Graves' Disease

Graves' disease is an autoimmune disorder in which the thyroid gland overproduces thyroid hormones, causing a condition called hyperthyroidism. It occurs when the body’s immune system–which normally fights off infection—mistakenly attacks the thyroid gland, which is located in the neck.

Having excess thyroid hormone in the bloodstream makes the body’s metabolism too active and affects many different parts of the body. As a result, Graves' disease symptoms can be extremely varied. They can include weight loss, anxiety, heart palpitations, sleep difficulties, and erectile dysfunction or reduced libido.

An estimated 30% of people with Graves’ disease develop what’s called Graves’ ophthalmopathy, which can cause bulging eyes, vision problems, pain and redness.

Some people have a rarer skin problem called Graves’ dermopathy, in which the skin reddens and thickens, usually on the shins or tops of the feet.

Left untreated, Graves’ disease can lead to complications such as pregnancy issues, heart disorders, brittle bones, and a life-threatening condition called thyroid storm. The sudden increase in thyroid hormones creates a “storm” of effects including severe weakness, fever, seizures, delirium, severe low blood pressure, and coma.

While Graves’ disease can affect anyone, it’s more commonly seen in women and in people under the age of 40. It can even affect newborns if the mother has or had Graves’ disease, and can be fatal if not diagnosed right away.

Graves’ disease treatment aims to control the overproduction of thyroid hormones and reduce the severity of symptoms. Options include radioactive iodine therapy (an oral pill with a radioactive substance that targets and destroys overactive thyroid cells), anti-thyroid medications, and surgery to remove part or all of the thyroid gland.

Because Graves’ disease can be confused with other medical conditions and be challenging to diagnose, it’s important to see an endocrinology specialist for a timely, accurate diagnosis and appropriate treatment.

Why Choose Cooper to Diagnose and Treat Graves’ Disease

With 10 board-certified endocrinologists, Cooper is home to South Jersey’s largest and most comprehensive team of Graves’ disease experts. They also serve as faculty at Cooper Medical School at Rowan University—testament to the high level of advanced expertise available here. Count on us for:

  • The latest knowledge about Graves’ disease treatments, including radioactive iodine therapy, medications and surgery
  • A multidisciplinary team approach to care— Because Graves’ can affect multiple body systems, including the eyes, heart and skin, effective care requires many specialists. As an academic health system, Cooper has experts in more than 75 specialties, giving you streamlined access to all the expertise you need, all in one place.

Graves’ Disease Causes and Risk Factors

We don’t yet know for certain the precise cause of Graves’ disease. As with any autoimmune disorder, it occurs when your immune system mistakenly attacks your body instead of an outside “invader” such as infection.

When you have Graves’ disease, your immune system creates antibodies that trick your thyroid gland into producing more thyroid hormone than your body needs, causing hyperthyroidism.

Risk factors for Graves’ disease include:

  • Family history: If you have a family member with Graves’ disease, you are more likely to develop it. Scientists are working to identify the specific gene(s) that trigger(s) this disorder.
  • Gender: As with many other autoimmune conditions, women are much more likely than men to develop Graves’ disease
  • Age: Graves’ disease most often develops in people under age 40
  • Having other autoimmune disorders: People with other immune system diseases such as rheumatoid arthritis or lupus have an increased risk of developing Graves’ disease
  • Pregnancy: Being pregnant or recently giving birth may increase the risk of Grave’s disease, especially in women with a family history of this disorder
  • Stress: Emotional or physical stress may trigger the onset of Graves’ disease in people who are genetically susceptible
  • Smoking: Because smoking affects the immune system, it increases the risk of Graves’ disease as well as Graves’ ophthalmopathy

Symptoms of Graves’ Disease

The signs and symptoms of Graves’ disease are extremely varied and can include:

  • Anxiety and irritability
  • Bulging eyes (Graves' ophthalmopathy)
  • Chest pain
  • Difficulty sleeping/insomnia
  • Erectile dysfunction or reduced libido
  • Eye problems (blurred vision, light sensitivity, grittiness sensation, eye pain)
  • Fatigue
  • Frequent bowel movements or diarrhea
  • Hand tremors
  • Heart palpitations (fast or irregular heartbeat)
  • Heat sensitivity and increased perspiration
  • Increased blood pressure
  • Menstrual irregularities
  • Muscle weakness
  • Restlessness
  • Shortness of breath and/or breathing difficulty
  • Thick, red skin, usually on the shins or tops of the feet (Graves' dermopathy)
  • Thyroid gland enlargement (goiter)
  • Weight loss, despite normal or increased appetite

Treating Graves’ Disease

The goals in treating Graves' disease are to lower the production of thyroid hormones and block their effect on the body. Treatment options include:

  • Radioactive iodine (RAI) therapy: This is given in a pill or water-based solution that you swallow. It works by destroying thyroid tissue cells, which reduces your thyroid hormone levels and symptoms over weeks or months. Usually only one dose is needed. Many patients eventually develop hypothyroidism (too little thyroid hormone), so you will be given synthetic thyroid pills to achieve the right balance. RAI cannot be used if you are pregnant or breastfeeding.
  • Anti-thyroid medications: These prescription oral medications help prevent the thyroid from producing hormones by interfering with the gland’s use of iodine (which it needs for hormone production). These drugs may also be used before or after RAI as a supplemental treatment.
  • Surgery: Surgery to remove a portion or all of your thyroid gland is also an option for treating Graves’ disease. You will probably have to take synthetic thyroid hormone pills to supply your body with the appropriate level of hormones after surgery.
  • Beta blockers: While these medications don’t block production of thyroid hormones, they can block the effects of hormones on your body, providing relief for such symptoms as heart palpitations, tremors, anxiety, heat intolerance and sweating, muscle weakness and diarrhea.

If you have Graves’ ophthalmopathy, you may be able to manage mild symptoms with over-the-counter lubricating drops and gels. If your symptoms are more severe, your doctor may recommend:

  • Corticosteroids to reduce swelling behind the eyeballs
  • Prisms in your eyeglasses, which may correct double vision
  • Orbital decompression surgery to address bulging eyes; this procedure gives your eyes room to return to their normal position. It’s usually performed if you risk vision loss due to pressure on the optic nerve.

Make an Appointment with a Graves' Disease Expert at Cooper

To learn more about the resources available for treating Graves’ disease at Cooper or to request an appointment, please call 800.8.COOPER (800.826.6737).