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Graves' disease

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Endocrine System

Graves disease, named after Robert J. Graves, MD, circa 1830s, is an autoimmune disease characterized by hyperthyroidism due to circulating autoantibodies. Thyroid-stimulating immunoglobulins (TSIs) bind to and activate the thyroid stimulating hormone (TSH) receptors, causing the thyroid gland to grow and the thyroid follicles to increase synthesis of thyroid hormone. Graves disease, along with Hashimoto thyroiditis, is classified as an autoimmune thyroid disorder. Graves' disease is the most common form of hyperthyroidism. It occurs when your immune system, which normally protects your body from bacteria and viruses, mistakenly attacks your thyroid gland and causes it to overproduce the thyroid hormone, thyroxine. This autoimmune response can also affect the tissue behind your eyes (Graves' ophthalmopathy) and the skin on your lower legs and feet (Graves' dermopathy).

When you have too much thyroid hormone in your system, your body's metabolism rate can increase by 60 percent to 100 percent, because thyroxine regulates your cells' metabolism. A higher metabolism can lead to a number of health problems, such as an irregular heartbeat or anxiety.

Graves' disease is rarely life-threatening. Although it may develop at any age and in either men or women, Graves' disease is far more common in women and usually begins between 20 and 40 years of age.

There's no way to stop your immune system from attacking the thyroid gland, but treatments can decrease the production of thyroxine.


There's no treatment to stop your immune system from producing the antibodies that cause Graves' disease. Treatments to control the symptoms of Graves' disease are designed to decrease the production of thyroxine or to block its action. They include:

  • Beta blockers. These medications, which include propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor) and nadolol (Corgard), often bring quick relief of hyperthyroid signs and symptoms, such as a rapid heart rate, nervousness and tremors. These medications aren't a cure for Graves' because your body will still produce too much thyroxine, but beta blockers block some of the action of the thyroid hormone. Beta blockers are often used in conjunction with other forms of treatment.

  • Anti-thyroid medications. These prescription medications include propylthiouracil and methimazole (Tapazole) and prevent your thyroid from producing excessive amounts of hormones. Typically, treatment with anti-thyroid medications continues for at least a year. For 20 percent to 30 percent of people with Graves' disease, treatment with anti-thyroid medications for 12 to 18 months causes a long-term remission of the disease. However, relapse is fairly common. These drugs are often used in combination with radioactive iodine treatment or surgery to help control signs and symptoms. About 5 percent of people who take these medications have an adverse reaction to them.

  • Radioactive iodine treatment. To make thyroid hormone, your body needs iodine and will use whatever form of iodine is available in your blood. If you take radioactive iodine, the iodine collects in your thyroid gland, and over time the radioactivity destroys the overactive thyroid cells. This causes the thyroid gland to shrink, and problems lessen gradually, usually over several weeks to several months. Because this treatment causes thyroid activity to decline, you likely will later need thyroxine treatment to supply your body with normal amounts of thyroid hormones. Treatment doesn't require a hospital stay. Radioactive iodine treatment given in the small doses used to treat Graves' disease has few side effects. After radioactive iodine treatment, any iodine not taken up into the thyroid gland is excreted in your urine and saliva. This treatment is used for more than 70 percent of adults with hyperthyroidism.

  • Surgery. If you can't tolerate an anti-thyroid drug and don't want to have radioactive iodine therapy, surgery to remove your thyroid gland (thyroidectomy) is an option. After the surgery, you'll likely need thyroxine treatment to supply your body with normal amounts of thyroid hormones after the surgery. Risks of this surgery include potential damage to your vocal cords and your parathyroid glands, tiny glands located on your thyroid gland. Your parathyroid glands produce a hormone that controls the level of calcium in your blood. Complications occur in less than 1 percent of people under the care of a surgeon experienced in thyroid surgery.

If Graves' disease affects your eyes (Graves' ophthalmopathy), you can manage mild symptoms by using artificial tears liberally during the day and lubricating gels at night. If your symptoms are more severe, your doctor may recommend:

  • Medications. Treatment with prescription corticosteroids may diminish swelling behind your eyeball.

  • Orbital decompression surgery. In this surgery, your doctor removes the bone between your eye socket (orbit) and your sinuses — the air spaces next to the orbit. This gives the eyes room to move back to their original position. Possible complications include double vision and lip numbness.

  • Eye muscle surgery. The inflammation caused by Graves' disease can affect your eye muscles, making them too short to allow the eyes to align properly. In eye muscle surgery, your doctor cuts the muscle where it attaches to your eyeball and then reattaches it farther back. Sometimes, more than one operation is necessary.

  • Prisms. You may have double vision either because of Graves' disease or as a side effect of surgery for Graves' disease. Though they don't work for everyone, prisms in your glasses may correct your double vision.

Orbital radiotherapy was once a common treatment for Graves' ophthalmopathy. Orbital radiotherapy uses targeted X-rays over the course of several days to destroy some of the tissue behind your eyes. However, Mayo Clinic studies have suggested that this treatment provides no benefit for people who have mild to moderately severe Graves' ophthalmopathy. Researchers believe that because of the costs, risks and ineffectiveness, orbital radiotherapy isn't for people who have mild to moderately severe Graves' ophthalmopathy.

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