• Also Known As:
  • Diffuse Thyrotoxic Goiter
  • Toxic Diffuse Goiter
  • Autoimmune Hyperthyroidism
  • Basedow Disease
  • Exophthalmic Goiter
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What is Graves Disease?

Graves disease is the most common cause of overactive thyroid (hyperthyroidism). It results from an autoimmune disorder.

The thyroid is a butterfly-shaped gland that lies flat against the windpipe at the base of the throat. It produces the hormones thyroxine (T4) and triiodothyronine (T3) and plays an important role in controlling the rate at which your body uses energy (metabolism).

Thyroid hormone production is normally regulated by a feedback system that includes the pituitary gland, a pea-sized organ at the base of the brain. The pituitary makes thyroid-stimulating hormone (TSH) that stimulates the thyroid to make T4 and T3.

With Graves disease, the immune system, which normally protects against diseases, makes an autoantibody called thyroid stimulating immunoglobulin (TSI). TSI acts like TSH and causes the thyroid gland to make too much thyroid hormone. Over time, this can cause the thyroid gland to enlarge.

According to the National Institutes of Health, Graves disease affects 1 in 200 people in the U.S., and it is 7 to 8 times more common in women than men. Graves disease most often affects people between the ages of 30 and 50, but it may also occur in children or the elderly.

People with family members who have Graves disease and people with another autoimmune disorder, such as rheumatoid arthritis, type 1 diabetes, pernicious anemia, or lupus, are at an increased risk of developing the disease.

Examples of other risk factors include:


About Graves Disease

Signs, Symptoms and Complications

Graves disease may cause a wide range of signs and symptoms. They can often be mild and go unnoticed at first, then develop slowly and get worse over time. Different people may experience a different combination of symptoms at various times.

Some examples of signs and symptoms include:

  • Difficulty concentrating
  • Problems with vision
  • Eye irritation and tearing
  • Tiredness, fatigue
  • Frequent bowel movements
  • Enlarged thyroid gland (goiter)
  • Hand tremors
  • Heat sensitivity
  • Erectile dysfunction or decreased sex drive
  • Increased or irregular heartbeat (palpitations or arrhythmia)
  • Difficulty sleeping
  • Irregular menstrual periods
  • Muscle weakness
  • Nervousness
  • Reddening and thickening of skin on shins and/or tops of the feet
  • Restlessness and nervousness
  • Sweating
  • Unexplained weight loss despite increase in appetite
  • In children, delayed growth, development and puberty


  • Graves disease can cause a condition known as exophthalmos or Graves ophthalmopathy. It causes swelling behind the eyes, making them bulge outward. The person may appear to be staring. This complication can dry and irritate the eyes and affect vision. In severe cases, it can cause damage to the cornea, the transparent covering at the front of the eye, and to the optic nerve, the nerve that transmits light images to the brain, resulting in vision loss. This complication affects about 30% of people diagnosed with Graves disease. Smoking is a risk factor for developing this condition.
  • During pregnancy, a woman with untreated Graves disease can pass the thyroid autoantibodies to her developing baby. This can cause temporary hyperthyroidism when the baby is born.
  • Long-term exposure to excess thyroid hormones can cause osteoporosis.
  • Sudden acute increases in thyroid hormones can cause a “thyroid storm” or thyrotoxic crisis that can be life-threatening.


A diagnosis of Graves disease may be made based on signs and symptoms like an enlarged thyroid (goiter) or bulging eyes. However, 50% of people with Graves disease may not have obvious signs and symptoms. Laboratory tests can help confirm a diagnosis. Testing is also performed to evaluate the health of the thyroid and monitor treatment.

Laboratory Tests

One or more of the following blood tests may be performed to determine whether your thyroid is functioning properly:

The above tests may also be ordered periodically to monitor thyroid function and hormone production.

Laboratory tests used to help diagnose Graves disease and distinguish it from other autoimmune conditions may include one or more of the following. These tests detect the presence of thyroid antibodies:

  • Thyroid stimulating immunoglobulin (TSI) — presence of this antibody is diagnostic for Graves disease
  • Thyroid stimulating hormone receptor antibody (TRAb) — less specific than TSI
  • Anti-thyroid peroxidase antibody (anti-TPO) — this autoantibody is found in most people with Graves disease as well as in Hashimoto thyroiditis

Non-Laboratory Tests

  • Radioactive iodine uptake — The thyroid absorbs iodine from the blood and uses it to make thyroid hormone. If the thyroid is making too much hormone, it will take up more iodine. For this test, you swallow a capsule or “cocktail” containing a small, harmless amount of radioactive iodine. After a specified amount of time, the amount of radioactive iodine that has been taken up by your thyroid is measured. If your thyroid is overactive, an increased amount of radioactivity will be detected. For additional details, visit RadiologyInfo.org.
  • Ultrasound may be used for people who can’t undergo a radioactive iodine uptake test. Ultrasound uses sound waves to create images of the thyroid, showing the size of your thyroid and other features of Graves disease. Ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodules.


Treatment of Graves disease is aimed at reducing the hormones produced by the thyroid gland and relieving symptoms. Typically, there are three main treatment options:

  • Medications
    • Beta-blockers, such as propranolol, may reduce the effects of thyroid hormone on the body. These medications can relieve rapid heart rate, sweating, and anxiety and minimize shaking and nervousness caused by increased hormone activity. Beta-blockers work quickly and provide relief while waiting for long-term treatments to take effect.
    • Anti-thyroid drugs reduce thyroid hormone production. These are usually prescribed for no more than 1 to 2 years. For some people, normal thyroid function will continue after the drugs are stopped. For most people, additional treatment will be required.
  • A large dose of radioactive iodine may be given to destroy most or all of the thyroid gland, reducing hormone levels and eliminating the symptoms of hyperthyroidism. In some cases, this therapy is not enough to cure Graves disease and may need to be repeated. Over time, the thyroid gland may have decreased function and you may develop hypothyroidism, though this may not develop for many years. Because of this, those who have been treated may need to be monitored.
  • Sometimes surgery is performed to remove the thyroid gland. Once the thyroid has been removed or destroyed, you will need to take thyroid hormone replacement medication.

Most of the eye problems associated with Graves disease improve as the hormone levels are lowered, but some may require further action. For more about treatment, see the links in the Related Content section.

View Sources

Sources Used in Current Review

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(September 2017) National Institutes of Diabetes and Digestive and Kidney Diseases. Graves’ disease. Available online at https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease#what. Accessed August 6, 2019.

(March 23, 2018). Yeung SJ. Graves disease. Available online at https://emedicine.medscape.com/article/120619-overview#a6. Accessed August 9, 2019.

(March 7, 2019) Ing E. Thyroid-associated orbitopathy. Available online at https://emedicine.medscape.com/article/1218444-overview. Accessed August 9, 2019.

(October 18, 2018) U.S. Department of Health & Human Services, Office on Women’s Health. Graves’ Disease. Available online at https://www.womenshealth.gov/a-z-topics/graves-disease. Accessed October 2019.

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