Graves’ disease

Graves’ disease is an autoimmune disorder where the thyroid is attacked by your immune system. Because of this attack on the thyroid, it becomes overactive and produces more hormone than it needs to.

The symptoms of Graves’ disease reflect the usual role of thyroid hormone in regulating many of the body’s metabolic processes.  Symptoms can therefore be many and varied in severity and may include:

• Increased /irregular heart rate – noticed as palpitations
• Weight loss
• Difficulty sleeping
• Tiredness
• Conversely also an increase in energy levels
• Feeling irritated or anxious
• Change in bowel habits (e.g. needing to go more often or having diarrhoea)
• Eye symptoms including redness, dryness, irritation and in more severe cases, Graves’ ophthalmopathy – with protruberant staring eyes and double vision
• Weakness in your muscles
• Tremors in your fingers or hands
• Becoming more sensitive to heat
• Changes to your menstrual cycle
• Erectile dysfunction
• Diminished sex drive
• Goitre (an enlargement of the thyroid gland) – this does not always occur
• Graves’ dermopathy – a relatively rare symptom where the skin on the legs or top of feet can become red and thick

Graves’ disease is caused when your body begins attacking your thyroid, but it isn’t known exactly why this happens and who might get it. There are certain risk factors which are thought to make it more likely that you develop Graves’ disease, which include:

• Age – Graves can occur at any age but most people who get Graves’ disease are under the age of 50
• Family history – if someone in your family has Graves’ disease, you have an increased chance of developing it as well
• Gender – women are more likely to get Graves’ disease than men
• Having other autoimmune disorders (e.g. Crohn’s disease)
• Pregnancy
• Smoking
• Stress

If you have any of the symptoms listed above, you should speak to your GP or consultant.

At your appointment, your consultant will enquire about your symptoms, medical and family history and perform a physical examination.

If they think you might have Graves’ disease they will likely recommend that you undergo further tests to confirm the diagnosis. These tests include:

• Blood tests
• TSH (Thyroid-Stimulating Hormone) test – a test which measures the amount of TSH in your bloodstream
• T3 & T4
• TSH Receptor antibody
• Radio-iodine uptake scan – this may be used to distinguish hyperthyroidism due to Graves’ versus a single overactive thyroid nodule

If you are diagnosed with Graves’ disease, there are three main treatment options that can help. These are:

• Medication – certain medications (eg Carbimazole) can help limit the amount of hormones produced by your thyroid – in around half of patients, Graves’ will naturally burn itself out and disappear within 1-2 years and medication can control it until this occurs. However, if it goes on longer, recurs (which happens in 40-50%) or a person cannot tolerate the medicines, another treatment is required:
• Radioactive iodine treatment – this treatment works on the principle that the thyroid gland takes up iodine: a capsule of iodine which has been labelled with radiation is taken. The iodine is taken up by the thyroid cells and radiation destroys them which in turn limits the amount of hormone the thyroid can produce.  This treatment is contra-indicated in pregnancy, breast feeding and severe eye disease.
• Thyroid surgery – surgery to remove the thyroid gland provides an instant and lasting cure and is the preferred option for patients who cannot undergo radioactive iodine for some reason.

You and your consultant can discuss which treatment will be best for you.

If you’re unsure what treatment you should go for, or the above treatments don’t work for you, our team of expert specialists are here to help.