Graves Disease: What Are The Symptoms In Females?

Graves’ disease is an autoimmune disorder where a person’s immune system produces antibodies that target cells in their thyroid. The thyroid is an important gland that produces hormones that help control and regulate many different functions throughout the body. 

Having an abnormal level of thyroid hormones in the blood leads to negative health outcomes. 

Graves’ disease is the main cause of hyperthyroidism. When certain antibodies bind to cells on the thyroid gland, they can cause an excessive production of thyroid hormones, which speeds up many processes in the body. 

Graves’ disease can affect men and women of all ages. However, studies show that it is five to ten times more common¹ in women than in men. It is particularly prevalent in women of reproductive age (generally between the ages of 20 and 40). Furthermore, Graves’ disease can be triggered in women who have recently been pregnant. 

Experts believe this is due to the effects of female sex hormones on the immune system, where estrogen and progesterone appear to be able to modulate and trigger an autoimmune response. The stress of pregnancy on the body can trigger an autoimmune disease to occur, such as Graves’ disease.

Graves’ disease is the second most common² endocrine disorder in women of reproductive age, and it is also the most common cause³ of autoimmune hyperthyroidism during pregnancy. 

So, it is important to be aware of the possible signs and symptoms of Graves’ disease and the serious complications that can result from failing to treat them. 

So, what are the symptoms of Graves’ disease in females?

General symptoms

Many of the symptoms associated with Graves’ disease are experienced in both females and males. 

In some instances, these symptoms have been reported as being less severe in⁴ females, although this could be because females are generally diagnosed with Graves’ disease at an earlier stage. 

Women often also have a better response to treatment compared to men. 

The symptoms of Graves’ disease that both women and men can experience include:

• Personality and mood changes, including anxiety or irritability

• A tremor in the hands and fingers

• Unintentional weight loss (often due to increased metabolism)

• An enlarged thyroid gland (goiter). 

• An increased frequency of bowel movements and/or diarrhea

• Fatigue

• A rapid heart rate (tachycardia)

• Insomnia (difficulty sleeping)

• Excessive sweating and moist skin

• A reduced sex drive (low libido)

• Fine or brittle hair that breaks easily

• Muscle weakness, which might be noticed in everyday activities (e.g., not being able to get out of a chair without using your arms)

• Intolerance to heat

Symptoms of Graves' ophthalmopathy 

Graves’ ophthalmopathy arises as a complication of Graves’ disease in approximately one-third of patients. It affects the muscles and tissues in the eyes, causing symptoms such as: 

• Eyes that bulge outward 

• A dry or gritty feeling in the eyes 

• Pain behind the eyes due to increased pressure

• Double vision or vision loss, in severe cases 

• Sensitivity to light

• Red, swollen, and inflamed eyes

Some evidence suggests that Graves’ ophthalmopathy is more common⁵ in females than males. 

Graves’ dermopathy

Graves’ dermopathy is another complication associated with Graves’ disease. It is rare, though, affecting very few women or men with Graves’ disease. 

Although it is usually mild and painless, the main symptom of Graves’ dermopathy is thickened, swollen, and red skin on the shins and tops of the feet.

Symptoms in women

The largest difference in the symptoms of Graves’ disease between males and females is that women often have reproductive system symptoms. If Graves’ disease is left undiagnosed and untreated, serious complications can occur. 

Here are some female-specific symptoms:

Changes to the menstrual cycle

Thyroid hormones help to control the menstrual cycle. Therefore, any long-term disruption to the thyroid function, and hence disruption to the level of thyroid hormones, can impact menstruation. 

Women with Graves’ disease may experience:

• Changes to the frequency of their menstrual periods, usually becoming less frequent

• Periods that are lighter than normal 

• Complete loss of periods for more than three months 

Difficulty getting pregnant

The rate of infertility is high in females with Graves’ disease, and studies show that around half⁶ of women with the condition have difficulty getting pregnant. 

Graves’ disease can cause you to have more anovulatory cycles.⁷ This happens when you have a menstrual bleed but don’t release an egg. 

Hyperthyroidism, which can occur with Graves’ disease, can affect the number of pregnancies you can have and your ability to conceive, especially if your periods are irregular and you aren’t ovulating every month. 

What Graves’ disease symptoms can arise during pregnancy?

Graves’ disease affects approximately 1 to 4 out of every 1,000⁸ pregnant women in the United States.

And while some women have pre-existing Graves’ disease before becoming pregnant, pregnancy itself can alter thyroid function and increase the levels of thyroid hormones. This can, in turn, trigger Graves’ disease, either early on during pregnancy or in the postpartum period. 

To protect yourself and your unborn baby, it is important to keep a close eye on the signs and symptoms of Graves’ disease during this time. 

Unfortunately, when Graves’ disease is triggered for the first time during pregnancy, it can be difficult to detect based on the pregnant woman’s physical symptoms alone. 

This is because some of the symptoms of Graves’ disease appear similar to the changes that healthy women experience during a normal pregnancy.

Such ‘crossover’ symptoms include: 

• Heat intolerance

• Heart palpitations and an increased heart rate (90 to 100 beats per minute)

• Shortness of breath on exertion (dyspnea) 

• An excessive appetite (hyperphagia) 

• Difficulty sleeping 

• Warm skin

• Increased bowel movements

• Systolic heart murmur

• Emotional upset

• Nausea and vomiting

These are in addition to the numerous additional factors identified as common symptoms of Graves’ disease affecting both males and females. 

Obvious symptoms 

There are, nevertheless, more obvious symptoms to look out for that could point towards Graves’ disease during pregnancy. 

These are either considered unusual or very severe symptoms in typical pregnancies.

These include: 

• Weight loss or struggling to put on normal pregnancy weight gain, despite having a normal or increased food intake 

• Enlarged thyroid gland 

• Muscle weakness 

• Eyes that appear more prominent 

• Nausea and vomiting that is more severe than standard ‘morning sickness’

• A heart rate above 100 beats per minute 

Complications of untreated Graves’ disease during pregnancy

Graves’ disease can cause several complications during pregnancy, such as: 

Preeclampsia

This involves a dangerous rise in blood pressure and is a significant sign of irregular kidney and liver function. It most commonly occurs during late pregnancy.

The risk of developing preeclampsia as a pregnant woman with Graves’ disease is almost five times higher⁸ if Graves’ disease is untreated and out of control.

Symptoms of preeclampsia include:

• Headaches

• Vomiting

• Swollen feet and ankles

Thyroid storm

Also known as ‘accelerated hyperthyroidism,’ thyroid storm is a rare but serious medical emergency characterized by extremely high levels of thyroid hormones. 

A thyroid storm causes a sudden worsening of hyperthyroidism-related symptoms, such as:

• Confusion

• High fever

• Dehydration

• Rapid and/or irregular heart rate

• Diarrhea

• Shock

It can be fatal for the mother and the unborn baby, so it is essential to seek immediate emergency care if these symptoms are experienced. 

A thyroid storm is more likely to happen if Graves’ disease worsens during pregnancy or if it goes undiagnosed and/or uncontrolled. 

Maternal congestive heart failure

This is a condition where your heart gets bigger and loses its power to pump adequately. This can make it harder for the heart to move blood around the whole body, which can cause blood to pool and fluids to build up. 

You may experience symptoms such as:

• Shortness of breath

• Swelling in your legs and ankles

• Fatigue

Heart failure is recorded in around 10%⁹ of pregnant women with severe untreated hyperthyroidism and is most prevalent during the first trimester.¹⁰ 

Other complications 

• Increased risk of stillbirth/miscarriage

• Increased risk of preterm delivery (a baby born before 37 weeks of pregnancy) For women with untreated Graves’ disease, this risk is 16 times the normal rate.⁸

• Placental abruption is where the placenta detaches from the inner wall of the womb (uterus). A thyroid storm can cause this. 

Symptoms in the first trimester 

In many cases, the symptoms that women with pre-existing Graves’ disease experience during pregnancy are at their worst during the first trimester. This is due to the presence of a specific hormone that stimulates the thyroid gland and can lead to the overproduction of thyroid hormones. 

However, during the second and third trimesters of pregnancy, hyperthyroidism-related symptoms generally improve. Some women even experience a temporary remission from Graves’ disease. 

This improvement in symptoms could be because the immune system is less active during this time. In particular, thyroid antibodies, responsible for the autoimmune reactions that cause Graves’ disease, decrease from the second trimester onwards.

Symptoms of Graves’ disease in postpartum women

After pregnancy, there is typically a rebound of the immune system after it was suppressed during the final months of pregnancy. 

Because of this, it is typical for some or all of the common Graves’ disease symptoms to return and/or worsen in the 4 to 12 months after giving birth.⁸ This is the case even if you go into remission during pregnancy. 

When should you see a doctor?

Graves’ disease can be a serious disorder for anyone. 

However, for females, the symptoms of Graves’ may be exacerbated during specific times in life, particularly during the first few months of pregnancy and in the postpartum period. 

If you notice symptoms related to hyperthyroidism, see your doctor or an endocrinologist as soon as possible, especially if you think you could be pregnant. 

The lowdown

In general, the symptoms of Graves’ disease are similar in men and women, even though women are more likely to get Graves’ disease and often have less severe symptoms than men. 

If you are experiencing irregular menstrual cycles, have difficulty getting pregnant, or your symptoms are triggered or worsen during pregnancy, Graves’ disease is a potential cause. 

Fortunately, with a diagnosis from a medical professional and effective treatment, you can manage these symptoms and enjoy a good quality of life.