Graves' disease (patient information)

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What is Graves' disease?

Graves’ disease, also known as toxic diffuse goiter, is the most common cause of hyperthyroidism in the United States. Hyperthyroidism is a disorder that occurs when the thyroid gland makes more thyroid hormone than the body needs.

The thyroid is a small, butterfly-shaped gland in the front of the neck below the larynx, or voice box. The thyroid gland makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.

Thyroid hormone production is regulated by another hormone called thyroid-stimulating hormone (TSH), which is made by the pituitary gland located in the brain.

Graves’ disease is an autoimmune disorder, meaning the body’s immune system acts against its own healthy cells and tissues. In Graves’ disease, the immune system makes antibodies called thyroid-stimulating immunoglobulin (TSI) that attach to thyroid cells. TSI mimics the action of TSH and stimulates the thyroid to make too much thyroid hormone. Sometimes the antibodies can instead block thyroid hormone production, leading to a confusing clinical picture. The diagnosis and treatment of Graves’ disease is often performed by an endocrinologist—a doctor who specializes in the body’s hormone-secreting glands.

What are the symptoms of Graves' disease?

• Anxiety
• Breast enlargement in men
• Difficulty concentrating
• Double vision
• Eyeballs that stick out (exophthalmos)
• Eye irritation and tearing
• Fatigue
• Frequent bowel movements
• Goiter
• Heat intolerance
• Increased appetite
• Increased sweating
• Insomnia
• Menstrual irregularities in women
• Muscle weakness
• Nervousness
• Rapid or irregular heartbeat (palpitations or arrhythmia)
• Restlessness and difficulty sleeping
• Shortness of breath with exertion
• Tremor
• Weight loss (rarely, weight gain)

What are the causes of Graves' disease?

The thyroid gland is an important organ of the endocrine system. It is located in the front of the neck just below the voice box. This gland releases the hormones thyroxine (T4) and triiodothyronine (T3), which control body metabolism. Controlling metabolism is critical for regulating mood, weight, and mental and physical energy levels.

If the body makes too much thyroid hormone, the condition is called hyperthyroidism.

Who is at risk for Graves' disease?

Scientists don’t know exactly why some people develop Graves’ disease, but they believe factors such as age, sex, heredity, and emotional and environmental stress are involved.

Graves’ disease usually occurs in people younger than age 40 and is five to 10 times more common in women than men. An individual’s chance of developing Graves’ disease increases if other family members have it.

Researchers have not been able to find a specific gene that causes the disease to be passed from one generation to the next. Scientists know that some people inherit an immune system that can make antibodies against healthy cells, but predicting who will be affected is difficult.

People with other autoimmune diseases have an increased chance of developing Graves’ disease. Type 1 diabetes, rheumatoid arthritis, and vitiligo—a disorder in which some parts of the skin are not pigmented—are among the conditions associated with Graves’ disease.

How to know you have Graves' disease?

Doctors can sometimes diagnose Graves’ disease based only on a physical examination and a medical history. Laboratory tests confirm the diagnosis.

The ultrasensitive TSH test is usually the first test a doctor performs. This test detects even tiny amounts of TSH in the blood and is the most accurate measure of thyroid activity available. Another blood test used to diagnose Graves’ disease measures T3 and T4. In making a diagnosis, doctors look for below-normal levels of TSH, normal to elevated levels of T4, and elevated levels of T3.

Because the combination of low TSH and high T3 and T4 can occur with other thyroid problems, doctors may order other tests to finalize the diagnosis. Two of these tests are based on the fact that the thyroid gland uses iodine to make thyroid hormone. Both tests use small, safe doses of radioactive iodine.

• • The radioactive iodine uptake test measures the amount of iodine the thyroid collects from the bloodstream. High levels of iodine uptake can indicate Graves’ disease.
  • A thyroid scan shows how and where iodine is distributed in the thyroid. In Graves’ disease, the entire thyroid gland is involved so the iodine shows up throughout the gland. Other causes of hyperthyroidism such as nodules—small lumps in the gland—will show a different pattern of iodine distribution.

Doctors may also consider the thyroid-stimulating immunoglobulin test, although this test usually isn’t necessary to diagnose Graves’ disease. This test, also called a TSH antibody test, measures the level of TSI in the blood. Most people with Graves’ disease have this antibody, but people whose hyperthyroidism is caused by other conditions do not.

When to seek urgent medical care

Call your health care provider if you have symptoms of Graves disease. Also call if your eye problems or general symptoms get worse (or do not improve) with treatment.

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of hyperthyroidism with:

• Decrease in consciousness
• Fever
• Rapid, irregular heartbeat

Where to find medical care for Graves' disease

Directions to Hospitals Treating Graves' disease

Sources

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