Graves’ Disease - Causes, Symptoms, Risks, Diagnosis, Treatment and Prevention

What is Graves’ Disease?

Graves’ disease, also known as toxic diffuse goiter or Flajani-Basedow-Graves disease, is an autoimmune disorder that causes your immune system to mistakenly attack the thyroid gland. This leads to an overproduction of thyroid hormones, a condition known as hyperthyroidism.

The thyroid gland is a small, butterfly-shaped organ located at the front of your neck. It plays a vital role in regulating your metabolism, energy levels, body temperature, weight, and more. When thyroid hormone levels become excessively high due to Graves’ disease, it can disrupt numerous bodily functions and trigger serious health complications.

Graves’ Disease: Key Facts

• Primary Cause of Hyperthyroidism: Graves’ disease is one of the most common causes of an overactive thyroid.
• Widespread Impact: Excess thyroid hormones can affect the heart, bones, muscles, menstrual cycle, fertility, skin, and even the eyes.
• Demographics: While it can affect anyone, Graves’ disease is more prevalent in:
  • Women
  • Individuals under 40 years of age

Graves’ Disease Symptoms

Graves’ disease can affect multiple systems in the body due to excess production of thyroid hormones. Symptoms may develop gradually or appear suddenly, and their severity can vary from person to person.

Common Symptoms of Graves’ Disease:

• Irritability and anxiety
• Unintentional weight loss despite normal eating habits
• Heat sensitivity, increased sweating, and warm, moist skin
• Fatigue and muscle weakness
• Fine tremors in hands or fingers
• Irregular or rapid heartbeat (palpitations)
• Goiter (enlargement of the thyroid gland)
• Frequent bowel movements
• Sleep disturbances
• Menstrual irregularities
• Reduced libido or erectile dysfunction

Some individuals may also develop specific complications such as:

• Graves’ ophthalmopathy – bulging eyes, eye discomfort, light sensitivity
• Graves’ dermopathy – red, thickened skin, typically on the shins or tops of the feet

These manifestations are explained in detail in the next section.

Manifestations of Graves’ Disease

Graves’ disease can present with specific characteristic manifestations beyond general hyperthyroid symptoms. The two most recognized are Graves’ ophthalmopathy and Graves’ dermopathy.

Graves’ Ophthalmopathy

About 30% of individuals with Graves’ disease develop this eye-related complication. It occurs when inflammation affects the muscles and tissues around the eyes. Common signs and symptoms include:

• Bulging eyes (exophthalmos)
• Eye pressure and pain
• Retracted or swollen eyelids
• Red, irritated eyes
• Sensitivity to light
• Double vision
• In severe cases, it can lead to vision loss

Graves’ Dermopathy

This is a rare skin-related manifestation of Graves’ disease. It typically affects the shins or tops of the feet, leading to:

• Red, swollen skin
• A thickened texture, resembling orange peel
• Caused by the accumulation of mucopolysaccharides (a type of carbohydrate) in the skin

What Causes Graves’ Disease?

Graves’ disease is primarily caused by a malfunction in the immune system, but the exact reason behind this immune response remains unclear.

In healthy individuals, the pituitary gland, a tiny master gland located at the base of the brain, regulates thyroid function by producing thyroid-stimulating hormone (TSH). TSH signals the thyroid to produce the necessary hormones: thyroxine (T4) and triiodothyronine (T3).

However, in people with Graves’ disease, the immune system creates a thyrotropin receptor antibody (TRAb). This antibody mimics TSH, causing the thyroid gland to become overactive and produce excess thyroid hormones, resulting in hyperthyroidism.

The Role of TRAb in Eye and Skin Symptoms

• In Graves’ ophthalmopathy, the TRAb antibody also affects the tissues and muscles around the eyes, leading to inflammation and the buildup of carbohydrates, which can cause bulging eyes, pain, and vision problems.
• In Graves’ dermopathy, the same mechanism may cause skin thickening and reddening, especially on the shins and tops of the feet.

What Are the Risk Factors for Graves’ Disease?

Graves’ disease can affect anyone, but certain factors increase the likelihood of developing this autoimmune thyroid disorder:

• Sex: Women are significantly more likely than men to develop Graves’ disease.
• Age: It most commonly appears in people under the age of 40.
• Family History: A genetic predisposition plays a major role. If you have a close family member with Graves’ disease or another autoimmune disorder, your risk is higher.
• Other Autoimmune Conditions: Conditions like Type 1 diabetes, rheumatoid arthritis, or celiac disease may increase your susceptibility.
• Stress: High levels of emotional or physical stress can trigger the onset in individuals with a genetic predisposition.
• Pregnancy or Recent Childbirth: Hormonal changes during or after pregnancy can initiate Graves’ disease in genetically prone women.
• Smoking: Cigarette smoking impairs the immune system and significantly raises the risk of developing Graves’ ophthalmopathy, a serious eye complication.

While these risk factors increase your chances, some individuals with Graves’ disease have no known risk factors at all.

What Are the Complications of Graves’ Disease?

If left untreated, Graves’ disease can lead to serious complications affecting various organs and systems in the body. These include:

• Heart Problems: Graves’ disease can lead to irregular heart rhythms (arrhythmias), cardiomyopathy (heart muscle disease), and even heart failure, due to the heart being overworked from prolonged hyperthyroidism.
• Pregnancy Complications: Pregnant women with untreated or poorly managed Graves’ disease are at a higher risk of:
  • Miscarriage
  • Preterm birth
  • Preeclampsia (high blood pressure)
  • Poor fetal growth
  • Maternal heart issues
• Thyroid Storm (Thyrotoxic Crisis): A life-threatening emergency caused by severely high levels of thyroid hormone. Symptoms include fever, rapid heartbeat, agitation, and confusion, and can lead to organ failure if not treated immediately.
• Bone Disorders: Long-term, untreated hyperthyroidism can interfere with calcium and mineral absorption, leading to osteoporosis, a condition where bones become weak and brittle.

Prompt diagnosis and appropriate treatment of Graves’ disease are crucial to avoid these potentially severe outcomes.

How Is Graves’ Disease Diagnosed?

Diagnosing Graves’ disease involves a combination of physical examination, blood tests, and imaging studies to assess thyroid function and rule out other conditions. The key diagnostic steps include:

1. Physical Examination

The doctor will:

• Check for swelling in the thyroid gland (goiter)
• Examine the eyes for irritation, protrusion, or puffiness
• Measure heart rate, blood pressure, and look for tremors, which indicate an overactive metabolism

2. Blood Tests

These help assess thyroid function and identify autoimmune activity:

• Thyroid-Stimulating Hormone (TSH): Often suppressed in Graves’ disease
• Thyroid hormones (T3 and T4): Typically elevated
• Thyroid-stimulating immunoglobulin (TSI) or thyrotropin receptor antibodies (TRAb): Specific antibodies that confirm the autoimmune nature of Graves’ disease

3. Radioactive Iodine Uptake (RAIU) Test

• Measures how much radioactive iodine the thyroid absorbs
• In Graves’ disease, the uptake is typically high and diffuse, indicating overactivity throughout the gland

4. Thyroid Ultrasound

• Recommended for patients who cannot undergo radioactive testing (e.g., pregnant women)
• Assesses the size and texture of the thyroid gland and can detect nodules

5. Imaging Tests (CT or MRI)

• May be used if Graves’ ophthalmopathy is suspected
• Helps evaluate the extent of eye involvement and rule out other causes of symptoms

Early and accurate diagnosis of Graves’ disease is critical to initiate timely treatment and prevent complications.

Graves’ Disease Treatment Options

Treatment for Graves’ disease aims to reduce thyroid hormone production, manage symptoms, and treat complications like Graves’ ophthalmopathy. The choice of treatment depends on age, severity of symptoms, underlying health conditions, and personal preferences.

1. Radioactive Iodine Therapy (RAI)

• What it is: Patients take a small dose of radioactive iodine orally.
• How it works: The thyroid gland absorbs iodine to produce hormones. The radioiodine targets and destroys overactive thyroid cells, shrinking the gland and reducing hormone levels.
• Onset: Symptoms improve over a few weeks to months.
• Who it's for: Most non-pregnant adults.
• Side effects: Temporary increase in thyroid hormone levels, neck tenderness, and possibly worsening of eye symptoms in Graves’ ophthalmopathy.
• Not recommended for: Pregnant/nursing women and those with moderate to severe eye disease.
• Post-treatment: Lifelong thyroid hormone replacement therapy may be needed.

2. Anti-Thyroid Medications

• Examples: Methimazole, Propylthiouracil (PTU)
• How they work: These drugs block the thyroid gland from producing excess hormones.
• Preferred drug: Methimazole is typically the first-line treatment due to fewer side effects.
• During pregnancy: PTU is preferred during the first trimester, as methimazole may cause birth defects.
• Side effects: Rash, joint pain, liver damage, and lowered white blood cell count.

3. Beta Blockers

• Examples: Propranolol, Atenolol, Metoprolol
• Purpose: These drugs do not treat the underlying disease but relieve symptoms such as:
  • Rapid heartbeat
  • Tremors
  • Heat intolerance
  • Anxiety
  • Sweating
  • Muscle weakness
• Not suitable for: People with asthma or diabetes without medical supervision.

4. Surgery (Thyroidectomy)

• Procedure: Partial or complete removal of the thyroid gland.
• When it’s used: When other treatments fail, during pregnancy (if urgent), or in cases of large goiters.
• Risks: Possible damage to vocal cords or parathyroid glands (which regulate calcium).
• Post-surgery: Lifelong thyroid hormone replacement is required.

5. Treatment for Graves’ Ophthalmopathy

• Mild cases: Lubricating eye drops (artificial tears), gels at night, and selenium supplements.
• Moderate to severe cases:
  • Corticosteroids to reduce eye inflammation
  • Prism glasses to correct double vision
  • Orbital decompression surgery if vision is threatened – involves removing bone between the eye socket and sinus to relieve pressure
  • Orbital radiotherapy to reduce swelling in eye muscles if corticosteroids are not effective

Graves’ disease is manageable with timely and appropriate treatment. Consult a specialist to find the right treatment plan tailored to your condition.

Prevention of Graves’ Disease

Currently, there are no known ways to prevent Graves’ disease, as the exact cause of the condition remains unclear. Since it is largely influenced by autoimmune and genetic factors, there are no specific preventive measures doctors can recommend. However, maintaining a healthy lifestyle and managing stress may help reduce the risk of triggering autoimmune responses in those who are genetically predisposed.

When to See a Doctor for Graves’ Disease

If you experience symptoms such as unexplained weight loss, persistent fatigue, rapid heartbeat, anxiety, or changes in your eyes or skin, it’s important not to ignore them. These could be signs of Graves’ disease or another thyroid-related condition.

Early diagnosis and timely treatment are essential to prevent complications and manage symptoms effectively.

Request an appointment with an Endocrinologist at Apollo Hospitals

Call 1860-500-1066 to book a consultation with our specialists.