Patient education: Graves' disease (The Basics)

What is Graves' disease? — Graves' disease is an autoimmune disorder that affects the thyroid gland. The thyroid is in the middle of the neck (figure 1). It makes a hormone called "thyroid hormone."

"Autoimmune" means that the immune system, which is the body's infection-fighting system, attacks healthy tissue instead of infections.

What are the symptoms of Graves' disease? — Graves' disease is a common cause of a condition called "hyperthyroidism." This is when the thyroid gland makes too much thyroid hormone. Hyperthyroidism can cause symptoms like:

●Anxiety, irritability, or trouble sleeping

●Weakness, especially in the arms and thighs – This can make it hard to lift heavy things or climb stairs.

●Trembling

●Sweating a lot, and having trouble dealing with hot weather

●Fast or uneven heartbeat

●Feeling tired

●Losing weight without trying

●Frequent bowel movements

●A swelling in the neck called a "goiter" (figure 2)

Some people with Graves' disease also get eye problems. These include:

●Bulging eyes and swelling of the tissue around the eyes (figure 2)

●Feeling like the eyes are "gritty" or there is something in your eye

●Watery eyes – This is usually worse when the eyes come in contact with cold air, wind, or bright light.

●Eye pain

●Blurry vision

●Double vision

●Problems with color vision – You might notice that colors start to look "washed out."

●Loss of vision – This only happens in severe cases.

Rarely, people with Graves' disease can have thickened, lumpy skin on their shins.

What causes Graves' disease? — Graves' disease happens when the immune system starts making "autoantibodies." Autoantibodies are cells that attack the body's own tissues. In Graves' disease, they target the thyroid gland. This is what causes it to make too much thyroid hormone.

Some things seem to increase a person's risk of getting Graves' disease. They include:

●Family history – This is when 1 or more of your family members had or has Graves' disease.

●Being female

●A stressful life event, such as the death of a partner

●Smoking – Quitting smoking, if you smoke, can lower your risk.

Should I see a doctor or nurse? — Yes. If you have any symptoms of hyperthyroidism or eye problems, see your doctor or nurse. They will ask about your symptoms and do an exam.

Will I need tests? — Yes. Tests might include:

●Blood tests to measure your thyroid hormones

●Blood tests to check for autoantibodies

●Radioactive iodine uptake ("RAIU") test – For this test, you swallow a very small amount of something called "radioactive iodine." Then, a device measures how much of the iodine is absorbed by the thyroid. A high result can be a sign of Graves' disease. This test does expose you to radiation. But the amount is very small, and the test is generally safe, except if you are pregnant or breastfeeding. Radioactive iodine can also be used to treat hyperthyroidism.

●Ultrasound – An ultrasound is type of imaging test. (Imaging tests create pictures of the inside of the body.) Doctors can do an ultrasound to check blood flow to the thyroid gland. If you have hyperthyroidism while you are pregnant or breastfeeding, ultrasound can be safely used to help figure out the cause.

●Imaging tests of the eyes – Doctors might use imaging tests, such as CT scans or MRI, to check your eyes for Graves' disease.

How is Graves' disease treated? — Treatment for Graves' disease involves treating the symptoms. For example, you might get:

●Treatments for hyperthyroidism – These might include medicines, surgery, or radioactive iodine.

●Treatments to help with eye symptoms – These might include:

•Wearing sunglasses

•Using saline eyedrops

•Raising the head of your bed – This can help reduce swelling of the tissues around the eyes.

•Wearing an eye patch – This can help with double vision.

•Taking medicines, including steroids – These medicines can reduce swelling and inflammation.

•Surgery – This is only needed in severe cases.

Is there anything I can do on my own to feel better? — Stop smoking, if you smoke. Quitting smoking also improves your overall health. If you are having trouble quitting, your doctor or nurse can help.

What if I am pregnant or want to get pregnant? — Certain treatments for hyperthyroidism, such as radioactive iodine, are not safe while pregnant. This is because they can harm a developing baby. Tell the doctor who treats your Graves' disease if you are pregnant or want to get pregnant.

●If possible, it's best to treat hyperthyroidism before you try to get pregnant. This way, you won't have to take medicines for it during pregnancy.

●People who get radioactive iodine or surgery need to wait at least 6 months before trying to get pregnant. That way, their doctor will have enough time to check whether they are making enough thyroid hormone. Many people treated with radioactive iodine or surgery end up making too little thyroid hormone after treatment. This can make it harder to get pregnant. It can also affect a baby's development early in pregnancy.

●A small number of people with Graves' disease will have a baby with hyperthyroidism. If you have Graves' disease, your doctor will do tests during your pregnancy to check on the fetus, and again shortly after birth. If the baby does have hyperthyroidism, this can be treated.

If you have Graves' disease and want to get pregnant in the future, talk to your doctor. They can talk to you about your risks and what you need to know.

More on this topic

Patient education: Hyperthyroidism (overactive thyroid) (The Basics)
Patient education: Hyperthyroidism (overactive thyroid) and pregnancy (The Basics)
Patient education: Thyroiditis (The Basics)
Patient education: Thyroiditis after pregnancy (The Basics)
Patient education: Thyroid-stimulating hormone test (The Basics)

Patient education: Hyperthyroidism (overactive thyroid) (Beyond the Basics)