Graves disease

Endocrine glands

Thyroid enlargement scintiscan

Graves' disease

Thyroid gland

Definition:
Graves' disease is an autoimmune disease -- one in which the immune system attacks certain
tissues -- that causes overactivity of the thyroid gland (hyperthyroidism).
Alternative Names:
Diffuse thyrotoxic goiter
Causes, incidence, and risk factors:
Located in the front of the neck just below the larynx (voicebox), the thyroid gland is an
important organ of the endocrine system. The thyroid secretes the hormones thyroxine (T4) and
triiodothyronine (T3), which control body metabolism. Regulation of metabolism is critical in
controlling mood, weight and mental and physical energy levels.
Thyroid disorders caused by overproduction of thyroid hormones are called hyperthyroidism,
and underproduction of these hormones is known as hypothyroidism.
Graves' disease is the most common cause of hyperthyroidism. The production of thyroid
hormone is increased, causing a wide range of symptoms from anxiety and restlessness to
insomnia and weight loss. In addition, the eyeballs may begin to protrude (exophthalmos)
causing irritation and tearing.
Graves' disease is caused by innapropriate immune system activation that targets the thyroid
gland and causes overproduction of thyroid hormones. Risk factors are being a woman over 20
years old, although the disorder may occur at any age and may affect men.
Symptoms:
Protruding eyes (less common in children)

Weight loss

Increased appetite

Nervousness

Restlessness

Heat intolerance

Increased sweating

Fatigue

Muscle weakness

Double vision

Eye irritation

Breast enlargement in men (possible)

Tremor

Frequent bowel movements

Menstrual irregularities in women

Goiter (possible)
Signs and tests:
Physical examination shows an increased heart rate. Examination of the neck may show thyroid
enlargement or goiter.

Serum TSH is decreased

Serum T3, free T4 are elevated

Radioactive iodine uptake is usually high

This disease may also alter the following test results:

TSI
Orbit CT scan
Treatment:
The purpose of treatment is to control the overactivity of the thyroid gland. Beta-blockers such
as propranolol are often used to treat symptoms of rapid heart rate, sweating, and anxiety until
the hyperthyroidism is controlled. Hyperthyroidism is treated with antithyroid medications,
radioactive iodine or surgery.

Both radiation and surgery result in the need for lifelong use of replacement thyroid hormones,
because these treatments destroy or remove the gland.
The eye problems related to Graves' disease usually resolve when the hyperthyroidism is
effectively treated with medications, radiation or surgery. Sometimes use of prednisone (a
steroid medication which suppresses the immune system) is required to reduce eye irritation and
swelling.
Taping the eyes closed at night to prevent drying may sometimes be required. Sunglasses and
eyedrops may lessen irritation of the eyes. Rarely, surgery may be needed to return the eyes to
their normal position.
Expectations (prognosis):

For most people, Graves' disease responds well to treatment. However, thyroid surgery or
radioactive iodine will sometimes cause hypothyroidism, which can lead to weight gain,
depression and mental and physical sluggishness. Antithyroid medications can also have serious
side effects.
Complications:
Eye problems associated with the disease (called Graves' ophthalmopathy or
exophthalmos)

Cardiac complications including rapid heart rate, congestive heart failure (especially in
the elderly) and atrial fibrillation

Thyroid crisis or storm, a severe worsening of the symptoms of overactivity of the

thyroid gland

Increased risk for osteoporosis

Inadequate levels of thyroid hormone medications following surgery or radiation, leading

to fatigue, elevated cholesterol levels, mild weight gain, depression and mental and
physical sluggishness

Complications related to surgery, including visible scarring of the neck and hoarseness
due to damage of the nerve to the voicebox, and low calcium levels due to damage to the
parathyroid glands.
Calling your health care provider:
Call your health care provider if you have symptoms suggestive of Graves' disease. Also call if
eye problems or general symptoms worsen (or do not improve) with treatment.

Go to the emergency room or call the local emergency number (such as 911) if symptoms of
hyperthyroidism are associated with a rapid, irregular heart beat, fever, or a decrease in
consciousness.
Review Date: 8/6/2004
Reviewed By: Aniket R. Sidhaye, M.D., Division of Endocrinology and Metabolism, Johns
Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed
Healthcare Network.