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What is Graves’ Disease: Symptoms, Causes and Treatment Options

Story at-a-glance

  • According to the Graves’ Disease and Thyroid Foundation, about 2 to 3 percent of the American population has Graves’ disease
  • Two of the most well-known symptoms of Graves’ disease are eye changes and hyperthyroidism
  • About 70 percent of Graves’ disease can be attributed to the genetic background of an individual, while the remaining 30 percent may be influenced by other external factors
  • Changing your diet can help you deal with the symptoms of Graves’ disease

What Is Graves' Disease?

About 12 percent of the U.S. population is affected by some type of thyroid condition, with 60 percent of those affected being unaware of it.1 One of these thyroid conditions is Graves' disease, an autoimmune disease that causes hyperthyroidism. This thyroid disorder affects about one percent of Americans.2

The disease takes its name from Dr. Robert Graves, an Irish physician. While Graves did not discover the disease, he wrote a study on several women who exhibited goiters, tachycardia and protruding eyes.3 In other parts of the world, it is known as "Basedow's disease," named after Dr. Karl von Basedow who wrote about this thyroid disease. It also goes by the name "diffuse toxic goiter"4 and "exophthalmic goiter."5

What Is an Autoimmune Disease?

Autoimmune diseases are among the leading causes of death in America, and affect approximately 23.5 million Americans. The immune system serves as the filter for the body, tracking down foreign bodies that may harm the natural flow of bodily processes. But when the immune system loses the ability to differentiate between healthy cells from disease-causing particles in the body, it starts to produce autoimmune cells.

The immune system then signals the body to attack its own healthy cells by mistake.6 There are numerous autoimmune diseases that target different parts of the body, and some of them, like Graves' disease, specifically attack the thyroid gland.

How Does Graves' Disease Affect Your Thyroid and Body?

The thyroid is a butterfly-shaped gland found in front of the neck, below the voice box. It is responsible for producing hormones that regulate body growth, development and metabolism. It also plays an important role in the regulation of your heart rate, body temperature and emotional state.

The thyroid is responsible for the secretion of triiodothyronine (T3), tetraiodothyronine (T4) and diiodothyronine (T2), which have the ability to interact with the other hormones that are present in the body, like estrogen, progesterone and  testosterone. 7 Having sufficient levels of these hormones is vital, as an imbalance can cause a slew of adverse effects, and may even result in serious diseases such as hyperthyroidism, hypothyroidism, Hashimoto's disease and Graves' disease.

Graves' disease is actually one of the leading causes of hyperthyroidism. This autoimmune disease works by making the immune system secrete antibodies that act like thyroid-stimulating hormones (TSH), which then trigger hormone secretion in the thyroid.8

Who Is Usually Affected by Graves' Disease?

According to the Graves' Disease and Thyroid Foundation, about 2 to 3 percent of the American population has Graves' disease. This equates to  roughly  10 million people who are affected by this condition – and some of them remain undiagnosed.9 While Graves' disease may strike at any time in a person's life, the peak age is between 40 and 60 years.10 People with other autoimmune diseases are more predisposed to Graves' disease. These include:11

Vitiligo, a skin condition where white patches appear on the skin. This is caused by the destruction of melanocytes in the skin, or the cells responsible for the production of pigment.

Rheumatoid arthritis, an autoimmune disease that targets the joints. It usually causes swelling, pain and limited movement.

Lupus, a condition where the immune system starts attacking healthy cells. This is caused by the immune system's inability to differentiate between your cells and foreign invaders.

Symptoms of Graves' Disease

Graves' disease manifests through numerous symptoms, which include the appearance of a goiter (enlarged thyroid), heat sensitivity, sudden weight loss, muscle weakness and infertility. Two of the most well-known symptoms of Graves' disease are eye changes and hyperthyroidism, which are discussed in detail below.12

Symptoms of Graves' Ophthalmopathy (Eye Disease)

One of the most pronounced symptoms of Graves' disease is Graves' ophthalmopathy, or the uncharacteristic protruding of the eyes. About 35 to 50 percent of patients develop this condition,13 wherein the eyes are pushed outward because of the inflammation of tissues and muscles located behind the eye. The added pressure may also cause inflammation in the cornea and compression of the optic nerve, giving way to vision impairment.14

Graves' ophthalmopathy usually starts with eye irritation, excessive tearing or dry eyes, and sensitivity to light. If not diagnosed early, it may lead to the swelling of the eye, eye movement difficulties, corneal ulceration and even blindness.15

While not all people with Graves' are affected by this symptom, there is no foolproof way to prevent this eye condition from developing. However, smokers have a higher predisposition to develop this symptom.16 Studies have also shown that conventional treatment methods for Graves' disease, like radiation therapy, may even worsen Graves' ophthalmopathy.17

Using a cold compress can provide relief for mild Graves' ophthalmopathy. In severe cases where the vision of the individual is already affected, orbital decompression may be advised. This is a type of surgery wherein a bone (located between the eye sockets and the sinuses) is removed, in order to give way to the inflamed tissues that are putting pressure on the optic nerve.18

The Link Between Hyperthyroidism and Graves' Disease

Graves' disease is often classified as a type of hyperthyroidism, but it's actually is one of the most common causes of this condition.19 Hyperthyroidism is characterized by the over-activity of the thyroid gland, which leads to the secretion of excess thyroid hormones in the body. This increased production not only affects the overall hormonal balance of the body, but also leads to numerous health problems.

Because these two conditions are so tightly knit, the symptoms of Graves' disease are usually identical to those of hyperthyroidism. These include:

Weight loss. The thyroid hormone is responsible for metabolism in humans. The dramatic increase in thyroid hormones speeds up numerous body processes and puts the body into overdrive. One of these processes is the conversion of food into energy. As a result, the body burns up fat faster than normal and cannot promote weight gain even with the increased appetite that hyperthyroidism brings.20

Hyperthyroid myopathy, or thyrotoxic myopathy, causes muscle weakness, degeneration and fatigue. This affects 52 to 82 percent of people with hyperthyroidism.21 This is caused by the excessive amounts of thyroxine in the body. Immediate treatment should be sought when this symptom first appears and should not be ignored.22

Difficulty sleeping. Sleep troubles arise because of increased heart rate, anxiety and night sweats, which are all brought on by the overstimulation of the thyroid.23

Erectile dysfunction and low sex drive. Studies show that men with thyroid conditions often experience erectile dysfunction and low sex drive. In a 2008 study, 79 percent of the 71 men with thyroid dysfunction showed some level of erectile dysfunction.24 This is because of the interaction between thyroid hormones and the different sex hormones produced in the body.

Possible  Graves' Disease Complications

While Graves' is not characterized as a fatal disease, it can still lead to numerous debilitating complications if left untreated, two of which are discussed in detail below:

Thyroid storm

This is a very rare but extremely life-threatening condition where the functions of various organs in the body become compromised. If untreated, patients who have developed a thyroid storm have a 50 to 90 percent mortality rate.

The excessive amounts of thyroid hormones in the blood can lead to the alteration of the body's thermoregulation, as well as immune, cardiovascular, and gastrointestinal nervous function, and eventually to multi-organ decompensation. To get an early diagnosis, it is important that you are familiar with the symptoms of a thyroid storm:25

High fever. The patient typically has a temperature that's above 101.3 degrees Fahrenheit, and may go over 105.8 degrees Fahrenheit.

Tachycardia. Because of the increased activity of the nervous system, the cardiovascular system is forced to work overtime. This causes the heart to beat at a faster rate, sometimes even exceeding 140 beats per minute.26 Tachycardia may also be accompanied by dysrhythmias, or abnormal and irregular heartbeat.

Changes in mental status. Patients may exhibit restlessness, agitation and confusion. If not treated promptly, it may eventually lead to delirium and coma.

Vomiting and diarrhea. Accelerated intestinal transport and decreased absorption in the gut may lead to various digestive tract issues in the onset of this condition.27

Heart Problems

Because of the high amount of thyroxine in the blood, the heart becomes overstimulated. This causes a faster heartbeat, which may then cause atrial fibrillation, the most common form of arrhythmia.28

Atrial fibrillation is difficult to diagnose, as it shares the same symptoms with a handful of heart disorders. When a person has this condition, the heart starts to beat in an irregular manner, which may cause the blood to pool and form clots, increasing the risk of strokes and mortality.29

Untreated Graves' can also lead to brittle bones, miscarriages, infertility and psychosis because of the strong effect of the thyroid hormone on the various organs of the body.30,31

What Causes Graves' Disease?

The exact cause of Graves' disease has not yet been determined. However, family and twin studies show that this condition may be linked to genetics because people who have relatives with Graves' disease have a higher predisposition of also developing it. 

In one family study, it was found that a third of the siblings of patients with Graves' disease also developed it at some point in their lives. This study (along with others) showed that Graves' disease does not stem from a singular and isolated case of gene defect. The high susceptibility for this disease can be passed down from one generation to the succeeding generations.32

Although about 70 percent of occurences can be attributed to the genetic background of an individual, the remaining 30 percent may be influenced by other external factors.33 Extensive studies are being done to determine whether Graves' disease may also be caused by other emotional, environmental and lifestyle factors, including:

Smoking. Nicotine has been observed to have a direct effect on the increase in secretion patterns of thyroid hormones. This may lead to increased thyroid hormone levels in the blood, contributing to the development of Graves' disease. However, it may also work in an opposite manner, wherein Graves' disease contributes to the increase of cigarette smoking because of the heightened stress and anxiety levels of a person suffering from it.34

Allergens. Seasonal allergens are a contributing factor, and may even cause a relapse for patients who are in remission.35 It's advised that you limit or cut off any possible exposure to possible allergens.

Stress. Studies show that stress influences both the development and the severity of the symptoms of Graves' disease. A higher occurrence of of this disease was observed during times when physical and emotional stress was rampant in the population.36

Sex. Women are seven to eight times more likely to develop Graves' disease and other autoimmune thyroid diseases than men.37

Pregnancy. It's known to influence how the thyroid functions by triggering an increase in thyroid hormone production.38 Studies also show that women who have been pregnant 1 to 12 months prior had a higher risk of developing Graves' disease .39

It's a good idea to be aware of these potential risk factors, especially if Graves' disease runs in your family. This will help lower your risk and reduce your chances of developing this disease.

Graves' Disease Treatment and Diagnosis

The most important thing to make sure of if you suspect that you have Graves' disease is to become familiar with its symptoms. In rare cases, the diagnosis can become complicated when it coexists with a preexisting  condition or disorder.

Graves' is also usually overlooked in senior patients because they think the symptoms are only part of another condition. This can be resolved through differential diagnosis, or the medical differentiation between two diseases with the same symptoms.40

How Is Graves' Disease Diagnosed?

In diagnosing this condition, hyperthyroidism should be the first focus. If the patient has hyperthyroidism, the next step would be  to determine if it was caused by Graves' disease. There are various symptoms that can point to Graves' disease, but taking hormone tests will ensure that you're diagnosed correctly. These include:

TSH Test. It measures the thyroid-stimulating hormone (TSH), the hormone that the pituitary gland secretes to trigger the synthesis of thyroid hormones. Low blood levels of this hormone means that there is a high amount of thyroid hormones present in your blood, but this test can also indicate a problem with the pituitary gland.41

Free T4 Test. This test measures the levels of free thyroxine (T4) in the blood. This is more reliable because the levels of free T4 in the blood cannot be influenced by external factors like pregnancy, estrogen and androgen therapy.42

T3 Test. This is done to diagnose hyperthyroidism and its severity. It measures the amount of both free and bound T3 in your blood. High levels of T3 in the blood are usually indicative of Graves' disease or other thyroid disorders.

Before undergoing a T3 test, remember that certain drugs and medications can affect your T3 levels, including steroids and birth control pills, as they can alter the hormone levels in the blood.43 While thyroid testing is usually overlooked during your check-ups, you should keep in mind that it is a good idea to make sure that your thyroid is working well.

How to Treat Graves' Disease

Conventional treatments for Graves' disease focus on how to cut the hormone production of the thyroid. But while they may keep the symptoms at bay, they cannot stop the onset of the disease itself. Additionally, some of these conventional treatments may have negative drawbacks that may further worsen your health:

Radioiodine therapy. This consists of radiated iodine taken orally in order to shut down the abnormal cells in the thyroid gland that cause the disease. Although this is the most common treatment, studies show that it poses serious threats to the patient by killing off more thyroid cells than needed, increasing the threat of replacing Graves' disease with hypothyroidism.44,45

Anti-thyroid medications. These drugs work by blocking the iodine use of the thyroid gland, limiting the amount of thyroid hormones it synthesizes. This medication is usually taken for an extended period of time, but even so, there is still a high probability of a relapse. Meanwhile, beta-blockers, another class of this medication, do not treat the disease itself, but only keep the symptoms manageable.46

Thyroid surgery. This treatment requires removing the entire thyroid in order to cut your supply of thyroid hormones. This is usually done when patients remain unresponsive to other modes of treatment.

Total removal of the thyroid gland will require the patient to be permanently dependent on hormone replacement.47 The surgery can also damage the vocal cords and the parathyroid because of their close proximity to the thyroid.48 These conventional treatments for Graves' disease have been used by doctors for many years, despite their risks, causing irreparable damage and a permanent dependence on medication.

If you have developed Graves' ophthalmopathy with Graves' disease, it's important to note that the treatments above do not help in improving this condition. If your condition is starting to impair your vision, consult an expert and consider having orbital decompression done.49 However, be sure that you are familiar with the numerous health repercussions that this surgery may bring you.

If your Grave's disease is treated and you go into remission, Graves' ophthalmopathy may improve on its own, although not completely.50

Graves' Disease Natural Treatment Options

Instead of immediately seeking conventional treatments for Graves' disease, it is advisable to try safer, holistic remedies first. There are some natural ways that can help treat and improve the condition of patients with this disease, such as:51

Add vitamin D3 to your diet. Vitamin D3 helps regulate the immune system and limits inflammatory effects in the body. A 2014 study showed that vitamin D3 deficiency may make Graves' disease worse, while correcting the deficiency may assist in reversing it. However, more studies are required to prove this claim.52

When planning to get adequate levels of vitamin D from sunlight, it is recommended that you get about 20 to 25 minutes direct sunlight (without sunscreen), ideally near solar noon. You can also get vitamin D from fatty fish, like wild-caught Alaskan salmon.53 Supplementing with vitamin D3 is also a good option.

Use selenium. Selenium acts as an antioxidant and influences thyroid hormone production. It also limits or inhibits oxidative stress that is usually caused by the increased amount of thyroid hormones in the blood. Selenium-deficient people also show a higher susceptibility to developing various thyroid diseases.

You can incorporate selenium into your diet by consuming Brazil nuts, walnuts and cod.54 Be sure that you eat these foods in moderation, because too much may lead to adverse effects like selenosis (selenium poisoning).55

Supplement with L-carnitine. Taking L-carnitine helps prevent muscle weakness and other symptoms of hyperthyroidism. It has also been observed to decrease thyroid function and can serve as a preventive measure to the development of thyroid storm.56

You can get L-carnitine by eating moderate amounts of grass-fed beef and pastured chicken.57 Before adding L-carnitine-rich foods to your diet, be sure that you consult a health practitioner to ensure that you're not suffering from high blood pressure, kidney disease, liver disease or diabetes.58

Use bugleweed. For years, bugleweed has been lauded for its ability to inhibit the production of numerous thyroid hormones, which may benefit patients with overactive thyroids.59

Use cold compresses on the eyes. For Graves' ophthalmopathy, applying cold compress on the eyes can help ease the inflammation. It is also recommended that you sleep with your head elevated to reduce the pressure and the fluid buildup behind your eyes.60

Graves' Disease Diet: Foods to Help Manage the Symptoms

Changing your diet and choosing healthier foods may help you deal with the symptoms of Graves' disease. Due to the thyroid's important role in metabolism, patients with this autoimmune disease have a higher tendency to lose weight, even if they're eating sufficient amounts of food every day.61 Thus, it is important to eat foods that will help counteract this sudden weight loss.

What Foods Should You Eat?

To help you improve your diet, here are a few recommendations that you can start with:

Calcium-rich foods. Hyperthyroidism may lead to the deterioration of bones, eventually leading to osteoporosis.62 It is important that you add calcium-rich foods to your diet in order to counter this effect. Some calcium-rich foods include kale, collard greens, broccoli and bok choy.63

Cruciferous vegetables. These vegetables are famous for their goitrogenic properties, meaning they affect the production of thyroid hormones by blocking the iodine usage of the thyroid gland. Some good options are Brussels sprouts, spinach, watercress and cauliflower.64

Protein-rich foods.  By consuming protein-rich foods, you will provide your muscles enough nutrients to keep their mass.

Some examples of protein-rich foods include red and white meat, eggs and cheese.65 However, make sure to keep your protein intake at a normal level because excessive protein consumption can trigger adverse effects.

Berries. These fruits contain high amounts of antioxidants, which can strengthen your body's ability to fight off the negative effects of this autoimmune disease.66 Consider adding raspberries, strawberries, cranberries and blueberries into your diet in order to get an optimal amount of antioxidants. Just remember to consume them in moderation to avoid fructose overload.

While these foods don't necessarily treat Graves' disease, it is important that you keep your diet as healthy as possible so you can cope with the effects of this illness.

Avoid These Foods if You Have Graves' Disease

Just as there are foods that you should add to your diet, there are also foods that you should avoid to keep your symptoms from worsening. These include:

Caffeine. Caffeine is a stimulant that can increase heart rate, anxiety and nervousness, aggravating the already existing symptoms of this disorder.67 Coffee, despite its potential health benefits (if consumed organic and black), may not be advisable for those with Graves' disease because it increases heart rate and blood pressure, and has led to higher anxiety levels in some individuals.68

Other food products that contain high amounts of caffeine include tea, soda, sports drinks and foods containing chocolate.69

Unfermented soy. Unfermented soy foods, like tofu and soy milk, are often touted to be healthy, but if you're affected by a thyroid condition, eating these foods may be a bad idea. Soy contains phytoestrogens that can damage the thyroid and cause cognitive decline, especially in women.70

Processed foods. Bromine, an ingredient often found in processed foods, is an endocrine-disrupting food additive. Endocrine disruptors are chemicals that interfere with hormone production, thus affecting the immunological, neurological and developmental processes of the body.71

To avoid accidentally ingesting foods that contain bromine, avoid baked goods that are not bromine-free. Baked goods in the market today contain brominated flour and potassium bromate.72 Carbonated soft drinks also contain high amounts of bromine through the use of brominated vegetable oils (BVOs), so they must be avoided at all costs.73

Frequently Asked Questions (FAQs) About Graves' Disease

Q: Is Graves' disease hereditary?

A: According to numerous studies, there is a high probability that Graves' disease is hereditary. About 70 percent of Graves' disease occurrences are rooted in genetics, with the remaining 30 percent potentially triggered by environmental factors.74

Q: Is Graves' disease fatal?

A: While Graves' disease alone is not fatal, it can still lead to severe complications if left untreated and undiagnosed. These complications often stem from the serious cardiovascular effects of this autoimmune disease.

Q: Is Graves' disease curable?

A: Graves' disease can be managed through various treatments. However, common conventional treatments may lead to serious effects. For example, thyroid surgery will require you to take hormone replacement for the rest of your life, while radioiodine therapy may cause hypothyroidism.

Alternative methods may help you manage and treat Graves' disease symptoms. You can regulate the thyroid's production of hormones by optimizing your diet and incorporating foods that are goitrogenic. Selenium and L-carnitine may also help in improving the symptoms of this condition.

Q: How is Graves' disease diagnosed?

A: It can be diagnosed through numerous blood tests (TSH test and Free T4 Test) and a thorough observation of the patient's symptoms. There are instances where differential diagnosis is employed in order to separate the symptoms of Graves' from the symptoms of another condition.

Q: Who is usually affected by Graves' disease?

A: People who have family members with Graves' disease have a high probability of being affected by the disease at some point in their lives. People with other autoimmune diseases have also been observed to have a higher chance of being affected by this disease. These include rheumatoid arthritis, anemia, Addison's disease, and Type 1 diabetes.75

People who are exposed to different environmental factors that have been proven to trigger Graves' disease also have a high susceptibility to this condition. For more information about these environmental factors, read the section on the causes of Graves' disease.

Q: Is Graves' disease contagious?

A: No. Graves' disease is an autoimmune disease that mainly stems from the immune system's attack on the thyroid gland. It cannot be passed from person to person through physical contact.

Q: Are hyperthyroidism and Graves' disease the same?

A: No. Some sources claim that Graves' disease is the most common type of hyperthyroidism but in actuality, Graves' disease is the most common cause of hyperthyroidism. Hyperthyroidism is merely an underlying symptom of Graves' disease.

Q: Can Graves' disease go away on its own?

A: No. Early diagnosis and treatment are recommended when dealing with Graves' disease in order to limit the possibility of contracting serious complications.

Q: Is Graves' eye disease reversible?

A: Through surgery, yes. While Graves' eye disease can improve over time, the exophthalmos (the bulging of the eyes) is usually irreversible without surgery. Conventional treatments for this usually focus only on stopping the continuous inflammation and irritation that this condition brings you. Ocular decompression is usually done to reverse the bulging of the eyes by removing tissues and bones behind the eyes.76

Q: Can Graves' disease come back?

A: Yes. There are numerous accounts of Graves' disease coming back after a stage of remission. This is usually caused by the unprecedented increase in the production of thyroid-stimulating immunoglobulin. Due to this, it is important that you have regular check-ups in order to monitor whether you're still in remission.77

To avoid the recurrence of Graves' disease, it is recommended that you follow healthy lifestyle habits, such as stopping cigarette smoking because studies show that it increases the risk of both contracting the disease and relapsing.

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