Grave's disease

What is Grave's disease?

Graves’ disease is an autoimmune disease that affects your thyroid — a butterfly-shaped gland in your throat. It can also affect your eyes, skin, liver, heart, and bones. 

Thyroid receptor antibodies (TRAb) attach to the thyroid-stimulating hormone (TSH) receptor on the surface of cells in your thyroid gland. This overstimulates them and causes the gland to grow larger, and to produce excess thyroid hormones.

Around 3 in 4 people with an overactive thyroid have Graves' disease and it’s more common in young and middle-aged women.

What causes Graves’ disease?

Graves’ disease is an autoimmune condition caused by the overproduction of TSH receptor antibodies. 

TSH receptor antibodies (TRAb) attach to the thyroid-stimulating hormone (TSH) receptor on the surface of cells in your thyroid gland. These antibodies overstimulate the receptors, causing the thyroid gland to grow in size and produce excess thyroid hormones. Around 3 in 4 people with an overactive thyroid have Graves' disease and it’s more common in young and middle-aged women.

Like Hashimoto’s disease, it’s also associated with other autoimmune diseases and can run in families and in both identical and non-identical twins. Graves’ disease is 7-8 times more common in women than in men.

Other risk factors for Graves’ disease include:

• smoking
• stress
• infection
• pregnancy (postpartum)
• iodine exposure — high levels can damage your thyroid gland
• drugs like amiodarone, or highly active antiretroviral therapy (HAART) — a treatment used to manage Human Immunodeficiency Virus (HIV)

What are the symptoms of Grave's disease?

Most of the symptoms of Graves’ disease are related to an overactive thyroid, including:

• increased appetite
• sweating or heat intolerance
• weight loss
• tremors — uncontrollable shaking or trembling in a part of your body
• fast or irregular heartbeat — your heart might feel like it's pounding or fluttering irregularly (palpitations)
• irregular periods
• irritability or nervousness
• diarrhoea
• hair loss

Graves’ disease can also cause problems with your eyes (Graves’ ophthalmopathy), including:

• redness and pain
• puffiness around your eyes
• bulging of your eyes
• vision loss as swelling progresses

Getting a Graves’ disease diagnosis

Getting a Graves’ disease diagnosis typically involves giving your GP information about your symptoms and whether or not you have a family history of autoimmune diseases and Graves’ disease.

Next, you’ll have a physical examination to look for clinical features of Graves disease. These can include:

• Thyroid eye disease (Graves’ ophthalmopathy) — affects 25% to 50% of people who have Graves’ disease. This can manifest as pain or pressure in or behind your eyes, but can also show no symptoms
• enlarged thyroid (also known as a goitre) — with or without bruit (a continuous sound that’s heard over your thyroid due to increased blood flow)
• Graves' dermopathy (pretibial myxedema) — thickening of the skin around your legs, although this is a less common symptom

As well as a physical examination, you’ll need a blood test to measure your thyroid-stimulating hormone (TSH) levels as a first screening test. Advanced thyroid tests detecting the presence of TRAb can then be used to confirm the diagnosis. You can do this by using a thyroid blood test at home.

How to treat Grave's disease

There are many treatment options for Graves’ disease.

Some of these include:

• beta-blockers — medication used to manage the symptoms of heart palpitations and muscle tremors by slowing down your heart
• carbimazole — medication used to block excessive production of thyroxine (T4) and triiodothyronine (T3)
• radioactive iodine treatments
• in severe cases, surgical removal of your thyroid gland

If left untreated, Graves’ Disease can lead to:

• psychosis — losing contact with reality
• tachyarrhythmia — a racing heart of 100 or more beats a minute
• heart failure — your heart is unable to pump blood around your body properly
• vision loss
• weak bones (osteoporosis)