What is another name for Graves disease?

Onset of the symptoms associated with Graves’ disease is usually gradual, often taking several weeks or months to develop. Symptoms may include behavioral changes such as nervousness, irritability, anxiousness, restlessness and difficulty sleeping (insomnia). Additional symptoms include unintended weight loss, muscle weakness, an abnormal intolerance to heat, increased sweating, a rapid, irregular heartbeat (tachycardia) and fatigue

Graves’ disease is often associated with abnormalities affecting the eyes often referred to as Graves’ ophthalmopathy. While mild ophthalmopathy is present in the majority of people who have Graves’ hyperthyroidism at some point in their lives, less than 10% have significant eye involvement that requires therapy. Eye symptoms can develop before, at the same time or after the development of hyperthyroidism. In rare instances, individuals with eye symptoms never develop hyperthyroidism. In some instances, Graves’ ophthalmopathy may first become apparent or may worsen following treatment for Graves’ hyperthyroidism.

Graves’ ophthalmopathy is highly variable. In some individuals it may remain the same for many years, while in other individuals it may improve or worsen. It can also follow a pattern of worsening (exacerbations) and then going improving greatly (remission). Most individuals have mild disease with no progression.

Common eye abnormalities include swelling of the tissues surrounding the eye that may cause the eye to protrude or bulge out of its protective socket (orbit), a condition referred to as proptosis. Affected individuals may also experience dry eyes, puffy eyelids, eyelid retraction, inflammation, redness, pain, and irritation of the eyes. Some individuals describe a gritty sensation in the eyes. Less often, blurred or double vision, sensitivity to light, and/or diminished vision may also occur.

Very rarely, individuals with Graves’ disease develop a skin condition known as pretibial dermopathy or myxedema. This condition is characterized by the development of thickened, reddish skin on the front of shins. It is usually limited to the shins but, sometimes, may also occur on the feet. Rarely, soft-tissue swelling of the hands and clubbing of the fingers and toes (acropachy).

Additional symptoms associated with Graves’ disease include heart palpitations, slight tremors of the hands and/or fingers, hair loss, brittle nails, exaggerated reflexes (hyperreflexia), increased appetite, and an increase in the frequency of bowel movements. Females with Graves’ disease may experience an alteration in the menstrual cycle. Males may experience erectile dysfunction. In some instances, Graves’ disease may progress to cause congestive heart failure or abnormal thinning and weakness of the bones (osteoporosis) that leaves them brittle and susceptible to repeated fractures.

The treatment of hyperthyroidism is described in detail in the Hyperthyroidism brochure. All hyperthyroid patients should be initially treated with beta-blockers. Treatment options to control Graves’ disease hyperthyroidism include antithyroid drugs (generally methimazole [Tapazole®], although propylthiouracil [PTU] may be used in rare instances such as the first trimester of pregnancy), radioactive iodine and surgery.

Antithyroid medications are typically preferred in patients who have a high likelihood of remission (women, mild disease, small goiters, negative or low titer of antibodies). These medications do not cure Graves’ hyperthyroidism, but when given in adequate doses are effective in controlling the hyperthyroidism.

If methimazole is chosen, it can be continued for 12-18 months and then discontinued if TSH and TRAb levels are normal at that time. If TRAb levels remain elevated, the chances of remission are much lower and prolonging treatment with antithyroid drugs is safe and may increase chances of remission. Long term treatment of hyperthyroidism with antithyroid drugs may be considered in selected cases.

If your hyperthyroidism due to Graves’ disease persists after 6 months, then your doctor may recommend definitive treatment with either radioactive iodine or surgery.

If surgery (thyroidectomy) is selected as the treatment modality, the surgery should be performed by a skilled surgeon with expertise in thyroid surgery to reduce the risk of complications.

Your doctor should discuss each of the treatment options with you including the logistics, benefits and potential side effects, expected speed of recovery and costs. Although each treatment has its advantages and disadvantages, most patients will find one treatment plan that is right for them. Hyperthyroidism due to Graves’ disease is, in general, controllable and safely treated and treatment is almost always successful.

Hollenberg A, Wiersinga WM. Hyperthyroid disorders. In: Melmed S, Auchus RJ, Golfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 12.

Jonklaas J, Cooper DS. Thyroid. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 213.

Marcdante KJ, Kleigman RM. Thyroid disease. In: Marcdante KJ, Kliegman RM, eds. Nelson Essentials of Pediatrics. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 175.

Marino M, Vitti P, Chiovato L. Graves' disease. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 82.

Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-1421. PMID: 27521067pubmed.ncbi.nlm.nih.gov/27521067/.

Last reviewed on: 2/1/2022

Reviewed by: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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