Graves disease

Definition

Graves disease is an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism). An autoimmune disorder is a condition that occurs when the immune system mistakenly attacks healthy tissue.

Alternative Names

Diffuse thyrotoxic goiter; Hyperthyroidism - Graves; Thyrotoxicosis - Graves; Exophthalmos - Graves; Ophthalmopathy - Graves; Exophthalmia - Graves; Exorbitism - Graves; Graves' disease

Causes

The thyroid gland is an important organ of the endocrine system. The gland is located at the front of the neck above where the collarbones meet. This gland releases the hormones thyroxine (T4) and triiodothyronine (T3), which control body metabolism. Controlling metabolism is important for regulating mood, weight, and mental and physical energy levels.

When the body makes too much thyroid hormone, the condition is called hyperthyroidism. (An underactive thyroid leads to hypothyroidism.)

Graves disease is the most common cause of hyperthyroidism. It is due to an abnormal immune system response that causes the thyroid gland to produce too much thyroid hormone. Graves disease is most common in women over age 20. But the disorder can occur at any age and can affect men as well.

Symptoms

Younger people may have these symptoms:

Many people with Graves disease have problems with their eyes:

Older people may have these symptoms:

Exams and Tests

During the physical exam, your health care provider may find:

Other tests include:

This disease may also affect the following test results:

Treatment

Treatment is aimed at controlling your overactive thyroid. You may receive one or more types of treatment.

Beta-blocker medicines may help treat:

They may be given until the hyperthyroidism is controlled.

Antithyroid medicines:

Radioactive iodine is given by mouth. It then concentrates in the overactive thyroid tissue and causes damage.

Surgery may be done to remove the thyroid.

If you have had radioactive iodine treatment or surgery, you will need to take replacement thyroid hormones for the rest of your life. This is because these treatments destroy or remove the gland.

TREATMENT OF THE EYES

Some of the eye problems related to Graves disease often improve after treatment with medicines (including selenium), radiation, or surgery. Radioiodine therapy can sometimes make eye problems worse. Eye problems are worse in people who smoke, even after the hyperthyroidism is treated.

Sometimes, prednisone is needed to reduce eye irritation and swelling. Prednisone is a steroid medicine that suppresses the immune system. Other treatments to suppress the immune system may be needed. Ask your provider if these would help you.

Sunglasses, cool compresses, and eye drops may reduce eye irritation. In rare cases, surgery or radiation therapy (different from radioactive iodine) may be needed to prevent further damage to the eye and loss of vision.

Outlook (Prognosis)

Graves disease often responds well to treatment. Thyroid surgery or radioactive iodine often will cause an underactive thyroid (hypothyroidism). Without getting the correct dosage of thyroid hormone replacement, hypothyroidism can lead to:

When to Contact a Medical Professional

Contact your provider if you have symptoms of Graves disease or your eye problems or other symptoms get worse or do not improve with treatment.

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

References

Hollenberg A, Wiersinga WM. Hyperthyroid disorders. In: Melmed S, Auchus RJ, Golfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 12.

Pearce EN, Hollenberg AN. Thyroid. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 207.

Smith JR, Wassner AJ. Thyrotoxicosis. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 584.

Weetman AP, Kahaly GJ. Graves disease. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 71.



Review Date: 2/28/2024
Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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