Graves Diseases: Symptoms, Causes, Diagnosis & Treatment

Written by Medicover Team and Medically Reviewed by Dr Kurumeti Vamsi Krishna , Endocrinologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Graves Diseases is an autoimmune disorder and the most common cause of hyperthyroidism, in which the immune system stimulates the thyroid gland to produce excessive thyroid hormones. It can cause weight loss, rapid heartbeat, anxiety, tremors, heat intolerance, and eye problems. Early diagnosis and appropriate treatment help regulate thyroid hormone levels, relieve symptoms, and prevent long-term complications.

What Are the Types of Graves Diseases?

Graves' disease may present with different clinical manifestations depending on the organs affected.

Classic Graves' Disease: Characterized by hyperthyroidism caused by autoimmune stimulation of the thyroid gland.
Graves' Ophthalmopathy: Involves inflammation of the tissues around the eyes, causing bulging eyes, redness, and vision problems.
Graves' Dermopathy: A rare form causing thickened, reddish skin, usually over the shins.
Thyroid Acropachy: A rare manifestation causing swelling of the fingers and toes with clubbing.

What Are the Symptoms of Graves Diseases?

Common symptoms of Graves' disease are

Anxiety
Irritation
Trembling of hands or fingers
Heat sensitivity
Warm, or moist skin
Sudden weight loss
Enlargement of the thyroid gland (goitre)
Change in menstrual cycle
Erectile dysfunction or reduced libido
Frequent bowel movements
Bulging eyes
Fatigue
Thick, red skin usually on the shins or tops of the feet
Rapid or irregular heartbeat (palpitations)
Sleep disturbance
Hair loss

What are the Causes for Graves Diseases?

A breakdown in the immune system, which the body uses to combat diseases, is the root cause of Graves' disease. Normally, the immune system makes antibodies that are intended to attack a particular virus, bacteria, or any other foreign item. In Graves disease, unknown factors cause the immune system to develop antibodies in the neck's hormone-producing gland (thyroid gland).

Normally, a small gland at the base of the brain releases a hormone that controls thyroid function (pituitary gland). Thyrotropin receptor antibody (TRAb), an antibody linked to Graves' disease, functions similarly to the regulating pituitary hormone. This indicates that TRAb interferes with the thyroid's natural function, leading to an excess production of the thyroid hormones (hyperthyroidism).

Graves disease can also affect the eyes which causes Graves' ophthalmopathy. The signs and symptoms are easily noticeable. Let's understand in detail.

Graves' ophthalmopathy's root cause

The cause of Graves' ophthalmopathy, which develops from an accumulation of certain carbohydrates in the muscles and tissues behind the eyes is unknown. Tissues surrounding the eyes may be "attracted" by the same antibodies that can lead to thyroid disease.

Frequently, Graves' ophthalmopathy develops concurrently with hyperthyroidism, however at times, it may also occur many months later. Ophthalmopathy can show symptoms years before or after the development of hyperthyroidism. It is noteworthy here that even in the absence of hyperthyroidism, Graves' ophthalmopathy can still develop.

When to See a Doctor for Graves Diseases?

Consult an endocrinologist if you experience symptoms such as unexplained weight loss, rapid heartbeat, persistent anxiety, tremors, or swelling in the neck. Early diagnosis and treatment can help prevent serious complications affecting the heart, bones, and eyes.

You should see a doctor if you have:

Persistent rapid heartbeat or palpitations
Unexplained weight loss with increased appetite
Bulging eyes or vision changes
Persistent neck swelling or difficulty swallowing

Get medical help immediately if:

Chest pain or severe shortness of breath
High fever, confusion, and rapid heartbeat (possible thyroid storm)
Sudden vision loss or severe eye pain
Loss of consciousness or severe weakness

These could be signs of serious complications such as thyroid storm or severe eye disease requiring urgent medical care.

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How Is Graves Diseases Diagnosed?

Your doctor may perform a physical examination and look for symptoms of Graves' disease to make the diagnosis. He or she might also talk about your health and family background. To complete the diagnosis, your physician may also recommend tests such as:

A blood Test: Your doctor can determine your thyroid hormone levels and thyroid-stimulating hormone (TSH) levels through blood tests. TSH is a hormone produced by the pituitary gland that typically stimulates the thyroid gland. In patients suffering from Graves' disease, TSH levels are often lower and thyroid hormone levels are often higher than normal.
Uptake of Radioactive Iodine: Iodine is required by your body to manufacture thyroid hormones. Using a specialised camera, your doctor can ascertain the rate at which your thyroid gland absorbs iodine. This is done by giving you a small quantity of radioactive iodine, and then measuring the quantity in your thyroid gland. If Graves' disease or another condition is the source of the hyperthyroidism, it can be determined by this method. A radioactive iodine scan in conjunction with this test may be used to produce a visual representation of the uptake pattern.
Antibody Tests: In order to check the levels of the antibodies causing Graves' disease, your doctor can request another lab test. Antibodies are typically not required for the diagnosis of the illness. If Results don't show any antibodies,it may point to another cause of antibodies.
Ultrasound: Ultrasound creates images of internal body structures using high-frequency sound waves. It can demonstrate whether the thyroid is enlarged or not. Pregnant ladies and other persons who are unable to endure radioactive iodine uptake, benefit from this scan.
Imaging Exams: Your doctor may request specialised imaging tests to confirm whether you have Graves' disease.

What Are the Treatment Options for Graves Diseases?

Treatment includes:

Beta-blockers: Propranolol and metoprolol are examples of beta-blockers that are frequently used as the first line of treatment. Until other hyperthyroidism therapies take action, these drugs control your heart rate and safeguard your cardiovascular system.
Drugs that Block the Thyroid: Propylthiouracil and methimazole, two antithyroid drugs prevent the thyroid gland from producing thyroid hormone. These drugs may raise your risk of infection by causing skin rashes and low white blood cell counts in a small percentage of patients. This may seldom cause liver illness.
Radiation Therapy: A thyroidectomy entails the removal of the thyroid gland entirely or in part. Following surgery, some individuals produce insufficient thyroid hormones, a condition called hypothyroidism. If you develop this condition, Levothyroxine or naturally occurring desiccated thyroid may be required as a lifelong treatment.
Surgery: A thyroidectomy entails the removal of the thyroid gland entirely or in part. Following surgery, some individuals produce insufficient thyroid hormones, a condition called hypothyroidism. If you develop this condition, Levothyroxine or naturally occurring desiccated thyroid may be required as a lifelong treatment.
Treating Graves' Eye Disease (Ophthalmopathy): Over-the-counter artificial tear lubricants can be used to treat mild symptoms of Graves' ophthalmopathy. Usually, lubricating gels are used at night.
Corticosteroids: Prednisone or other corticosteroid therapy may help reduce eyelid swelling. Possible side effects include, fluid retention, weight gain, blood sugar and blood pressure elevations, as well as mood fluctuations.
Teprotumumab: The Graves' ophthalmopathy condition may be treated with this medicine. It is administered eight times, every three weeks through an IV in the arm. It may result in negative side effects including nausea, constipation, muscle spasms, and high blood sugar. Since this drug is new, its function in treating Graves' opthalmopathy hasn't yet been established.
Prisms: Double vision could be a symptom of Graves' disease or a side effect of Graves' disease surgery. While they may not always work, prisms in your spectacles could eliminate your double vision.
Surgery to Deflate the Orbit: In this procedure, your surgeon removes the bone that connects your sinuses, the air spaces near to your orbit, and your eye socket (orbit). Your eyes will have enough space to return to their normal position as a result. This therapy is typically used when pressure on the optic nerve threatens to cause vision loss. Double vision is one potential issue.
Radiotherapy in Orbit: Although the advantages are unclear, this was once a widely used treatment. Some tissue behind your eyes is destroyed over the course of several days using focused X-rays. Your doctor may suggest this, if your eye issues are getting worse and corticosteroids alone aren't working or being tolerated well.

Treatment for Graves' illness does not always result in improvement in Graves' ophthalmopathy. For three to six months, Graves' ophthalmopathy symptoms may possibly deteriorate. After that, Graves' ophthalmopathy signs and symptoms typically stabilise for a year or so before starting to improve, frequently on their own.

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What is the Recovery Process for Graves Diseases?

Recovery varies depending on treatment type and individual response, but long-term management is often required.

Gradual improvement in symptoms after treatment initiation
Regular monitoring of thyroid hormone levels
Lifelong medication in some cases
Management of eye symptoms if present
Adopting a healthy lifestyle including diet and stress control
Regular follow-up to prevent recurrence or complications

Frequently Asked Questions

1. What makes Graves diseases different from other thyroid disorders?

Graves' disease is an autoimmune condition where the body's immune system directly overstimulates the thyroid, unlike other thyroid issues caused by inflammation or deficiency.