What Do I Need to Know About Graves’ Disease?

Graves’ disease is an autoimmune disease that affects the thyroid — a butterfly-shaped gland in the neck that makes thyroid hormone. Thyroid hormone plays a key role in many parts of your body: It helps control metabolism, body temperature, and even heart rate. In Graves’ disease the thyroid is overactive, which means it makes too much thyroid hormone (called hyperthyroidism). 

Graves’ disease is the most common cause of hyperthyroidism in the U.S., affecting about 1 in 200 people. Keep reading to find out more about what causes Graves’ disease, its symptoms, and how it’s diagnosed and treated. 

What causes Graves’ disease?

In an autoimmune disease, your own immune system reacts against healthy parts of your body. In Graves’ disease, this happens when your body makes antibodies to thyrotropin receptors — a part of the thyroid that’s important in controlling thyroid hormone levels. This causes the thyroid to make more hormone than normal and sometimes get larger in size.

The exact cause of Graves’ disease is unknown, but it’s thought to be due to a combination of genetics and environmental triggers. 

What are the symptoms?

Graves’ disease causes symptoms of hyperthyroidism. Common signs and symptoms include:

• Weight loss

• Fatigue 

• Feeling too hot

• Increased sweating

• Fast heart rate or palpitations

• High blood pressure

• Tremor

• Anxiety or irritability

• Diarrhea

• Muscle weakness

• Difficulty sleeping

In Graves’ disease, the thyroid can get larger in size, leading to a goiter. Depending on its size, a goiter may be visible as a large lump or swelling in the middle of the neck where the thyroid is located.

Graves’ disease can cause other signs and symptoms that aren’t seen with other causes of hyperthyroidism:

• Ophthalmopathy: This is when Graves’ disease affects the eyes. It can happen in up to 50% of people with Graves’ disease. Symptoms can vary, but they include swelling around the eye, vision changes, eye pain or discomfort, dryness, and watery eyes. The eyelids may be pulled back, causing the eyes to look like they’re bulging or protruding from the face.

• Thyroid dermopathy: This is a skin rash. It usually occurs in the lower legs on the shins or tops of the feet (called pretibial myxedema), but it can also occur in other areas. The skin becomes scaly and thick and can be itchy or painful. It’s uncommon and is only seen in up to 4% of people with Graves’ disease. People with dermopathy often also have ophthalmopathy. 

• Acropachy: This is when the fingertips or toes appear swollen with curved nails. This is only seen in people with Graves’ who also have dermopathy. 

How do I test for Graves’ disease?

If you have the common signs and symptoms of Graves’ disease, you won’t need a lot of testing to make the diagnosis. Your healthcare provider can check your thyroid hormone and thyrotropin antibody levels in your blood. The diagnosis is confirmed if you have thyroid hormone levels that show hyperthyroidism and the antibodies. You may be referred to see an endocrinologist, a specialist in the thyroid gland, to discuss how to treat it.

What medication and treatments are used?

Once you’ve been diagnosed with Graves’ disease, you can discuss treatment options with your healthcare provider. The best treatment for you will depend on your own preferences, any other health conditions, and the severity of your symptoms. Medications that treat Graves’ disease include antithyroid medications, radioactive iodine, and beta blockers.

Antithyroid medications

The most common treatment is antithyroid medication. Two prescription medications are available in pill form: methimazole (Tapazole) and propylthiouracil (PTU). Methimazole is preferred, except in early pregnancy when propylthiouracil is used. These drugs work by blocking steps in the making of thyroid hormone, so the thyroid gland doesn’t produce as much. The goal of treatment is to reduce the amount of thyroid hormone to a normal amount. 

Radioactive iodine

This is a treatment that can be in pill or liquid form. Radioactive iodine damages thyroid tissue with little exposure to the rest of the body. The goal of this treatment is to cause hypothyroidism — when the thyroid no longer makes enough thyroid hormone. This cures hyperthyroidism. But you will need to take a lifelong thyroid hormone medication, like levothyroxine (Synthroid), to replace the hormone your body no longer makes. This treatment can’t be used in people who are pregnant, planning to become pregnant, or breastfeeding.

Beta blockers

Beta blockers are a class of prescription medications commonly used to treat high blood pressure. They are taken in pill form and can be started right away to treat hyperthyroidism symptoms. Beta blockers don’t cure Graves’ disease, but they can decrease symptoms of tremor, fast heart rate, anxiety, and high blood pressure. This can help you feel better while other treatments are being started or planned. Examples include propranolol (Inderal), atenolol (Tenormin), and metoprolol (Lopressor). Of note, these medications are not FDA approved (called “off-label”) for the treatment of hyperthyroidism. 

Future treatments

Medical treatment for Graves’ disease hasn’t changed in many decades. But new treatments may be available in the future. One goal of newer treatments is to stop too much thyroid hormone from being made without causing hypothyroidism. Researchers are studying new treatments that target the immune system and thyrotropin receptors. 

Will I need surgery for Graves’ disease?

Surgery to remove all (total thyroidectomy) or part (subtotal thyroidectomy) of the thyroid gland can also treat Graves’ disease. It is less common than antithyroid medications and radioactive iodine as a first-choice treatment. Surgery is usually only recommended for people who have:

• Severe symptoms

• A large goiter

• A preference to avoid or inability to take radioactive iodine or antithyroid medications long term

Thyroid surgery is very effective for treatment of hyperthyroidism. After total thyroidectomy, the chance of hyperthyroidism recurring is near 0%. With subtotal thyroidectomy, it is 8% after 5 years. After surgery, you’ll most likely have hypothyroidism because you’ll no longer have enough thyroid gland to make thyroid hormone. This means life-long thyroid hormone replacement medication will be necessary. 

How long will Graves’ disease last?

This depends on the type of treatment you receive. If you take antithyroid medication, you’ll take the medication for 1 to 2 years while your bloodwork is checked to watch thyroid hormone and antibody levels. The goal of treatment is to get these levels into a normal range before stopping the medication. 

After antithyroid medication, about 40% to 50% of people will have long-term remission or normal thyroid hormone levels for at least 12 months. But after you stop medication, hyperthyroidism can come back. Some people will need medication again, or they can consider surgery or radioactive iodine treatment. Surgery and radioactive iodine cure Graves’ disease, but they often lead to long-term hypothyroidism.

What are some complications of Graves’ disease?

Thyroid hormone affects the entire body, and having too much of it can lead to complications over time. The most serious complications involve the heart. Graves’ disease can cause abnormal heart rhythms (like atrial fibrillation) and heart failure (when the heart muscle can’t pump blood normally). Other complications include osteoporosis, muscle weakness, and stroke (though this is rare). 

Thyroid storm is a rare but serious complication that can be life-threatening. The exact cause of thyroid storm is unknown, but it happens in people with high thyroid hormone levels. Thyroid storm causes symptoms similar to what is usually seen in hyperthyroidism, but they are much more severe. People with thyroid storm may have very high body temperature, high heart rate, heart failure, and confusion. Because the symptoms are severe, thyroid storm is treated in the intensive care unit.

The best way to prevent complications from Graves’ disease is to get treatment once you are diagnosed.

Why trust our experts?

Written by:

Sarah Pozniak, MD

Sarah Pozniak, MD, has 9 years of experience since graduating medical school (6 since completing residency). She is a board-certified general internal medicine physician and has practiced as a primary care physician in both Utah and Washington, D.C. Currently, she cares for patients with chronic illnesses such as diabetes and high blood pressure using telemedicine as part of a virtual care program.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Our editorial standards

Meet our experts