Graves' Disease

Medically Reviewed by Poonam Sachdev on June 23, 2024
Written by Frances Gatta, Kristin Mitchell, WebMD Editorial Contributor
12 min read

Graves' disease is an autoimmune condition that causes your thyroid to become hyperactive, making it work harder than it needs to. It is one of the most common thyroid problems and the leading cause of hyperthyroidism, a condition in which the thyroid gland produces too many hormones. The condition gets its name from the man who first described it in the early 19th century, Sir Robert Graves.

The thyroid gland is a small butterfly-shaped gland that sits in the front of your neck and releases hormones that help regulate your metabolism. When you have Graves' disease, your immune system attacks your thyroid, causing it to overproduce those hormones. This causes several problems in different parts of your body. It usually affects people between the ages of 30 and 60. It is also more common in women and people assigned female at birth than in men and those assigned male at birth, with a ratio of 4:1.

Once the disorder has been correctly diagnosed, it is quite easy to treat. In some cases, Graves' disease goes into remission or disappears completely after several months or years. Left untreated, however, it can lead to serious complications and even death.

Hormones secreted by the thyroid gland control metabolism, or the speed at which the body converts food into energy. Metabolism is directly linked to the amount of hormones that circulate in the bloodstream. If, for some reason, the thyroid gland secretes too much of these hormones, the body's metabolism kicks into high gear, causing a pounding heart, sweating, trembling, and weight loss.

Normally, the thyroid gets its production orders through another chemical called thyroid-stimulating hormone (TSH), released by the pituitary gland in the brain. But in Graves' disease, a malfunction in the body's immune system releases abnormal antibodies that act like TSH. Spurred by these false signals, the thyroid's hormone factories work overtime and overproduce.

Is Graves' disease hereditary?

Heredity, environment, and other characteristics seem to play a role in the likelihood that you’ll have Graves’ disease. But no single gene has been found to cause Graves' disease.

You're more likely to have the condition if someone in your family has had Graves' disease, Hashimoto’s disease, or other autoimmune disorders. 

Older studies show, for example, that if one identical twin contracts Graves' disease, there is a 30%-35% likelihood that the other twin will get it, too.

Aside from having a family history of Graves' disease, other risk factors that increase your chances include:

  • Gender. People assigned female at birth are more likely than those assigned male at birth to develop the disease.
  • Age. Graves' disease often happens in people over 30.
  • Having other autoimmune conditions. You’re more likely to have Graves' disease if you have other autoimmune conditions such as vitiligo and type 1 diabetes.
  • Smoking. Using products that contain nicotine, such as smoking tobacco, increases your risk of having Graves' disease. And smokers who develop Graves' disease are more prone to eye problems than nonsmokers with the disease.

The most common symptoms of Graves' disease are symptoms of hyperthyroidism, which include:

Graves' eye disease

Graves' disease may also cause you to have symptoms that involve your eyes. In this case, your immune system attacks tissues around your eyes.

When Graves' disease affects your eyes, your doctor might tell you that you have Graves' ophthalmopathy, orbitopathy, or thyroid eye disease.

Graves' disease eye symptoms appear in 1 in 3 people with Graves' disease. These symptoms are often mild and include:

  • Gritty, irritated eye
  • Eye sensitivity to light
  • Bulging eyes
  • Puffy eyes
  • Feeling pressure or pain in your eyes
  • Blurred or double vision

You can have these symptoms before you start having Graves' disease symptoms. You can also have them at the same time as your other symptoms. In rare cases, these eye problems may start after treating Graves' disease.

Some people can have Graves' eye disease, even when they don’t have any thyroid condition.

See a doctor if you’re showing any symptoms affecting your eyes.

If you have symptoms or signs of the complications of Graves' disease, your doctor will probably ask you if you have a family history of the condition and order one or more of the following tests:

A blood test to check your levels of thyroid stimulating hormone (TSH) and other thyroid hormones. With Graves' disease, your TSH levels are usually lower and other hormones are elevated.

Lab tests to look for the antibodies that cause Graves' disease. If you don’t have them, that’s a sign that your hyperthyroidism is caused by something else.

A radioactive iodine uptake test that uses small doses of radioactive iodine to watch how much of it is taken up into your thyroid from your bloodstream. Your body normally uses iodine to make thyroid hormones. So, if it takes in a lot of the radioactive iodine, it is a sign that it is working harder than it needs to.

A thyroid scan to see where the radioactive iodine travels in your thyroid gland. If it goes all over your thyroid, that suggests you have Graves' disease. That's because, with other causes of hyperthyroidism, only some parts of the gland are involved.

Graves' disease vs. Hashimoto's disease

Just like Graves' disease, Hashimoto’s disease is an autoimmune disease. With Hashimoto's disease, the immune system makes antibodies that attack and damage the thyroid gland, making it unable to produce enough thyroid hormones. The thyroid then becomes underactive and stops working as well as it should.

You may have no symptoms at first, but later on, you might start having symptoms such as:

  • Tiredness
  • Weight gain
  • Slow heart rate
  • Feeling constipated
  • Dry skin
  • Thinning hair
  • Not being able to tolerate cold
  • Heavy or irregular periods
  • Fertility problems

Graves' disease, on the other hand, causes your thyroid gland to make too much thyroid hormones, so your body’s functions work faster than it should. That’s why, with Graves' disease, you may have symptoms such as nervousness, anxiety, difficulty sleeping, weight loss, and more sweating.

Graves' disease and eye health

A small percentage of all patients with Graves' disease will develop a condition called thyroid eye disease in which your eye muscles and tissues become swollen. This can cause exophthalmos — your eyeballs protrude from their sockets — and is considered a hallmark of Graves' disease, even though it’s rare. But having this complication doesn’t have anything to do with how severe your Graves' disease is. In fact, it isn't clear whether such eye complications stem from Graves' disease itself or a totally separate but closely linked disorder. If you have developed thyroid eye disease, your eyes may ache and feel dry and irritated. Protruding eyeballs are prone to excessive tearing and redness, partly because the eyelids can’t protect them as well.

In severe cases of exophthalmos, which are rare, swollen eye muscles can put tremendous pressure on the optic nerve, possibly leading to partial blindness. Eye muscles weakened by long periods of inflammation can lose their ability to control movement, resulting in double vision.

Graves' disease and skin health

Some people with Graves' disease may develop a rare skin condition known as pretibial myxedema or Graves' dermopathy. It is a lumpy reddish thickening of the skin on the shins. It is usually painless and is not serious. Like exophthalmos, this condition does not necessarily begin with the onset of Graves' disease and doesn’t have to do with how severe your disease is.

Graves' disease and heart health

Left untreated, Graves' disease can change how your heart works and functions, causing you to be at a higher risk of having heart problems such as irregular heart rhythms, high blood pressure, stroke, and heart failure.

Graves' disease and osteoporosis

Another health problem you can have with untreated or poorly managed Graves' disease is osteoporosis. Osteoporosis is a condition that causes you to have weak, brittle bones, making them more likely to break. Your bones become weak and brittle when they don’t hold enough calcium. Too much thyroid hormone, in the case of Graves' disease, can affect how much calcium can get into the bones.

Graves' disease and menstrual health

Graves’ disease may cause people who menstruate to have changes in their period. Their periods may become irregular, light, and infrequent. You may not release an egg or ovulate each month when your periods are irregular — not ovulating as often as you should — making it hard to get pregnant.

Your period symptoms may improve as you start your Graves' disease treatment.

Graves' disease and thyroid storm

In rare cases, untreated Graves' disease can cause you to have a life-threatening condition called thyroid storm. With a thyroid storm, your body experiences a sudden and serious rise in thyroid hormones due to triggers such as an infection. 

You may have symptoms such as:

  • Fever
  • Sweating
  • Agitation
  • Psychosis
  • Tremors
  • Heart failure
  • Irregular heart rhythm
  • Stomach pain
  • Nausea
  • Vomiting
  • Coma

Get medical help immediately if you have any of these symptoms.

Graves' disease can make it harder to get pregnant because it changes your menstrual cycle. If you do get pregnant, your symptoms may get worse in the first 3 months and then improve later. Your doctor may stop your anti-thyroid medicines in the last 4-8 weeks of pregnancy if your thyroid levels become normal. They will recheck your condition after the baby is born and adjust your treatment if needed.

Your doctor may recommend anti-thyroid medicines during pregnancy rather than radioiodine therapy. Radioiodine therapy uses radiation, which may affect your pregnancy and your unborn baby.

There are two goals in the treatment of Graves' disease. One is to stop your thyroid gland from overproducing thyroid hormone. The other is to stop the increased levels of thyroid hormone from causing problems in your body. There are several treatment options to achieve one or both of these goals.

Radioactive iodine therapy

With this treatment, you take another form of radioactive iodine by mouth than what is used in the test to diagnose Graves' disease. The iodine gets into your thyroid and the radiation kills some of the cells in your thyroid that are overproducing thyroid hormones. It’s possible that this treatment could temporarily worsen any eye problems you have from Graves' disease. It may also lead to a lower production of thyroid hormone than is healthy. If that happens, your low thyroid can be treated. Because this treatment uses radiation, it’s not used on pregnant or breastfeeding women.

Medications

Anti-thyroid medications make your thyroid produce less thyroid hormone. They aren’t permanent treatments but can be used for long periods and sometimes help even after you’ve stopped treatment. They’re usually the treatment of choice for pregnant or breastfeeding women who can’t be exposed to radiation. They’re also sometimes used in combination with radioactive iodine therapy.

Beta-blockers are medications typically used to reduce blood pressure, and they can help rapidly relieve some of the symptoms of hyperthyroidism including shaking, rapid heartbeat, and anxiety.

Surgery

Surgery is a less common treatment for Graves' disease but may be a good choice if you have a goiter or you’re pregnant and can’t take anti-thyroid medications. During surgery, some or all of your thyroid gland is removed. After surgery, you may need to take a daily thyroid medication for the rest of your life.

Although the symptoms can cause discomfort, Graves' disease generally has no long-term adverse health consequences if you get prompt and proper medical care.

Is Graves' disease curable?

Graves' disease is a lifelong condition that has no cure. However, with treatment, some people may stop having Graves' disease symptoms, meaning they’re in remission. However, remission may only be temporary.

Though Graves' disease is a lifelong condition, it is well-treated when you follow your treatment plan. See your doctor immediately if you start having new symptoms or you become pregnant. They may need to adjust your treatment plan.

Also, speak with your doctor about dietary and lifestyle changes to manage your Graves' disease symptoms and reduce your risk of complications. Ask them about:

  • Foods to avoid or limit, such as seaweed
  • Supplements to avoid, such as multivitamins and iodine supplements
  • Cough syrups that may contain iodine

Graves' disease diet

Your thyroid needs iodine to make thyroid hormones. If you have Graves' disease, you need to be aware of how much iodine you get in your food or from supplements. Having too much iodine in your diet, which can come from foods like kelp and other types of seaweed, could make hyperthyroidism symptoms worse..

To be sure your iodine intake is okay, talk to your doctor about the following:

  • Multivitamins or cough medicines you're taking (as some may contain iodine)
  • Foods to eat less of or to stay away from
  • Supplements you're taking

 

Although the symptoms can be distressing, Graves' disease generally has no long-term adverse health consequences if you get prompt and proper medical care. Some people, especially those with mild Graves' disease, may go into remission, where the disease goes away. This remission may be temporary, especially when it happens in childhood.

Graves’ disease is a lifelong condition. Ensure you make it to your doctor’s appointment as often as possible. They’ll check your thyroid levels, see how your treatment works, and adjust your treatment plan when needed.

Also, see your doctor if you start having new symptoms.

Graves' disease is a lifelong autoimmune condition that occurs when your body makes too much thyroid hormones. It may cause symptoms such as bulging and puffy eyes, tiredness, weakness, diarrhea, irregular periods, and a fast heart rate. Treatment works well in managing your symptoms and reducing your risk of developing health problems. You may also need to change your diet and eat less food with high iodine. Go for your doctor’s appointment regularly and see them immediately if your symptoms worsen or you start having new symptoms.

Is Graves' disease life-threatening?

Graves' disease can be life-threatening if it’s left untreated or you don’t follow your treatment regularly. It may put you at risk of developing life-threatening conditions such as a thyroid storm, stroke, and heart failure.

How long can you live with Graves' disease?

Graves' disease won’t affect how long you’ll live when you treat it well. However, if left untreated, it can cause complications such as heart disease, which can affect how long you can live.

What to expect when you have Graves' disease?

You can expect symptoms such as tiredness, weakness, shaking in your hands, weight loss, sleep problems, fast heartbeat, period changes, and low sex drive when you have Graves' disease. You can also expect to follow a lifelong treatment plan and make lifestyle changes.

Can Graves' disease go away?

Graves' disease can go away when you follow treatment. But it can also come back, especially if it went away when you were a child.