Graves' Disease

Graves’ Disease
This page and its contents
are Copyright © 2005
the American Thyroid Association
What is Graves’ disease?
ADDITIONAL PATIENT RESOURCES
WWW.THYROID.ORG
Graves’ disease, a type of hyperthyroidism, is caused by a
For further details on this and other
thyroid-related topics, please visit the
generalized overactivity of the entire thyroid gland. It is named
patient resources section on the
for Robert Graves, an Irish physician, who was the first to
American Thyroid Association website
describe this form of hyperthyroidism about 150 years ago.
at www.thyroid.org
1 SYMPTOMS
2 CAUSES
What are the symptoms of Graves’ disease?
What causes Graves’ disease?
• Hyperthyroidism
Graves’ disease is triggered by some process in the body’s immune
The hyperthyroid symptoms of Graves’ disease are often the same as
system, which normally protects us from foreign invaders such as
those caused by other types of hyper thyroidism (see the
bacteria and viruses. The immune system destroys foreign invaders with
Hyper thyroidism brochure).
substances called antibodies produced by blood cells known as
lymphocytes. Many people inherit an immune system that can cause
• Eye disease
problems. Their lymphocytes make antibodies against their own tissues
Graves’ disease is the only kind of hyperthyroidism that has
that stimulate or damage them. In Graves’ disease, antibodies bind to
inflammation of the eyes, swelling of the tissues around the eyes, and
the surface of thyroid cells and stimulate those cells to overproduce
bulging of the eyes (called Graves’ ophthalmopathy). The cause of
thyroid hormones. This results in an overactive thyroid. Physicians have
these problems is unknown. Although many patients with Graves’
long suspected that severe emotional stress, such as the death of a loved
disease have redness and irritation of the eyes at some time, less than
one, can set off Graves’ disease in some patients. Dr. Graves himself
1% ever develop enough inflammation of the eye tissues to cause
commented on stressful events in his patients’ lives that came several
serious or permanent trouble. Patients who have severe eye symptoms
months before the development of hyperthyroidism. However, many
may benefit from visiting an eye doctor (an ophthalmologist).
patients who develop Graves’ disease report no stress in their lives.
Eye symptoms generally begin about 6 months before or after the
diagnosis of Graves’ disease has been made. Seldom do eye problems
occur long after the disease has been treated. In some patients with
eye symptoms, hyperthyroidism never develops. The severity of the
3 DIAGNOSIS
eye problems is not related to the severity of the hyperthyroidism.
Early signs of trouble might be red or inflamed eyes or a bulging of
How is the diagnosis of Graves’ disease made?
the eyes due to inflammation of the tissues behind the eyeball.
The diagnosis of hyperthyroidism is made on the basis of findings
Diminished or double vision are rare problems that usually occur
during a physical exam and confirmed by laboratory tests that measure
later. We do not know why, but problems with the eyes occur much
the amount of thyroid hormone (thyroxine, or T4, and triiodothyronine,
more often in people with Graves’ disease who smoke cigarettes than
or T3) and thyroid-stimulating hormone (TSH) in your blood (see the
in those who don’t smoke.
Hyper thyroidism brochure). Sometimes your doctor may want you to
• Skin disease
have a radioactive image, or scan, of the thyroid to see whether the entire
Rarely, patients with Graves’ disease develop a lumpy reddish
thyroid gland is overactive. Your doctor may also wish to do a blood
thickening of the skin in front of the shins known as pretibial
test to confirm the presence of thyroid-stimulating antibodies (TSAb)
myxedema. This skin condition is usually painless and is not serious.
that cause Graves’ disease, but this test is not usually necessary.
Like the eye trouble of Graves’ disease, the skin problem does not
Clues that your hyperthyroidism is caused by Graves’ disease are the
necessarily begin precisely when the hyperthyroidism starts. Its
presence of Graves’ eye disease (see above), an enlarged thyroid, and a
severity is not related to the level of thyroid hormone. We don’t know
history of other family members with thyroid problems. Some relatives
why this problem is usually limited to the lower leg or why so few
may have had hyperthyroidism or an underactive thyroid; others may
people have it.
have acquired gray hair prematurely (beginning in their 20’s). Similarly,
there may be a history of related immune problems in the family,
including juvenile diabetes, pernicious anemia (due to lack of vitamin
B12), or painless white patches on the skin known as vitiligo.

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This page and its contents
are Copyright © 2005
Graves’ Disease
the American Thyroid Association
4 TREATMENT
How is Graves’ disease treated?
The treatment of hyperthyroidism is described in detail in the
Hyper thyroidism brochure. Treatment includes antithyroid drugs
(methimazole [Tapazole®]) or propylthiouracil [PTU]), radioiodine,
and surgery. Although each treatment has its advantages and
disadvantages, most patients will find one that is just right for them.
Hyperthyroidism due to Graves’ disease is, in general, easily controlled
and safely treated, and treatment is almost always successful.
What will be the outcome of treatment?
No matter how your hyperthyroidism is controlled, you probably will
have hypothyroidism someday. Hyperthyroidism tends to lead towards
hypothyroidism, probably because of low-grade inflammation within
your thyroid gland. Hypothyroidism will occur sooner if your thyroid
has been damaged by radioactive iodine or removed in an operation.
Even if you are treated with antithyroid drugs alone, hypothyroidism
still can occur.
Because of this natural tendency to progress toward hypothyroidism
sometime after you have been hyperthyroid, every patient who has ever
had hyperthyroidism due to Graves’ disease should have blood tests at
least once a year to measure thyroid function. Low thyroid hormone
levels cause your pituitary gland to produce increased amounts of
thyroid-stimulating hormone (TSH). A high TSH blood level is the most
sensitive indicator of hypothyroidism, and so your annual thyroid
evaluation should always include a TSH test. When hypothyroidism
occurs, a thyroid hormone tablet taken once a day can treat it simply
and safely (see the Hypothyroidism brochure).
Other family members at risk
Because Graves’ disease is an inherited condition, examinations of the
members of your family may reveal other individuals with thyroid
problems.
ADDITIONAL PATIENT RESOURCES
WWW.THYROID.ORG
For further details on this and other
thyroid-related topics, please visit the
patient resources section on the
American Thyroid Association website
at www.thyroid.org

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