Graves’ disease is the most common cause of hyperthyroidism, a condition in which the thyroid gland produces excessive amounts of a hormone called thyroxine. This causes a person’s metabolism to speed up, resulting in various health consequences.

Graves’ disease is an autoimmune disorder, meaning the immune system mistakenly attacks the body and stimulates increased production of thyroid hormone. In addition, some people with Graves’ disease may experience a swelling of tissues behind the eyes that causes the eyes to bulge. This is known as Graves’ ophthalmopathy.

Finally, some patients with Graves’ diseases develop a reddening and swelling of the skin that affects the shins and the top of the feet. This is known as Graves’ dermopathy.

Patients with Graves’ disease may experience many of the symptoms of hyperthyroidism, including anxiety and irritability. They may have trouble sleeping and may experience fatigue and unexplained weight loss, despite eating normally.

In diagnosing Graves’ disease, a physician will review the patient’s medical history and perform a physical examination. Thyroid blood testing and other techniques may also be used. Treatments are similar to those for hyperthyroidism and may include medications or surgery.

In addition, patients with Graves’ ophthalmopathy may benefit from various self-care techniques. Patients with Graves’ dermopathy may benefit from using creams designed to provide relief from their symptoms.

Graves’ disease is a condition in which the body’s immune system attacks itself, causing an overproduction of a hormone called thyroxine. This hormonal excess causes hyperthyroidism. Graves’ disease is the most common cause of hyperthyroidism, which causes the body’s metabolism to speed up.

The thyroid gland sits just below the Adam’s apple in the neck. It secretes hormones (especially thyroxine) that regulate a person’s metabolism, the physical and chemical processes necessary for the maintenance of life. Thyroid hormones help to:

• Control the rate at which the body uses fats and carbohydrates
  
• Maintain body temperature
  
• Influence heart rate
  
• Regulate the production of protein
  
• Regulate the amount of calcium in the blood

Graves’ disease can increase a person’s metabolism by between 60 to 100 percent. Patients may experience symptoms such as anxiety and irregular heartbeat. The disease rarely is life-threatening if treated properly.

Graves’ disease is an autoimmune disorder that disrupts the thyroid gland’s function. In a healthy person, the immune system uses proteins called antibodies and white blood cells to attack harmful substances that enter the body, including viruses, bacteria and other foreign substances. Patients with autoimmune disorders such as Graves' disease have immune system antibodies that attack normal cells as if they were foreign invaders. In Graves' disease, an antibody called thyrotropin receptor antibody causes the thyroid to make excessive amounts of thyroid hormone. This can lead to symptoms that adversely affect a person’s health.

Some cases of Graves’ disease may cause the eyes to bulge beyond their normal protective orbit. This occurs when tissues and muscles behind the eyes swell, a condition known as Graves’ ophthalmopathy. As the eye pushes out farther, it is more vulnerable to dryness. Inflammation associated with this process causes a buildup of scar tissue that causes the eye muscles to shorten and tighten. This forces the eyes out of proper alignment, and may result in double vision.

In other cases, patients may develop a reddening and swelling of the skin that affects the shins and the top of the feet. This is known as Graves’ dermopathy.

Graves’ disease usually is treated effectively with medications or thyroid surgery or frequently with a capsule composed of radioactive iodine. However, untreated Graves’ disease can be fatal.

This condition is named after Robert Graves, an Irish physician who described it in the 19th century. Other terms for Graves’ disease include toxic diffuse goiter and diffuse thyrotoxic goiter. Goiter, an enlargement of the thyroid gland, is a symptom of hyperthyroidism.

Graves’ disease is an autoimmune disorder that disrupts the thyroid gland’s function. Patients with Graves’ disease have immune systems that mistakenly attack the thyroid. An antibody called thyrotropin receptor antibody causes the thyroid to make excessive amounts of thyroid hormone.

Graves’ disease is more common in women than men. With the notable exception of type 1 diabetes, this prevalence is typical of autoimmune disorders – about 75 percent  of autoimmune disorders affect women, according to the U.S. Department of Health and Human Services. People who have one autoimmune condition are at increased risk of developing others.

Graves’ disease typically affects people after the age of 20 and is most likely to strike women during childbearing years. There may be a genetic component to the disease, and stress may play a role in triggering the illness.

Other potential risk factors may include exposure to radioactive iodine.

Graves’ ophthalmopathy is a complication of Graves’ disease that occurs when tissues behind the eye attract and hold water. This results in a swelling that pushes the eye forward past its protective socket. People who have Graves’ disease and smoke cigarettes may be at increased risk of eye problems such as Graves’ ophthalmopathy, according to the Centers for Disease Control and Prevention (CDC).

Patients with Graves’ disease may experience many of the symptoms of hyperthyroidism, including anxiety and irritability. They may have trouble sleeping and may experience fatigue and unexplained weight loss, despite eating normally or excessively (polyphagia).

Other symptoms may include:

• Changes in bowel patterns. In particular, patients are more likely to have increased frequency of bowel movements.
  
  
• Changes to appearance. Patients may experience thinning of the skin and may develop fine, brittle hair.
  
  
• Enlarged thyroid gland. Also known as goiter, this can be felt or even seen as a swelling at the base of the neck.
  
  
• Increased sweating. Some patients also may experience increased sensitivity to heat.
  
  
• Irregular or rapid heartbeat. Patients may experience irregular heartbeat (arrhythmia) and palpitations. They also may experience rapid heartbeat of more than 100 beats per minute.
  
  
• Irritability. Patients sometimes experience anxiety attacks.
  
  
• Tremor. Most often, this appears as a fine trembling in the hands or fingers.
  
  
• Irregular menstruation. Women may experience light or absent periods.

Graves’ disease is the only cause of hyperthyroidism that causes swelling of tissues behind the eyes. This is known as Graves’ ophthalmopathy, and its symptoms may include:

• Blurry or double vision
  
• Bulging eyes beyond the protective socket
  
• Dryness on the eye surface
  
• Excessive tearing or discomfort
  
• Inflammation
  
• Red or swollen eyes
  
• Reduced eye movement
  
• Sensation of grit or sand in the eyes
  
• Sensitivity to light
  
• Widening of space between eyelids

Less frequently, patients with Graves’ ophthalmopathy may experience more severe symptoms. These may include ulcers on the cornea of the eye, double vision, limitations on eye movement, and blurred or reduced vision.

Graves’ disease also may cause a lumpy, reddish thickening on the skin in front of the shins and on the top of the feet. This is known as Graves’ dermopathy, or pretibial myxedema. In most cases, this skin condition does not cause pain.

In diagnosing Graves’ disease, a physician will review the patient’s medical history and perform a physical examination. The patient will be asked to swallow while the physician examines the thyroid gland for changes. The physician also will look for signs such as tremor in the fingers when they are extended and changes in the eyes.

Changes in certain vital signs (pulse, rate of breathing) may indicate an increased heart rate. Blood pressure may be high, particularly systolic pressure (the top number in a blood pressure reading).

Graves’ disease can also be diagnosed with an imaging test called a radioactive iodine uptake and scan.

Methods of diagnosing and treating Graves’ disease are similar to those of diagnosing and treating hyperthyroidism. Treatment may involve different medications or surgery.

In addition to the types of blood tests used for hyperthyroidism, patients suspected of having Graves’ disease may receive a blood test known as a thyroid stimulating immunoglobulin (TSI) test. For example, this test is often used in patients who have eye problems that appear to be related to Graves’ disease but who also have normal thyroid function.

Graves’ ophthalmopathy usually can be diagnosed visually by looking for the characteristic bulging of a patient’s eyes. Mild cases of this disorder may be treated with self-care techniques. These include avoiding wind and bright lights and using over-the-counter substances (e.g., artificial tears, lubricating gels).

Symptoms can be treated with cool compresses to the eyes or lubricating eyedrops. Wearing sunglasses can protect the eyes from the ultraviolet rays of the sun. Elevating the head of the bed can reduce blood flow to the head, which in turn reduces pressure on the eyes. Patients who experience swelling of the skin may benefit from over-the-counter hydrocortisone or triamcinolone creams. Patients are advised not to use any medication without first consulting a physician.

More significant cases of Graves’ ophthalmopathy may require prescription medications or surgery. Prescription corticosteroids, a class of anti-inflammatory and immunosuppressive drugs, can be used to reduce swelling behind the eyes. Possible risks of long-term use of corticosteroids include diabetes, osteoporosis, glaucoma and cataracts.

Severe cases of Graves’ ophthalmopathy may require surgery. Orbital decompression surgery involves removal of the bone between the eye socket and sinuses to improve vision and provide room for the eyes to return to their normal position. Eye muscle surgery involves cutting a muscle from an eye and reattaching it farther back. This can reduce double vision caused by Graves’ ophthalmopathy. Surgery also may be used to reposition the eyelids so that they better cover the surface of the eye. This helps prevent the eyes from tearing excessively.

In some cases, double vision associated with Graves’ ophthalmopathy is treated by adding prisms to a patient’s prescription lenses to help force the eyes to work together. These can either be ground into the prescription itself or temporarily pasted on to the lenses.

Graves’ dermopathy can be treated with over-the-counter creams or ointments that contain hydrocortisone. Compression wraps worn around the legs also may help reduce symptoms.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to Graves’ disease:

1. What are the first signs that I may have Graves’ disease?
   
   
2. How will you diagnose my Graves’ disease?
   
   
3. Do I need to do anything to prepare for blood tests or imaging tests?
   
   
4. What is the likely source of my Graves’ disease?
   
   
5. Do I have Graves’ ophthalmopathy?
   
   
6. Do I have Graves’ dermopathy?
   
   
7. What are my treatment options? What are the pros and cons of these treatments?
   
   
8. How long will I need to take my antithyroid medication or radioactive iodine?
   
   
9. Will I need to take a thyroid supplement for the rest of my life?
   
   
10. What is my long-term prognosis?