What Is It?

Graves’ disease is a disorder of the immune system that causes the thyroid gland to become overactive. It can also produce eye and skin symptoms. It is an autoimmune disorder, an illness in which the body’s immune system mistakenly targets the body’s own cells rather than protect them from outside invaders. In Graves’ disease, the body’s immune system produces abnormal chemicals called immunoglobulins that stimulate the thyroid gland to produce high levels of thyroid hormone (hyperthyroidism). Although the exact trigger of this abnormal production of immunoglobulins remains a mystery, the fact that Graves’ disease tends to run in families indicates that the disease may have a genetic (inherited) component. It is possible that the abnormal production of immunoglobulins is triggered by some unknown factor in the environment, and the immune system fails to stop this overproduction because of an inherited defect.

Graves’ disease affects women more than men. It most frequently strikes between the ages of 20 and 40 but can occur at any age.

Graves’ disease can cause the following symptoms:

• Nervousness
• Insomnia
• Dramatic emotional swings
• Sweating
• Tremors and shakes
• Increased heart rate
• Frequent bowel movements
• Unexplained weight loss (often despite increased appetite)
• Sensitivity to warm temperatures (feeling hot all the time)
• Muscle weakness
• Shortness of breath
• Palpitations

In women, menstrual periods may become less frequent or stop altogether. In older patients, there may be heart failure or heart-related chest pain called angina.

Graves’ disease also may cause:

• Goiter — Goiter is a swelling in the lower front portion of the neck caused by an enlarged thyroid gland.
• Eye symptoms — Graves’ disease can cause swelling of tissues around the eyes, which produces a characteristic “staring” or “frightened” appearance. The eyes bulge out and the eyelids are further back in the head than normal, there is less blinking. The person may have double vision, itching and weeping.
• Skin symptoms — There may be swelling of the feet and lower legs. Skin in this swollen area may appear thicker and darker than normal skin, and it may itch.

Your doctor will look for physical evidence of Graves’ disease, including goiter, eye signs and skin signs. He or she also will ask you about recent weight loss, nervousness, tremors (shakes), increased sweating, palpitations, unusually frequent bowel movements, menstrual irregularities and unusual sensitivity to warm temperatures (feeling hot all the time).

Your doctor will diagnose Graves’ disease based on the results of a physical examination and laboratory tests. During your physical examination, your doctor will feel your thyroid for signs of enlargement and for abnormal nodules (lumps). He or she also may use a stethoscope to listen for signs of abnormal blood flow in the area of your thyroid gland. In other parts of your body, your doctor will check for additional signs of hyperthyroidism, including tremors, muscle wasting, eye signs, increased heart rate and other cardiac abnormalities.

Your doctor will order blood tests to check how well your thyroid is functioning. If your doctor is not sure what is causing your eye problems, he or she may order a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of your eyes. In patients with symptoms or physical findings involving the heart, an electrocardiogram (EKG) and/or other cardiac tests probably will be needed.

Graves’ occasionally improves on its own, but most patients require treatment. Once treatment is started, the symptoms go away in six to 12 weeks. However, the medication is taken for a year to try to prevent symptoms from returning.

There is no way to prevent Graves’ disease.

The hyperthyroidism of Graves’ disease can be treated with antithyroid medications such as propylthiouracil (sold as a generic) or methimazole (Tapazole, Thiamazole). These drugs block the thyroid gland’s production of hormone and also can affect the immune system. Alternative treatments include radioactive iodine to cause radioactive destruction of the thyroid, or surgical removal of a portion of the thyroid gland (subtotal thyroidectomy).

Patients with eye signs of Graves’ disease may be given moisturizing eye drops to prevent drying of the cornea and tinted eyeglasses to protect the eyes from sun, wind and dust. In patients with severe eye symptoms, glucocorticoid medications may be necessary, either alone or together with radiation treatments to the orbits. Skin symptoms of Graves’ disease may be treated with glucocorticoid creams and ointments.

Call your doctor if you have any of the symptoms of hyperthyroidism, including:

• Constant feelings of anxiety
• Tremors or “shakes”
• Difficulty sleeping
• Abnormal sweating or unusual sensitivity to warm temperatures
• Abnormally frequent bowel movements
• Palpitations, shortness of breath, or chest pain
• Weight loss, in spite of a normal or increased appetite
• Muscle weakness or wasting
• Menstrual irregularities

Also call your doctor if you develop swelling or skin changes in your feet or lower legs, or if you notice a change in your eye appearance or eye function.

Up to one half of patients who take antithyroid drugs for 12 to 24 months have prolonged remissions of their illness. (Radioactive iodide is also an effective and quick treatment, but 40 percent to 70 percent of patients develop abnormally low levels of thyroid hormones (hypothyroidism) as a side effect within 10 years. Although hypothyroidism also can follow subtotal thyroidectomy, it probably does not occur as often as with radioactive iodine.

The eye signs of Graves’ disease usually improve on their own over time. However, some element of the staring appearance often remains. Treatment with corticosteroids gives partial relief of skin symptoms in about 40 percent to 50 percent of patients, but only about 10 percent experience a complete skin cure.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.