Graves’ disease is a common form of hyperthyroidism or overactive thyroid. Another name for Graves' disease is diffuse toxic goiter.
Graves’ disease primarily affects the thyroid gland but can also affect other organs, such as the eyes and the skin. Because thyroid hormones influence many aspects of your body’s functioning, you can have widespread symptoms ranging from tremors to diarrhea to heat intolerance if you have Graves' disease.
If you’ve been diagnosed with Graves’ disease or think that you may have it, read on to find out more about the signs and symptoms of this common form of an overactive thyroid.
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Hyperthyroidism affects between 1% and 3% of people¹ in the US. Graves’ disease is the most common form of hyperthyroidism and accounts for around 60%–80%² of hyperthyroidism cases.
Graves’ disease is more common in women. Some studies² suggest that the lifetime risk of getting Graves’ disease if you are a woman is 3%, while if you are a man, it is 0.5%.
Graves’ disease is most common² in people between 20 and 50.
To understand Graves’ disease and why it presents with the signs and symptoms that it does, it’s important to have a basic understanding of your thyroid gland.
Your thyroid gland is situated in the front of your neck, just below your Adam’s apple. Your thyroid gland consists of two sections, or lobes, that lie on either side of your windpipe. Each lobe is about the size of half a plum. The right and left lobes are joined by a central bridge called the isthmus.
When your thyroid becomes overactive (as happens in Graves’ disease) or underactive, it can become enlarged. It’s possible, however, that your thyroid gland can be overactive or underactive and remain the same size.
Your thyroid gland forms part of your endocrine system. The endocrine system is involved with the secretion and regulation of your body’s hormones.
Your thyroid produces two hormones: thyroxine (T4) and triiodothyronine (T3), the latter being the active form of thyroid hormone. T3 is also produced outside the thyroid. It’s converted from T4 by your cells.
These two hormones are necessary for all the cells in your body to function normally.
The thyroid hormone regulates your cellular metabolism. Another way of describing this is that the thyroid hormone regulates how quickly the cells in your bodywork.
If you have too much thyroid hormone (when your thyroid is overactive), your cellular metabolism increases. If you have too little thyroid hormone (when your thyroid is underactive), the rate at which your cells work slows down.
When you understand this, it’s easy to see how a problem with your thyroid gland can affect your whole body and cause a very wide range of symptoms.
Although the terms ‘signs’ and ‘symptoms’ are often used interchangeably, they have subtle differences. It’s helpful to understand this difference when we delve deeper into the signs and symptoms of Graves’ disease.
The signs of a disease are the physical changes that doctors may notice when they examine you. The symptoms of a disease describe how the disease makes you feel and the changes in your mood, behavior, physical habits, or appearance — things that you may have noticed.
Common symptoms of Graves’ disease include:
Goiter or neck swelling
Unintentional weight loss
Frequent bowel movements
Tremor or shaking hands
Nervousness, anxiety, or irritability
Insomnia or sleep disturbances
Palpitations, racing heart, or irregular heartbeat
Loss of libido and erectile dysfunction
Symptoms that are very specific to Graves’ disease are:
Graves’ ophthalmopathy causes swelling of the tissue and muscles around your eyes, which leads to bulging eyes and lids that are retracted. You can experience red and gritty eyes and double vision or a drop in vision.
Graves’ dermopathy describes skin changes accompanying Graves’ ophthalmopathy. Your skin, usually over the front of your shins and the top of your feet, may become red and thick and take on a dimpled appearance. The condition is not painful.
Thyroid acropachy is swelling of your fingers and toes accompanied by clubbing of your fingernails and toenails.
These are some of the things that you may feel or notice in yourself if you have Graves’ disease:
One of the first symptoms you may notice if you have Graves’ disease is that you have a swollen neck in the area where your thyroid gland is positioned. This is termed a goiter.
Developing a goiter that you can see and feel is more common² if you’re under the age of 60 years.
Changes in the eye (or ocular changes) associated with Graves’ disease are called Graves’ ophthalmopathy. Around 30% of people³, or nearly one in three people with Graves’ disease, develop Graves’ ophthalmopathy.
Graves’ ophthalmopathy is caused when your body’s immune system attacks the tissues and muscles surrounding your eyes. These tissues and muscles then become swollen and cause your eyes to bulge out and give your eyelids the appearance of being pulled back or retracted.
As well as noticing that your eyes are bulging, you may find that your eyes become gritty, reddened, and sensitive to light. Some people experience double vision or a drop in vision.
You may also experience pressure in or around your eyes. Symptoms of Graves’ ophthalmopathy are very suggestive that you have Graves’ disease.
You may develop Graves’ ophthalmopathy at the same time that other symptoms appear, or you may notice that your eyes are bulging before any other symptoms develop.
Some people develop Graves’ ophthalmopathy only after they have begun treatment for their Graves’ disease, but this is rare.
Some fairly characteristic skin changes are associated with Graves’ disease. These occur in about 2%–3%² of people with Graves’ disease.
The skin changes caused by Graves’ disease are called Graves’ dermopathy. Another name for them is pretibial myxedema.
You may notice that your skin becomes thickened and red. It may develop a dimpled appearance, similar to the skin of an orange, and can become difficult to pinch.
Skin changes usually occur over the front of your shin and may extend onto the tops of your feet.
Only very rarely are other areas of your skin involved.
Although you may dislike how your skin looks, Graves’ dermopathy is a painless condition.
You most often develop pretibial myxedema if you already have Graves’ ophthalmopathy.
Swelling of your fingers and/or toes
In some cases, people with Graves’ disease develop swelling of their fingers and toes. This is called thyroid acropachy and is relatively rare. During Graves’ disease, new bone growth occurs in your fingers and toes.
This causes swelling of the tissue surrounding your finger and toe bones.
Weight loss with Graves’ disease is very common, although around 10%² of people may gain weight. When you have Graves’ disease, you may notice that you’re losing weight despite having an increased appetite and eating more.
This makes sense when you consider the influence of an overactive thyroid gland on your metabolism.
If you have Graves’ disease, you may feel hot all the time and notice that you become irritable or distressed in warmer surroundings. This is termed heat intolerance. You may find that you prefer and selectively seek out cooler environments.
Heat intolerance can also cause interrupted sleep.
One symptom of Graves’ disease is increased sweating. You may notice that you’re sweating more than usual and that your skin frequently feels warm and moist.
If you have Graves’ disease, you may notice a fine tremor in your hands or fingers.
In some cases, this can become significant enough that your shaky hands interfere with your ability to do fine work and other people notice your shaking.
Anxiety and nervousness
A recognized medical cause of anxiety is an overactive thyroid. Graves’ disease can trigger feelings of anxiety, nervousness, and irritability. This is particularly noticeable if you aren’t usually an anxious person.
Other people may comment on your personality changes before you notice them. Sometimes the anxiety is severe enough to trigger full-blown panic attacks.
Insomnia, sleep disturbances, and difficulty sleeping can all be symptoms of Graves’ disease. Sleep disturbances can be worsened by heat intolerance and anxiety.
It’s common to feel that your heart is racing or beating irregularly if your thyroid is overactive.
In some people, especially older people², Graves’ disease triggers a heart arrhythmia called atrial fibrillation, which is characterized by a rapid, irregular heartbeat.
Shortness of breath
Very high levels of thyroid hormone can cause you to feel short of breath. If you have Graves’ disease, one symptom that you may experience is increased shortness of breath.
Graves’ disease can lead to diarrhea, frequent bowel movements, or hyper defecation. Your stool may become looser than usual if you develop an overactive thyroid, or you may need to go to the toilet more often than is usual for you.
Because your thyroid hormones affect all the cells in your body, your reproductive system may be affected.
If you’re a woman and have Graves’ disease, you may notice that you have lighter periods than usual (called oligomenorrhea), or your menstrual cycle may become irregular.
Sometimes your periods may disappear completely (called amenorrhea) if your thyroid is overactive.
Loss of libido
Graves’ disease can cause loss of libido in both men and women and can lead to erectile dysfunction in men.
One clue that you may have Graves’ disease is if your hair begins thinning or falling out. In many cases, this symptom is first noticed by your regular hairdresser, who picks up on the hair loss during a routine hair appointment.
If you develop Graves’ disease when you’re older, you may have symptoms that aren’t typically associated with an overactive thyroid, or your symptoms may not be as obvious as those in younger people. The term for this is apathetic thyrotoxicosis.
Your symptoms may be subtle and can include fatigue, unexplained weight loss, and new-onset atrial fibrillation.
These are some signs that your doctor may identify when they examine you that suggest that you have Graves’ disease:
Your doctor may notice that your heart rate has increased. They may also notice that the pressure of your pulse is increased.
Raised systolic blood pressure
If you have Graves’ disease, the top reading of your blood pressure may be higher than normal when your doctor takes your blood pressure.
Your doctor may be able to feel that your thyroid is swollen, even if you haven't noticed visible swelling. They may use a stethoscope over your thyroid gland to listen for the sound of increased blood flow through your thyroid blood vessels (called a bruit).
Your doctor may check your reflexes because, in very rare cases, Graves’ disease may cause hyperreflexia or increased speed of your reflexes.
Proptosis and eyelid retraction
Even if your vision is fine and you haven’t noticed a change in your eyes, your doctor may pick up that you have proptosis or slightly bulging eyes.
Your lids may not be able to close properly over your eyes if your proptosis is significant. This can lead to exposure keratitis, which you may experience as redness and irritation over the surface of your eyes.
Clubbing is the term given to a particular pattern of swelling of the base of your nails. Your doctor may examine your fingernails and toenails to look for clubbing. Clubbing is usually part of thyroid acropachy and is relatively rare.
Palmar erythema is the term used to describe red palms. Your doctor may look at the palms of your hands to see if they are unusually red, as this can be a sign of Graves’ disease.
If you have not been diagnosed with Graves’ disease, but many of the signs and symptoms listed above sound familiar to you, you may want to make an appointment to see your doctor.
There can be other causes for almost all of the symptoms of Graves’ disease, so it’s important that your doctor examines you and does the appropriate investigations to make a correct diagnosis.
If you have the symptoms of Graves’ disease and make an appointment to see your doctor, they may examine you for any of the signs of Graves’ disease before moving on to special investigations.
If your signs and symptoms suggest that you have Graves’ disease, your doctor will likely order further investigations that could include blood tests and imaging of your thyroid to confirm the diagnosis.
If you’re experiencing a racing heart or irregular heartbeat, or if your vision is deteriorating, you should see your doctor urgently.
Fortunately, treatment is available for Graves’ disease, and once your diagnosis has been confirmed, your doctor will discuss treatment options with you.
Graves’ disease is the most common form of hyperthyroidism or overactive thyroid. It’s more prevalent in women than men. In Graves’ disease, your body produces too much thyroid hormone.
Since your thyroid hormone affects the metabolism of all of the cells of your body, an overactive thyroid can cause a wide range of symptoms affecting most systems in your body.
Fortunately, Graves’ disease can be successfully treated, and most of your symptoms will resolve with treatment. Your doctor will discuss treatment options with you once you have a confirmed diagnosis.
Graves disease (2022)
Graves’ disease | NIH: National Institute of Diabetes and Digestive and Kidney Diseases