is an autoimmune disorder that causes the thyroid gland to produce excessive thyroid hormones, leading to hyperthyroidism. It is the most common cause of hyperthyroidism in the United States, affecting approximately 0.5% of men and 3% of women, with a 7–8 times higher prevalence in women, especially those of reproductive age.
Symptoms
Symptoms result from both hyperthyroidism and autoimmune effects:
Common hyperthyroid symptoms: Weight loss despite increased appetite, rapid or irregular heartbeat, nervousness, irritability, tremors, heat intolerance, excessive sweating, insomnia, and frequent bowel movements.
Unique to Graves' disease: Bulging eyes (Graves' ophthalmopathy), thick red skin on the shins or feet (pretibial myxedema), and an enlarged thyroid gland (goiter). Up to 30% of patients develop eye problems.
Causes and Risk Factors
Cause: Autoantibodies called thyroid-stimulating immunoglobulins (TSIs) bind to and activate the TSH receptor on thyroid cells, causing overproduction of thyroid hormones.
Risk factors:
Family history of autoimmune diseases (e.g., type 1 diabetes, rheumatoid arthritis).
Other autoimmune conditions.
Smoking (strongly linked to worsening eye disease).
Recent pregnancy or childbirth (risk increases in the year postpartum).
Infections (e.g., Epstein-Barr virus) and emotional or physical stress may trigger onset.
Diagnosis
Blood tests: High T3/T4, low TSH, and presence of TSI antibodies.
Radioactive iodine uptake (RAIU) test: Shows increased uptake, indicating Graves' disease.
Imaging: Ultrasound or scan may show diffuse thyroid enlargement.
Treatment Options
Antithyroid medications (e.g., methimazole, propylthiouracil): Reduce hormone production. Methimazole is preferred but avoided in early pregnancy.
Radioactive iodine (RAI): Destroys overactive thyroid tissue; often leads to hypothyroidism requiring lifelong thyroid hormone replacement.
Surgery (thyroidectomy): Removal of the thyroid gland; also results in hypothyroidism needing hormone replacement.
Beta blockers: Help manage symptoms like rapid heart rate and tremors while other treatments take effect.
Eye treatment: For Graves' ophthalmopathy — may include eye drops, corticosteroids, radiation, or surgery.
Complications
Untreated Graves’ disease can lead to:
Thyroid storm (life-threatening, sudden surge in thyroid hormones).
Heart problems (e.g., atrial fibrillation, heart failure).
Osteoporosis due to bone loss.
Infertility or complications during pregnancy.
Key Notes
Graves’ disease is lifelong, but symptoms are manageable with treatment.
Smoking significantly increases the risk and severity of eye disease; quitting improves outcomes.
Women may experience menstrual irregularities, fertility issues, and worsening symptoms postpartum.
For accurate diagnosis and treatment, consult an endocrinologist.