An infographic showing the symptoms of hyperthyroidism with illustration of the body parts affected.

What Is Graves' Disease?

by Dr. Matt Olesiak, M.D.

What Is Graves' Disease?

Graves' disease is an autoimmune condition resulting in the overproduction of thyroid hormone (hyperthyroidism). It is the most common cause of hyperthyroidism or an overactive thyroid gland. (1)

The immune system is designed to identify, attack, and destroy any harmful substances in the body's immune system. With Graves' disease, the immune system malfunctions, attacking healthy thyroid tissue.

An infographic on Graves' Disease with cartoon images of two women with a normal and an enlarged thyroid gland. and an illustration of antibodies stimulating receptors of thyroid cells with explanatory text. Explanatory text is described below.

Graves' Disease Infographic Text

The overproduction of hormones in Graves' disease causes symptoms of anxiety, tremor, goiter, bulging eyes, fatigue, thick red skin, rapid or irregular heartbeat.

End Graves' Disease Explanatory Text

This thyroid disease is named after Robert Graves, an Irish doctor who first identified the condition in the 1800s. (2)

The thyroid is a small butterfly-shaped gland located in your neck just beneath the larynx (Adam's apple). It produces and releases thyroid hormones that regulate numerous essential bodily functions, including metabolism, heartbeat, respiration, digestion, and mood. These hormones affect nearly every organ in the body.

So, when your thyroid hormone levels are too high, as with Graves' disease, many of your bodily functions speed up, causing numerous unpleasant and even dangerous symptoms.

What Are The Symptoms of Graves' Disease?

Graves' disease affects the thyroid gland and "speeds up" the function of several other bodily organs, including the eyes, skin, bones, heart, liver, etc.

Timely diagnosis is crucial due to the widespread systemic effects of this disease. Delayed diagnosis increases the risk of a "thyroid storm," a life-threatening condition that causes the person's heart rate, blood pressure, and body temperature to reach dangerously high levels quickly.

The symptoms of Graves' disease are similar to hyperthyroidism and can include:

Rapid heart rate (Tachycardia)
Irregular heartbeat (Arrhythmia)
Excessive sweating
Weight loss
Shortness of breath
Muscle weakness
Brittle hair and/or nails
Hair loss
Brain fog/memory lapses/difficulty concentrating
Anxiety
Depression
Fatigue
Irregular menstrual periods
Decrease in menstrual periods
Restlessness
Elevating blood pressure
Increased respiration
Bulging eyeballs called thyroid eye disease or Graves’ ophthalmopathy. This occurs when the immune system attacks the tissues and muscles around the eyes.
Insomnia
Irritability
Goiter (enlarged thyroid gland)
Hand tremors
Increased bowel movements
Heat intolerance

What Causes Graves' Disease?

Graves' disease is caused by the immune system producing an antibody that binds to the receptor for thyroid-stimulating hormone (TSH), prompting it to produce more hormone. The result is overproduction of thyroid hormones and hyperthyroidism. (3)

As with other autoimmune diseases, the exact reason for this response is unknown.

What Are The Complications of Graves' Disease?

The complications of Graves' disease are many and can include:

Difficulty conceiving/infertility/recurring miscarriage
Heart rhythm disorders and structural changes in the heart muscle
Graves' ophthalmology
Brittle bones that can lead to osteoporosis
Thyroid storm: occurs when the person's heart rate, blood pressure, and body temperature spike to dangerously high levels. A thyroid storm is usually fatal if aggressive treatment is not administered immediately.

How Common Is Graves' Disease?

According to the National Institutes of Health, "Graves’ disease affects nearly 1 in 100 Americans. About 4 out of 5 cases of hyperthyroidism in the United States are caused by Graves’ disease." (4)

What Are The Most Common Risk Factors For Graves' Disease?

Those at greater risk of developing Graves' disease include:

Gender.

Women are more likely to have any thyroid disorder than men, including Graves' disease. (5) Indeed, the American Thyroid Association (ATA) estimates that one in eight women will develop a thyroid disorder during their lifetimes. (6) Experts aren't sure why women are more susceptible to thyroid disease, but many believe hormonal fluctuations, hormone imbalances, or autoimmune susceptibility play a role.

Family History.

Having a family history of Graves' disease or Hashimoto's disease. (7)

Age.

Graves' disease typically occurs in those aged 40 to 60.

Pregnancy.

A woman's thyroid cells increase in number during pregnancy, causing the thyroid gland to grow by up to 40% (8).This can trigger an overproduction of thyroid hormone, often leading to Graves' disease diagnosis. (This condition can occur within one year postpartum.) Indeed, women who have recently given birth are about 7 times more likely to develop this disease (9).

An image of a pregnant woman sitting on green grass, looking on river on sunset, touching her belly.

History of Autoimmune Disorders.

Having other autoimmune disorders, such as type 1 diabetes, multiple sclerosis, rheumatoid arthritis, celiac disease, etc.

Smoking.

Research shows that cigarette smokers have a higher risk of developing Graves' disease than nonsmokers. Unlike lung cancer, past nicotine use does not seem to increase the risk for this condition, though. (10)

How Is Graves' Disease Diagnosed?

To diagnose Graves' disease, the doctor will take a medical history and perform a physical exam to check for signs of Graves' disease and then may order one or more of the following tests to confirm the diagnosis.

Thyroid Blood Tests

Here are some of the blood tests your doctor may order.

TSH. Measures thyroid activity by measuring thyroid-stimulating hormone. TSH is a hormone produced by the pituitary gland to send messages to the thyroid gland to produce more thyroid hormones.
T3 and T4. Measures the levels of these primary thyroid hormones.
TSI. Measures thyroid-stimulating immunoglobulin. (In Graves ' disease, TSI levels are incredibly high.) (11)
Antithyroid antibody test. Measures antibodies in the blood.

Radioiodine Uptake Test

An illustration of the thyroid gland and equipment used in a radioiodine uptake test.

The radioiodine uptake test measures the amount of iodine your thyroid takes up from your bloodstream to make thyroid hormones, which is an excellent measure of thyroid function.

If the test reveals that the thyroid gland is taking up too much iodine, this may indicate Graves' disease.

Thyroid Scan

In a thyroid scan, a small camera takes several images of the thyroid gland. It is performed in concert with the radioiodine uptake test, as the radioactive material highlights certain thyroid parts.

If you have Graves' disease, the iodine will appear throughout the thyroid gland. (The iodine will show up only in certain sections with other thyroid conditions.)

Thyroid Ultrasound

Called a Doppler Ultrasound, this test uses high-frequency sound waves to see increased blood flow to the thyroid gland as occurs in Graves' disease.

How Is Graves' Disease Treated?

The treatment protocol for Graves' disease is generally the same as for hyperthyroidism -- medications, radioiodine therapy, or surgery.

Medications

Medications for Graves' disease include:

Beta-blockers to prevent adrenaline or other substances from affecting nerve cells, which can reduce symptoms like rapid heart rate and tremors. Beta-blockers are often given short-term to minimize symptoms until other treatments start working.

Antithyroid medicines. Medications that cause the thyroid to make less thyroid hormone are the most common and simplest way of treating Graves' disease. The most common antithyroid medication doctors use is called Methimazole, though pregnant women in their first trimester are often given Propylthiouracil instead due to Methimazole's potential risk to the fetus. (12)

Radioactive iodine Treatment

In this treatment, radioactive iodine is taken orally and absorbed by the thyroid gland, damaging the cells and causing the thyroid to shrink. This method helps reduce thyroid hormone production within a few months.

However, the main drawback to this treatment is that it can increase your risk of developing hypothyroidism, which will require you to take medication to treat it for the rest of your life. On the plus side... an underactive thyroid (hypothyroidism) is easier to treat than an overactive one (hyperthyroidism/Graves' disease).

Thyroid Surgery

An image of the hands of surgeon with surgical instruments (tools) removing puzzle pieces from a thyroid hormone jigsaw puzzle.

Surgery to remove part of the thyroid gland is also a treatment option, although it is used less often with Graves' disease than with other thyroid conditions. It is thought that removing part of the thyroid gland can normalize hormone levels.

As with radioactive iodine, thyroid surgery risks developing hypothyroidism later on.

Natural Ways to Manage Graves' Disease Symptoms?

You should always follow your doctor's advice, including taking prescribed medications for Graves' disease. However, below are a few natural things you can do to help reduce symptoms, and they are excellent adjuncts to medical treatment.

Monitor Your Iodine Intake

Consuming too much iodine can dramatically increase thyroid hormone production, which you do NOT want if you have Graves' disease.

The recommended daily iodine intake is 150 micrograms (mcg) per day for most healthy adults. But the maximum intake may be lower if you have Graves' disease. (Always speak to your doctor before adjusting your iodine intake.)

You can add iodine to your diet by using iodized salt. However, a high sodium intake is not healthy, so you'll probably be better off consuming iodine foods.

Foods with high amounts of iodine include:

Scallops
Cod
Shrimp
Tuna
Salmon
Sardines

Get More Selenium

Selenium is a mineral crucial for converting thyroid hormone T4 to the active T3 form. So, without this mineral, your thyroid gland would not be able to function.

There is also a link between selenium and Graves' disease. For example, research shows that those newly diagnosed with Graves disease were more likely to have low selenium levels. And get this...those with higher levels of selenium showed a reduction in Graves' relapse rate. (13)

The current daily value (DV) for selenium is 55 micrograms.

You can obtain the recommended DV by increasing your intake of selenium-rich foods.

Foods containing selenium include:

Tuna
Oysters
Brazil nuts
Beef
Pork
Chicken
Tofu
Whole wheat pasta
Mushrooms
Shrimp

Speak with your health care provider before increasing your selenium intake.

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