Graves Disease

Fact: Graves' disease is the most common cause of hyperthyroidism

What is Graves' Disease?
Graves’ disease is named for the doctor who first described it in Ireland—Robert J. Graves. He noticed it in a patient in 1835. The disease is also referred to as Basedow’s disease—named after a German, Karl Adolph van Basedow, who described the disease in 1840. He didn’t know that Graves had described the same disease just a few years earlier. The term Basedow’s disease is more commonly used in continental Europe; in the United States, it’s called Graves’ disease.
Graves’ disease is a type of autoimmune problem that causes the thyroid gland to produce too much thyroid hormone, which is called hyperthyroidism. Graves’ disease is often the underlying cause of hyperthyroidism.

What are the symptoms of Graves’ disease?
People with Graves’ disease may have common symptoms of hyperthyroidism such as

  • nervousness or irritability
  • fatigue or muscle weakness
  • heat intolerance
  • trouble sleeping
  • hand tremors
  • rapid and irregular heartbeat
  • frequent bowel movements or diarrhea
  • weight loss
  • goiter, which is an enlarged thyroid that may cause the neck to look swollen and can interfere with normal breathing and swallowing

A small number of people with Graves’ disease also experience thickening and reddening of the skin on their shins. This usually painless problem is called pretibial myxedema or Graves’ dermopathy.

In addition, the eyes of people with Graves’ disease may appear enlarged because their eyelids are retracted—seem pulled back into the eye sockets—and their eyes bulge out from the eye sockets.  This condition is called Graves’ ophthalmopathy (GO).

Risk factors
Although anyone can develop Graves' disease, a number of factors can increase the risk of disease. These risk factors include the following:

  • Family history. Because a family history of Graves' disease is a known risk factor, there is likely a gene or genes that can make a person more susceptible to the disorder.
  • Gender. Women are much more likely to develop Graves' disease than are men.
  • Age. Graves' disease usually develops in people younger than 40.
  • Other autoimmune disorders. People with other disorders of the immune system, such as type 1 diabetes or rheumatoid arthritis, have an increased risk.
  • Emotional or physical stress. Stressful life events or illness may act as a trigger for the onset of Graves' disease among people who are genetically susceptible.
  • Pregnancy. Pregnancy or recent childbirth may increase the risk of the disorder, particularly among women who are genetically susceptible.
  • Smoking. Cigarette smoking, which can affect the immune system, increases the risk of Graves' disease. Smokers who have Graves' disease are also at increased risk of developing Graves' ophthalmopathy.

When to see a doctor
A number of medical conditions can cause the signs and symptoms associated with Graves' disease. See your doctor if you experience any potential Graves-related problems to get a prompt and accurate diagnosis.
Seek emergency care if you're experiencing heart-related signs and symptoms, such as a rapid or irregular heartbeat, or if you develop vision loss.

Testing & Diagnosis
The diagnosis of Graves' disease may include:

  • Physical exam. Your doctor examines your eyes to see if they're irritated or protruding and looks to see if your thyroid gland is enlarged. Because Graves' disease increases your metabolism, your doctor will check your pulse and blood pressure and look for signs of tremor.
  • Blood sample. Your doctor will order blood tests to determine your levels of thyroid-stimulating hormone (TSH), the pituitary hormone that normally stimulates the thyroid gland, as well as levels of thyroid hormones. People with Graves' disease usually have lower than normal levels of TSH and higher levels of thyroid hormones.

          Another laboratory test measures the levels
          of the antibody known to cause Graves'
          disease. This test usually isn't necessary to  
          make a diagnosis, but a negative result might
          indicate another cause for hyperthyroidism.

  • Radioactive iodine uptake. Your body needs iodine to make thyroid hormones. By giving you a small amount of radioactive iodine and later measuring the amount of it in your thyroid gland with a specialized scanning camera, your doctor can determine the rate at which your thyroid gland takes up iodine. The amount of radioactive iodine taken up by the thyroid gland helps determine if Graves' disease or another condition is the cause of the hyperthyroidism. This test may be combined with a radioactive iodine scan to show a visual image of the uptake pattern.
  • Ultrasound. Ultrasound uses high-frequency sound waves to produce images of structures inside the body. Ultrasound can show if the thyroid gland is enlarged, and is most useful in people who can't undergo radioactive iodine uptake, such as pregnant women.
  • Imaging tests. If the diagnosis of Graves' ophthalmopathy isn't clear from a clinical assessment, your doctor may order an imaging test, such as CT scan, a specialized X-ray technology that produces thin cross-sectional images. Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to create either cross-sectional or 3-D images, may also be used.

Graves’ Disease Treatment

1. Antithyroid Medications

These drugs help prevent the thyroid from producing hormones. Methimazole and propylthiouracil (PTU) are generic medications that interfere with the thyroid gland’s ability to produce hormones. While effective in relieving symptoms within a few weeks, hyperthyroidism may return after the drug is stopped.

2. Radioactive Iodine (RAI)
Some doctors favor radioactive iodine treatment because antithyroid medications do not always provide a long-term solution to Graves’ disease-related hyperthyroidism, and surgical complications (surgery is the third treatment option—you can read more about it below) may be serious. RAI is given as a capsule or in a water-based solution. It may take months for treatment to be effective, and sometimes repeated doses are required.
Radioactive iodine works by destroying thyroid tissue cells, thereby reducing your thyroid hormone levels. However, there is debate as to whether a fixed dose or individually prescribed dose is best.

3. Surgery
Some patients may require surgery for various reasons. For example, some people cannot take or tolerate antithyroid medication or RAI, and sometimes, these treatments are not successful. Additionally, if you’re pregnant and PTU (antithyroid medication) isn’t working, the doctor may recommend surgery.
While total removal of the thyroid effectively treats hyperthyroidism in most patients, it always results in hypothyroidism. Therefore, if you undergo a total thyroidectomy, you will need to take a thyroid replacement hormone every day. Your endocrinologist or treating physician will determine the correct dosage and monitor its effectiveness one or more times per year by simple blood work

​Want to learn more?
The following are organizations and/or websites dedicated to providing information and education surrounding Graves' Disease. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.

American Thyroid Association
Mayo Clinic
National Institute of Diabetes and Digestive and Kidney Diseases

Information on this page taken directly from:
Mayo Clinic
National Institute of Diabetes and Digestive and Kidney Diseases