thyroid in a person without symptoms. In such cases, doctors might suggest treatment or watchful waiting to see if levels return to normal.
  • Radioactive iodine uptake (RAIU). An RAIU tells how much iodine the thyroid takes up. The thyroid takes up iodine and uses it to make thyroid hormone. A high uptake suggests Graves' disease. This test can be helpful in ruling out other possible causes of overactive thyroid.
  • Antibody tests. A blood sample is sent to a lab to look for antibodies that suggest Graves' disease.

Graves' disease can be hard to diagnose during pregnancy because it has many of the same symptoms as normal pregnancy, like fatigue and heat intolerance. Also, some lab tests can be harder to interpret. Plus, doctors cannot use RAIU during pregnancy to rule out other causes.


Graves disease Treatments

There are 3 main treatments for Graves' disease:

  • Antithyroid medicine. Two drugs are used in the United States:These drugs keep the thyroid from making too much thyroid hormone. MMI is the preferred drug for most non-pregnant people. These drugs are generally not used for more than 1 or 2 years. For some people, thyroid function returns to normal when the drugs are stopped. But for most people, the overactive thyroid comes back.
  • Radioactive iodine (RAI). The thyroid gland uses iodine to make thyroid hormone. With this treatment, you swallow a pill that contains RAI, which is a form of iodine that damages the thyroid by giving it radiation. The RAI destroys thyroid cells so that less thyroid hormone is made. This cures the overactive thyroid. But you will likely need to take thyroid hormone for the rest of your life to replace the needed thyroid hormone your body can no longer make. RAI has been used for a long time and does not harm other parts of the body or cause infertility or birth defects.
  • Surgery. Most or all the thyroid is removed. As with RAI, surgery cures overactive thyroid. But you will need to take thyroid hormone to replace the needed thyroid hormone your body can no longer make.

The treatment that is best for you will depend on many factors. Antithyroid drugs and RAI — or a mix of both — often are preferred. During and after treatment, your doctor will want to monitor your thyroid hormone levels. Ask how often you need to be seen for follow-up visits.

Without treatment, Graves' disease can lead to heart problems, weak and brittle bones, and even death. “Thyroid storm” is a very rare, life-threatening condition that can occur if overactive thyroid is not treated. An acute stress, such as trauma, surgery, or infection, usually triggers it to occur. In pregnant women, untreated disease can threaten the mother and unborn baby's health.

Graves disease Other Treatments

Besides one of these 3 treatments, your doctor might also suggest you take a type of drug called a beta-blocker. Beta-blockers do not affect how much thyroid hormone is made. Rather, they block the action of thyroid hormone on your body. This slows down your heart rate and reduces symptoms such as shaking and nervousness. Beta-blockers work quickly and can help you feel better while waiting for the main treatment to take effect.