Graves Disease

This page and its contents

are Copyright 2012
the American Thyroid Association
WHAT ARE THE SYMPTOMS
OF GRAVES DISEASE?
HYPERTHYROIDISM
The majority of symptoms of Graves disease
are caused by the excessive production
of thyroid hormones by the thyroid (see
Hyperthyroidism brochure).
EYE DISEASE
Graves disease is the only kind of
hyperthyroidism that can be associated
with inflammation of the eyes, swelling of
the tissues around the eyes and bulging of
the eyes (called Graves ophthalmopathy).
Although many patients with Graves
disease have redness and irritation of the
eyes at some time, less than five percent
ever develop enough inflammation of the
eye tissues to cause serious or permanent
trouble. Patients who have more than very
mild eye symptoms do require an evaluation
with an eye doctor (an ophthalmologist) as
well as their endocrinologist.
Eye symptoms most often begin about six
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
and, rarely, patients may be hypothyroid. The
severity of the eye symptoms is not related
to the severity of the hyperthyroidism.
Early signs of trouble might be red or
inflamed eyes, a bulging of the eyes due
to inflammation of the tissues behind the
eyeball or double vision. Diminished vision
or double vision are rare problems that
usually occur later if at all. We do not know
why, but problems with the eyes occur much
more often and are more severe in people
with Graves disease who smoke cigarettes.
SKIN DISEASE
Rarely, patients with Graves disease develop
a lumpy reddish thickening of the skin in front
of the shins known as pretibial myxedema.
This skin condition is usually painless and
relatively mild, but can be painful. Like the
eye trouble of Graves disease, the skin
problem does not necessarily begin precisely
when the hyperthyroidism starts. Its severity
is not related to the level of thyroid hormone.
CAUSES
WHAT CAUSES GRAVES DISEASE?
Graves disease is triggered by some process
in the bodys immune system, which normally
protects us from foreign invaders such as
bacteria and viruses. The immune system
WHAT IS GRAVES DISEASE?
Graves disease is caused by a generalized
overactivity of the entire thyroid gland
(hyperthyroidism). It is named for Robert
Graves, an Irish physician, who described
this form of hyperthyroidism about 150
years ago.
WHAT IS THE THYROID GLAND?
The thyroid gland is a butterfly-shaped
endocrine gland that is normally located
in the lower front of the neck. The thyroids
job is to make thyroid hormones, which
are secreted into the blood and then
carried to every tissue in the body. Thyroid
hormone helps the body use energy, stay
warm and keep the brain, heart, muscles,
and other organs working as they should.
This page and its contents
are Copyright 2012
the American Thyroid Association
destroys foreign invaders with substances
called antibodies produced by blood cells
known as lymphocytes. Some people inherit
an immune system that can cause problems.
Their lymphocytes make antibodies against
their own tissues that stimulate or damage
them. In Graves disease, antibodies
bind to the surface of thyroid cells and
stimulate those cells to overproduce thyroid
hormones. This results in an overactive
thyroid. These same antibodies may also be
involved in the eye changes seen in Graves
ophthalmopathy, since the receptors on the
thyroid may also be found on the surface of
cells behind the eye. Physicians have long
suspected that severe emotional stress,
such as the death of a loved one, can set off
Graves disease in some patients. Dr. Graves
himself commented on stressful events in
his patients lives that came several months
before the development of hyperthyroidism.
However, most patients who develop Graves
disease report no particular recent stress in
their lives.
DIAGNOSIS
HOW IS THE DIAGNOSIS OF GRAVES
DISEASE MADE?
The diagnosis of hyperthyroidism is
made on the basis of your symptoms and
findings during a physical exam and it is
confirmed by laboratory tests that measure
the amount of thyroid hormone (thyroxine,
or T4, and triiodothyronine, or T3) and
thyroid-stimulating hormone (TSH) in your
blood (see the Hyperthyroidism brochure).
Sometimes your doctor may want you to
have a radioactive image, or scan, of the
thyroid to see whether the entire thyroid
gland is overactive. Your doctor may also
wish to do a blood test to confirm the
presence of thyroid-stimulating antibodies
(TSI or TRAb) that cause Graves disease,
but this test is not usually necessary.
Clues that your hyperthyroidism is caused by
Graves disease are the presence of Graves
eye disease (see above), an enlarged thyroid
and a history of other family members with
thyroid or autoimmune problems. Some
relatives may have had hyperthyroidism
or an underactive thyroid; others may
have other autoimmune diseases including
premature graying of the hair (beginning in
their 20s). 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.
TREATMENT
HOW IS GRAVES DISEASE TREATED?
The treatment of hyperthyroidism is
described in detail in the Hyperthyroidism
brochure. Treatment includes antithyroid
drugs (generally methimazole [Tapazole],
although propylthiouracil [PTU] may be
used in rare instances), radioactive iodine
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 will probably eventually
develop hypothyroidism (underactive thyroid).
Hypothyroidism will occur sooner if your
thyroid has been treated 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.
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 related to a
genetic predisposition, examinations of the
members of your family may reveal other
individuals with thyroid problems.
FURTHER INFORMATION
Further details on this and other thyroid-related topics are available in the patient
information section on the American Thyroid Association website at www.thyroid.org.