Graves’ disease is the leading cause of hyperthyroidism in the U.S., and it’s an autoimmune disorder that makes the thyroid gland release too much hormone. This results in symptoms such as a rapid heartbeat and anxiety that may come and go and, in rare cases, can lead to serious issues like heart failure. Named after the Irish doctor Robert Graves who identified the condition in 1835, this disease affects around 1% of the population, most often between the ages of 30 and 50.
Diagnosing Graves’ disease involves ruling out other causes of hyperthyroidism, like viruses, certain drugs, and thyroid growths. Thankfully, there are several effective treatments available, although managing the condition long-term is necessary. The excess thyroid hormone can impact various organs, and while symptoms can differ based on age and severity, they frequently come in episodes, though they can sometimes be persistent.
Around 25% of those with Graves’ might notice changes in their eyes, such as bulging or swelling that can affect vision. If untreated, elevated thyroid levels can cause heart problems like atrial fibrillation, where the heart’s upper chamber doesn’t beat normally, potentially leading to blood clots and strokes.
A small number of people with Graves’ disease could experience a thyroid storm, a life-threatening situation caused by a sudden increase in thyroid hormone, often triggered by something like an infection. This condition results in severe hyperthyroidism symptoms, alongside additional ones like fever, low blood pressure, liver failure, altered mental status, and even heart failure, requiring immediate medical attention.
Researchers are still trying to understand what triggers Graves’ disease. It’s known that the immune system starts overproducing an antibody that binds to healthy thyroid cells, causing an excess hormone release throughout the body. While certain genetic variations might influence susceptibility, not everyone with these variants develops Graves’ disease. Some environmental factors, like viruses, could also play a role in triggering the disease in some individuals.
Women are about five times more likely to develop Graves’ disease, with female genetic sex at birth being the biggest risk factor. Other potential risk factors aren’t clearly defined yet. Health history and physical exams might suggest hyperthyroidism, but determining the specific cause is important because Graves’ isn’t the only possibility.
Key tests for hyperthyroidism involve the thyroid gland’s use of iodine. A common diagnostic method is the radioactive iodine uptake test, which assesses how the thyroid is functioning. In this test, you swallow a pill with radioactive iodine that gets absorbed by your thyroid, making it visible to a special camera. Alternatively, a thyroid ultrasound can be used, which creates a 2D image using sound waves.
Graves’ disease treatment includes both immediate and long-term strategies. Initially, a healthcare provider might recommend beta-blockers to manage symptoms like a racing heart or anxiety. Propranolol is a common beta-blocker used for this purpose.
There are three main long-term treatment options for Graves’ disease. Your best choice may depend on your age, overall health, and personal preferences. After an ablation treatment, you might need to avoid others for a few days to prevent radiation exposure, but this method is safe and effective. However, it’s not suitable for pregnant individuals due to potential risks to the fetus.
Prevention of Graves’ disease isn’t fully understood, but avoiding smoking might reduce the risk and lessen the chances of developing eye symptoms, which can occur even after radioactive iodine treatment. The outlook for treated Graves’ disease is positive, though it varies based on treatment choices. Some can stop antithyroid medications without symptoms returning, but for about half, the symptoms come back within a year. It’s crucial to continue medications as directed to avoid a life-threatening thyroid storm.
Radioactive ablation or surgery can cure hyperthyroidism, but they result in permanent hypothyroidism since the thyroid no longer functions, necessitating lifelong thyroid hormone supplements. While manageable, this is a reason some people prefer trying antithyroid medication first.
