Graves’ Disease: Symptoms, Specific Causes, And Current Treatments

Graves’ disease is an autoimmune disorder that causes the thyroid gland to over-produce thyroid hormone. This condition leads to overactivity of the entire thyroid gland (hyperthyroidism). It is the most common cause of hyperthyroidism in the United States. It is named after Robert Graves, an Irish physician, who described this form of hyperthyroidism in 1868.

Graves’ Disease: Importance of Your Thyroid Gland

The thyroid gland is a butterfly-shaped organ located in the base of your neck. It releases hormones that control metabolism, the way your body uses energy. The thyroid’s hormones regulate vital body functions, including:

• Breathing
• Heart rate
• Central and peripheral nervous systems
• Body weight
• Muscle strength
• Menstrual cycles
• Body temperature
• Cholesterol levels
• Much more!

The thyroid gland is about 2-inches long and lies in front of your throat below the prominence of thyroid cartilage sometimes called the Adam’s apple. The thyroid has two sides called lobes that lie on either side of your windpipe, and is usually connected by a strip of thyroid tissue known as an isthmus. Some people do not have an isthmus, and instead have two separate thyroid lobes.

Graves Disease: How the Thyroid Gland Works

The thyroid is part of the endocrine system, which is made up of glands that produce, store, and release hormones into the bloodstream so the hormones can reach the body’s cells. The thyroid gland uses iodine from the foods you eat to make two main hormones:

• Triiodothyronine (T3)
• Thyroxine (T4)

It is important that T3 and T4 levels are neither too high nor too low. Two glands in the brain, the hypothalamus and the pituitary communicate to maintain T3 and T4 balance.

The hypothalamus produces TSH Releasing Hormone (TRH) that signals the pituitary to tell the thyroid gland to produce more or less of T3 and T4 by either increasing or decreasing the release of a hormone called thyroid stimulating hormone (TSH).

• When T3 and T4 levels are low in the blood, the pituitary gland releases more TSH to tell the thyroid gland to produce more thyroid hormones.
• If T3 and T4 levels are high, the pituitary gland releases less TSH to the thyroid gland to slow production of these hormones.

Graves’ Disease: Symptoms

Common Graves’ disease symptoms are:

• anxiety
• bulging eyes
• chest pain
• difficulty sleeping and/or insomnia
• elevated blood pressure
• fatigue
• hand tremors
• increased sweating
• irregular menstrual periods
• irritability or nervousness
• more frequent stools and/or diarrhea
• muscle weakness
• rapid or irregular heartbeat
• restlessness
• sensitivity to heat
• shortness of breath and/or difficulty breathing
• unexplained weight loss (typically despite an increase in appetite)
• vision problems or changes

Graves’ Disease: Specific Symptoms

Eye problems: Graves’ disease is the only type of hyperthyroidism that involves inflammation of the eyes and bulging eyes.

Eye problems  can be anywhere from mild to extremely severe. In more mild cases, your eyes may become red and inflamed. Or they may tear or be very sensitive to light.

In severe cases, the disease can cause inflammation of the eye muscles. The muscles and tissues of the eyes may become swollen and may cause your eyes to protrude from their sockets. This is called exophthalmos.

Goiter: A goiter is an enlarged thyroid gland that can cause the front of the neck to look swollen. These goiters can be small lumps or they can be large. A goiter can make swallowing difficult. If it’s big enough, it can also cause you to cough and may make it more difficult for you to sleep.

Skin problems: In rare cases, Graves’ disease can cause you to develop lumpy reddish patches and thickening of the skin of the shin. Although,this skin condition may look severe, it’s usually painless and is not serious.

It’s also important to note that some people with Grave’s disease will have many of these symptoms, not everyone will have it in the early stages.

Graves’ Disease: Causes

Researchers are still investigating what triggers this autoimmune response, some researchers think that the cause of Graves’ disease may be tied to your family history.

Because Graves’ disease may have a genetic link, that means if you have a family member with Graves’ disease, then you’re more likely to develop it, too.

Another risk factor that makes you more prone to developing Graves’ disease is your gender. As with other autoimmune conditions, Graves’ disease is more likely to affect women than men.

Graves’ is most common in women older than 20 years old. Researchers are also investigating specific genes involved in triggering Graves’ disease.

Graves’ Disease: Diagnosis

Testing Free T4 Hormone Levels

A free T4 is another type of blood test run if your TSH is not normal. It is a newer test than the total T4. Results from a total T4 (as described above) may be altered by blood proteins that bind to the T4 hormone.

However, a free T4 is less affected by blood proteins and reveals a more accurate picture of thyroid function or dysfunction. A free T4 may be recommended when you have a goiter, as in some cases of Graves’ disease.

Thyroid-stimulating immunoglobulin (TSI) is a type of antibody (immunoglobulin) measured from drawn blood. TSIs can bind to tissues in the eyeballs and beneath the skin and contribute to the development of exophthalmos (bulging eyes) and pretibial myxedema (skin thickening on the front of the lower legs). You can read our article on these possible symptoms of Graves’ disease to learn more.

Checking the TSI level is done if the doctor can’t definitively diagnose Graves’ disease from your symptoms and TSH, T3, and T4 levels.

Graves’ Disease: Testing Thyroid Peroxidase Antibodies (TPO) Level

Since Graves’ disease is an autoimmune disorder, this blood test may be recommended. TPO measures the level of thyroid peroxidase antibodies. If you have those antibodies in your blood, it suggests that the immune system has attacked the thyroid. However, about 5-10% of healthy people test positive for TPO antibodies, so the presence of these antibodies doesn’t always indicate that you have an autoimmune disorder.

Graves’ Disease: Radioactive Iodine Uptake (RAIU) and Scan

A radioactive iodine uptake test and scan will measure the amount of iodine your thyroid absorbs and also determine if all or only part of the thyroid is overactive. This test is usually performed in a hospital or medical center’s nuclear imaging department.

RAIU involves taking an iodine “pill” called a radioactive tracer four to six hours before your first thyroid gland scan.  It’s a specific test because the thyroid absorbs iodine much better than other parts of the body, especially if your thyroid is overactive.

Another scan is repeated 24 hours later. The test is not painful and requires you to lie on a padded table with your head tipped backward to fully expose your neck and thyroid area.

The amount of radioactive tracer your thyroid absorbs determines if your thyroid function is normal or abnormal. A high uptake of iodine tracer may mean you have hyperthyroidism or Graves’ disease.

Graves’ Disease: Treatments

With proper treatment, you can minimize the effects of Graves’ disease. The goal of treatment is to prevent over-production of thyroid hormones. There are three treatment options for Graves’ disease.