Graves disease

Overview

Graves disease is an autoimmune condition in which your body's immune system mistakenly attacks your thyroid gland, causing it to become overactive and produce too much thyroid hormone. This leads to hyperthyroidism, meaning your body's metabolism speeds up too much.

Yes, Graves disease is relatively common. It affects about 1 in 200 people globally.

It is much more common in women than in men, and it usually starts between ages 30 and 50. However, it can occur at any age, including in children and older adults.

Symptoms

Common symptoms

• Weight loss even though you are eating more
• Fast or irregular heartbeat (palpitations)
• Feeling hot and sweating a lot
• Shakiness (tremor) in your hands
• Feeling tired or weak
• Bulging eyes or a staring look (exophthalmos)
• A swollen neck from an enlarged thyroid (goiter)

Symptoms in children

• Same common symptoms, but children may also have trouble concentrating in school
• Restlessness or hyperactive behavior
• Poor sleep
• Rapid growth or early puberty in some cases

Symptoms in older adults

• Symptoms may be less obvious, often just weight loss and tiredness
• Irregular heartbeat (atrial fibrillation) is more common
• Feeling weak or breathless with activity
• Eye symptoms may be milder

Causes

Main causes

• The immune system makes abnormal antibodies that tell your thyroid to keep making more thyroid hormone, even when it is not needed.
• Genetics can play a role – the condition sometimes runs in families.
• Smoking is a strong risk factor, especially for eye problems.

Risk factors

• Being a woman (especially between ages 30 and 50)
• Having a family history of Graves disease or other autoimmune conditions
• Smoking cigarettes
• Having another autoimmune condition, such as type 1 diabetes or rheumatoid arthritis
• Stress or infection may trigger the condition in people who are already at risk

When to see a doctor

See a doctor urgently if:

• Seek same-day medical advice if you have a very fast or irregular heartbeat, chest pain, or difficulty breathing.
• If you have vision changes or severe eye discomfort, see a doctor urgently.

Book a routine appointment if:

• Make an appointment if you have ongoing symptoms like weight loss, shaking hands, feeling too hot, or swelling in your neck.
• Also see your doctor if you notice your eyes looking different or feel irritated.

Diagnosis

Your doctor will ask about your symptoms, examine your neck and eyes, and order blood tests to check your thyroid hormone levels.

Tests that may be done

• Blood tests: TSH (thyroid-stimulating hormone), T3, and T4 levels – in Graves disease, TSH is low and T3/T4 are high.
• Thyroid antibody test to look for the specific antibodies that cause Graves disease.
• A radioactive iodine uptake test or thyroid scan to see if the whole thyroid is overactive.
• An ultrasound of your thyroid may be done to check for nodules.

What to expect at your appointment

The process is straightforward. You may need to visit a specialist (endocrinologist) after the initial tests. The diagnosis is usually clear from the blood work and imaging.

Treatment

The goal of treatment is to bring your thyroid hormone levels back to normal and relieve symptoms. Treatment depends on your age, how severe the condition is, and whether you have eye problems.

Self-care at home

• If you smoke, quitting can greatly improve your symptoms and reduce eye problems.
• Get enough rest and manage stress – these can help reduce symptoms.
• Eat a balanced diet, but avoid foods very high in iodine (like seaweed and some supplements) as they can worsen hyperthyroidism.

Medical treatments

Doctors use several approaches. One is medication that blocks the thyroid from making too much hormone – these are called antithyroid drugs. Another option is radioactive iodine therapy, which is taken as a pill or liquid and slowly destroys overactive thyroid cells. Beta-blockers may be given to quickly control symptoms like rapid heart rate and shakiness. Your doctor will discuss the risks and benefits of each option for you.

When is surgery considered?

Surgery to remove part or all of the thyroid gland may be recommended if medications are not effective, if you have a very large goiter, or if you have severe eye disease. It is also an option for people who cannot take antithyroid drugs or prefer a one-time treatment.

Living with this condition

Living with Graves disease means staying on top of your treatment and monitoring your symptoms. You will likely need regular blood tests to check your thyroid levels. With treatment, most people feel much better within a few weeks.

Lifestyle tips

• Avoid smoking and exposure to secondhand smoke.
• Learn ways to manage stress, such as meditation or gentle exercise.
• Keep regular appointments with your doctor to adjust treatment as needed.
• Wear sunglasses if your eyes are sensitive to light or feel dry.

Diet and exercise

Eat a well-balanced diet with plenty of fruits, vegetables, and calcium-rich foods to protect your bones. Avoid high-iodine foods (like kelp, dulse, or iodine supplements). Light to moderate exercise, like walking or yoga, can help with energy levels, but avoid overdoing it while your heart rate is still high.

Mental health and emotional wellbeing

Graves disease can affect your mood – you may feel anxious, irritable, or depressed. These feelings often improve as treatment brings hormone levels under control. If you feel overwhelmed, talk to your doctor. If you have thoughts of harming yourself, reach out for help immediately.

Prevention

There is no known way to prevent Graves disease because it is an autoimmune condition. However, quitting smoking can lower your risk of developing it and can reduce eye problems if you already have it.

Complications

If left untreated

• Heart problems such as atrial fibrillation, heart failure, or high blood pressure
• Thyroid storm – a life-threatening condition with very high fever, rapid heart rate, and confusion
• Brittle bones (osteoporosis) from too much thyroid hormone over time
• Eye problems that can become permanent, including vision loss or double vision

Long-term outlook

With treatment, the outlook for Graves disease is excellent. Most people can get their thyroid levels back to normal and lead a full, healthy life. Some people may go into remission and no longer need medication. Even if you need ongoing treatment, you can manage the condition well with regular check-ups and a healthy lifestyle.

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