Understanding Graves’ Disease Symptoms, Causes, and Treatment

• Graves’ disease is the most common cause of hyperthyroidism and can impact physical and mental health. 
• There are many potential causes for Graves’ disease, though the condition is usually due to a mix of genetic factors and environmental triggers. 
• While there isn’t a cure to Graves’ disease, multiple treatment options exist that make it easier to manage symptoms. 

Graves’ disease, an autoimmune disease, is the most common cause of hyperthyroidism, or when the thyroid gland produces too much thyroid hormone. Hyperthyroidism speeds up the metabolism and can cause heart palpitations, mood disorders, and unwanted weight loss, among other symptoms. A 2020 study estimates that Graves’ disease affects about one in every 100 Americans.

Graves’ disease can hinder overall health and everyday life, making it important for those diagnosed to understand the symptoms, causes, and treatment options. This article explores all three and answers some of the most frequently asked questions about this disease.

Graves’ disease is an autoimmune condition that attacks the thyroid. In response, the thyroid creates more thyroid hormones than the body needs, which can upset various systems within our body. 

The thyroid is a gland in the throat. It determines metabolism speed and regulates bodily functions, thanks to its role pumping thyroid hormones into the bloodstream. It also provides energy for the body, making it easier to get through a long day or fight off a cold. 

Usually, the release of thyroid hormones is well-balanced and beneficial for overall health. When a condition like Graves’ disease disrupts that production, there’s often unwanted effects. Too many thyroid hormones often leads to weight loss, thinning bones, eye disease, heart palpitations, and other complications.

Graves’ disease only affects about 1.2% of Americans, but it’s responsible for 80% of hyperthyroidism cases. The condition is more common in women and typically occurs after the age of 30. 

Graves’ disease is due to a combination of genetics and experiencing certain environmental triggers. One 2020 study estimated that 79% of the risk was due to genetics and 21% stemmed from environmental factors. Causes for Graves’ disease include but are not limited to:

• HLA Genes: Researchers have pinpointed a specific genetic family, human leukocyte antigen (HLA) complex, that may be to blame. HLA genes support the body’s immune system, but when there are variations in these genes, it’s difficult for the body to identify its own proteins and those that belong to viruses, bacteria, and other invaders. The uncertainty can cause the immune system to attack the thyroid, a process diagnosed as Graves’ disease.
• Genetic Variations Disrupting Autoimmune Process: HLA genes aren’t the only ones that keep the immune system functioning properly. Variations with non-HLA genes related to autoimmune processes, such as cytotoxic T‑lymphocyte antigen‑4 (CTLA4) and PTPN22, may cause this condition too. 
• Hormone Levels: Abnormal hormone levels may also be to blame, especially when there’s too much estrogen. The condition is also five to ten times more common in women, suggesting a connection between gender and this autoimmune condition. 

Risk Factors for Graves’ Disease

Risk factors range from genetics to environmental factors for Graves’ disease, including:

• Environmental Factors: while it is possible for Graves’ disease to develop purely based on genetics, it’s usually triggered by something outside the body. Common triggers include:
  • Exposure to agent orange
  • Smoking
  • Iodine Excess
  • Selenium deficiency
  • Vitamin D deficiency 
• Viral or bacterial infections: because viral or bacterial infections impact the immune system, they may act as a trigger for Graves’ disease. One of the most studied viruses that may trigger this condition is COVID-19.
• Family History: A family history of Graves’ disease, Hashimoto’s disease (another type of thyroid disorder), or other thyroid disease increases a person’s risk of diagnosis. 
• Health History: The condition is also more common in those diagnosed with other autoimmune disorders, such as type 1 diabetes or rheumatoid arthritis. 
• Pregnancy: When pregnant, thyroid levels increase which can trigger the disease in those who are genetically predisposed to it. Typically, Graves’ gets worse in the first half of pregnancy, better in the second, and worse again after delivery. 

Can Graves’ Disease Be Prevented?

Since Graves’ has a genetic component, it is not preventable. It’s possible to limit certain triggers within an individual’s control, such as stopping or not starting to smoke. However, avoiding triggers doesn’t guarantee the disease won’t develop. 

Since thyroid hormones impact many bodily functions, the symptoms of Graves’ disease can vary greatly, including:

• Difficulty sleeping
• Unwanted weight loss
• Anxiety
• Depression
• Mood disorders
• Brain fog 
• Fatigue 
• Increased appetite
• Missed menstrual cycles
• Erectile dysfunction
• Disruption in bowel movements
• Heart palpitations
• Rapid heartbeat/​irregular heartbeat
• Hand tremors

Complications of Graves’ Disease

If left untreated, Graves’ disease can lead to complications such as hyperthyroidism, eye problems, and cardiovascular conditions.

Hyperthyroidism

Perhaps the most prevalent complication is hyperthyroidism, when the thyroid is too active and thyroid hormone production goes into overdrive. 

Symptoms associated with hyperthyroidism include:

• Difficulty concentrating
• Enlarged thyroid gland
• Hair loss
• Difficulty tolerating heat
• Sweating more than usual
• Weak nails
• Restlessness or nervousness
• High blood pressure
• Nausea
• Loss of bone density
• Skin rashes

In severe cases, there can be a thyroid storm, which is a life-threatening condition where hyperthyroidism symptoms develop too quickly for the body to handle. If you experience severe agitation, yellowing skin, or loss of consciousness (symptoms of a thyroid storm), head to an emergency room immediately. 

Graves’ Eye Disease

About one third of Graves’ disease cases lead to eye problems called Graves’ eye disease (otherwise known as ophthalmopathy or thyroid eye disease) in which the immune system attacks the muscles and tissues around the eyes. Thyroid eye disease is distinct since it causes the eyes to bulge out, as opposed to conditions like diabetes that cause eyesight to worsen and increase the chance of blindness. 

Specific Graves’ eye disease symptoms include: 

• Irritated or red eyes
• Swollen or puffy eyelids
• An inability to close eyelids
• Eyelids pulled back more than they should be
• Double vision
• Light sensitivity

These symptoms can be in one or both eyes. Usually, this complication is mild, though working with an ophthalmologist to manage symptoms is often useful. 

Graves’ Disease and Heart Health

The most common heart-related symptom related to excess thyroid hormones is heart palpitations. But if Graves’ disease is left untreated, it can increase the risk of various heart diseases, including:

• Congestive heart failure
• Hypertension
• Atrial fibrillation
• Tachycardia

While these conditions’ are the most serious complications, they’re also quite rare in people with Graves’ disease. Plus, a 2023 study demonstrated the risk for heart disease lowers when Graves’ disease is treated.

Graves’ disease cannot be self-diagnosed. Instead, a doctor examines a patient’s medical history and conducts a physical exam. They will also order a thyroid-stimulating hormone (TSH) test, a blood test that evaluates your thyroid function. It can detect an overactive or underactive thyroid, but not the cause. 

Once hyperthyroidism has been established, there are four potential ways doctors diagnose Graves’ disease:

• TSH receptor antibody (TRAb) Measurement: when Graves’ disease is to blame, the levels of certain antibodies will be higher. This blood test measures those antibody levels. Specifically, detecting the antibody called thyroid-stimulating immunoglobulin (TSI) helps provide a definitive diagnosis.
• Radioactive Iodine Uptake Test: this test demonstrates radioactive iodine uptake level, which will be higher when Graves’ disease is the cause. This is typically done along with a thyroid scan, which shows how the iodine is distributed throughout your body.
• Ultrasonogram: an ultrasonogram of the thyroid reveals the structure of the thyroid gland, including the size, shape, and texture. It can also show increased blood flow, or an overactive thyroid. It can also show any thyroid nodules that may be present.
• CT or MRI: the most rare diagnosing test, a CT scan or MRI can be used to detect Graves’ disease in those who have the condition, but don’t have hyperthyroidism. 

How is Someone With Grave’s Disease Diagnosed? 

If someone is displaying symptoms of Graves’ disease, they should make a visit with a primary care provider who can discover the underlying cause. There is very little someone should do ahead of this appointment to prepare, though thinking through any autoimmune diagnoses and their family medical history may be useful.

It’s also important to keep in mind that diagnosing Graves’ disease often includes many steps. Typically, a doctor will run two blood tests, if not more, before confirming this diagnosis. Once confirmed, they will work with patients to create a treatment plan. 

The bad news is there’s no cure for Graves’ disease. The good news is that symptoms are highly treatable. Treatment for Graves’ disease focuses on regulating thyroid hormone levels and managing symptoms. The three most common treatments are (oral) medication, radioiodine therapy, and surgery. Patients often start with a medication prescribed and managed by an endocrinologist. If medication fails, the other two treatments may be explored. 

When eye complications accompany Graves’ disease, an ophthalmologist will also be involved in the treatment process.

Medication

The primary prescription will most likely be an antithyroid medication, such as methimazole (MMI) or propylthiouracil (PTU). If eye swelling is present, an ophthalmologist may prescribe steroids or tepezza (teprotumumab), a new medication for Graves’ eye disease. Beta blockers may also be prescribed to help with Graves’ symptoms. Usually, medication is prescribed for life.

Radioactive Iodine Therapy

If medication doesn’t work, radioiodine therapy may be recommended. With this treatment, radioactive iodine (RAI) is consumed in a liquid or capsule format. The RAI destroys thyroid cells to help produce less thyroid hormone, which can help shrink an enlarged thyroid. Radiactive iodine therapy lasts up to six months.

Surgery

Thyroid surgery may be a final resort if medication and radioiodine therapy aren’t working. This surgery removes the entire thyroid gland. After surgery, medication produces thyroid hormones and must be taken for life.

Lifestyle Changes

While medication and radioiodine therapy are effective, they take time to work. Certain lifestyle changes can help reduce symptoms in the meantime and make the condition more manageable.

A 2021 study suggests hyperthyroidism symptoms, regardless of their cause, may be more manageable if those impacted focus on:

• Getting 7–9 hours of sleep each night
• Quitting smoking or not starting
• Eating foods high in selenium, including brazil nuts, tuna, and brown rice
• Avoiding foods high in gluten

When Graves’ eye is diagnosed, additional lifestyle changes may be required, including:

• Taking over-the-counter eye drops
• Wearing sunglasses outside
• Wearing contacts or glasses