Grave’s Disease

What is Grave’s Disease?

Grave’s disease is an autoimmune disease. It most commonly affects the thyroid gland which is a small gland, shaped like a butterfly, located in front of the neck below the larynx (the voice box). The gland is responsible for producing and secreting the thyroid hormones, T3 and T4. In addition, it also controls the use of energy by the body.

The thyroid hormone levels are monitored by the pituitary gland located in the brain. The pituitary produces the thyroid stimulating hormone, TSH, which stimulates the thyroid gland to make its hormones. When a patient suffers from Grave’s disease, his or her immune system produce antibodies which mimic the function of TSH. This results in the over-production of the thyroid hormones than what is required by the body. Thus, this state is termed as hyperthyroidism or overactive thyroid. As a result of hyperthyroidism, the main functions of the body like the heart rate and metabolism rate are all speeded up. Grave’s disease is an example of hyperthyroidism which is quite similar to Hashimoto’s disease (another autoimmune disease that affect the thyroid glands).

  • Symptoms of Grave’s Disease
  • Incidence of Graves’s Disease
  • Causes of Grave’s Disease
  •  Diagnosing Grave’s Disease
  •  Treatment for Grave’s Disease 
  •  Thyroid Disease and Pregnancy
  • Conclusion

Symptoms of Grave’s Disease

Many sufferers of Grave’s disease show symptoms related to hyperthyroidism, like:

  • Enlarged thyroid or Goitre
  • Sleeping problems
  • Irritability or uneasiness
  •  Increased sensitivity to heat
  • An increase in perspiration
  • Hand tremors
  • Increased heart rate
  • Thinning of hair and skin
  • Frequent bowel movements or diarrhoea
  • Weight loss
  • Fatigue
  • Changes in the menstrual cycle.
  • Pregnancy problems


Grave’s Disease can also affect other parts of the body. A feature that is not likely to happen in other  hyperthyroidism conditions. Grave’s Disease can affect:

  • EYES- some sufferers of Grave’s disease have had inflamed tissue behind the eyes which cause swelling. This generally results in ‘bulging’ in one or both the eyes which have the tendency to affect one’s vision too. The eye symptoms can occur before or along with or after the occurrence of Grave’s disease. This state hardly ever occurs with thyroid glands which have normal function. The exact reason for the eye conditions are yet not known. It seems to show up and are more common in smokers where smoking can make the condition worse. In addition, the eye problems have the tendency to get better without treatment. 
  • THICK, RED SKIN usually on the shins or top of the feet- this skin condition is rare and not severe. It is said to be painless and that most sufferers with the skin condition also have the eye condition associated with Grave’s disease.

The progression of the symptoms of Grave’s disease can occur gradually or immediately. The symptoms are often confused with other health conditions as a number of other medical conditions can cause the signs and symptoms which are associated with Grave’s disease. Importantly, some sufferers show no symptoms at all.


Incidence of Graves’s Disease

Although, men and women have chances of acquiring the disease, women are said to be 10 times more affected by Grave’s disease than men. The disease can occur in anyone regardless of one’s age,  but it is shown that the condition starts most often in people in their 20s and 30s. Patients who have been diagnosed with Grave’s disease often have family members suffering from  other autoimmune or thyroid conditions. Some patients have also shown to have other autoimmune diseases like: Vitiligo, Rheumatoid arthritis, Addison’s disease, Type 1 diabetes, Pernicious, Lupus, etc.

Causes of Grave’s Disease

Scientists have found many factors that could contribute to Grave’s disease, some of them being:

  • Genetics- plays an important role as some people are more prone to the disease than others. Research is currently being undertaken to find out the exact gene/genes which play a role.
  • Gender- sex hormones are said to be involved as statistics show that women are more affected than men.
  • Stress- Severe anxiety or emotions stress can launch the disease in people who are vulnerable.
  • Pregnancy-the thyroid glands are said to be affected during pregnancy.
  • Infection- even though no studies have shown any direct link between infection and Grave’s disease, infection is thought to play a part.

 Diagnosing Grave’s Disease

A medical doctor will assess your symptoms. He or she will require a physical exam and one or a number of tests to find out if you have Grave’s disease. Some of these tests are as follows:

  • Thyroid Function Test- A blood sample is withdrawn and sent to the diagnostic laboratory to check for normal levels of thyroid hormone (T4) and TSH. Hyperthyroidism will be depicted by low levels of TSH and high levels of T4 in the blood. Occasionally, routine screening for thyroid defects may show mild hyperthyroidism or an overactive thyroid without any symptoms that relate to Grave’s disease. In this case, medical doctors may put forward a treatment plan to follow or ‘watchful waiting’ to see if the levels go back to normal. 
  • Radioactive Iodine Uptake (RAIU)- this test will inform the doctor how much iodine the thyroid gland takes in. The iodine is used in the production of the thyroid hormone. An uptake which is higher than normal will indicate Grave’s disease. Thus, this test helps to differentiate Grave’s disease from other overactive thyroid conditions.
  • Antibody Tests- A blood sample is obtained to check for certain antibodies that relate to Grave’s disease.

Diagnosing Grave’s disease in a pregnant woman is quite complex. This is because most of the symptoms associated with Grave’s disease show up in a normal pregnancy too. For example, heat sensitivity and fatigue are symptoms that arise both in Grave’s disease and pregnancy. Furthermore, health care professionals make the use of the RAIU test to eliminate other causes during pregnancy.

 Treatment for Grave’s Disease 

Three main types of treatments are available for Grave’s Disease, they are:

  • Drugs

Antithyroid medicine- in the United States two types are used.
Methimazole or MMI
Propylthiouracil or PTU

The drugs inhibit the over production of the thyroid hormone in the thyroid glands. MMIs are usually prescribed and preferred for non-pregnant people. In addition, they are not used for more than 1- 2 years. In some patients, the thyroid gland starts functioning normally, producing normal levels of thyroid hormone, after the drugs are stopped. But in most cases, this is not so.

  • Radioactive Iodine (RAI)- As previously mentioned, the thyroid gland required iodine to make the thyroid hormone. The RAI treatment involves orally taking a pill that contains radioactive iodine (RAI) which will work towards damaging the thyroid gland through radiation. Therefore, when thyroid cells are damaged or destroyed, less hormones will be produced, curing the condition. Having said that, the patient might require to take thyroid hormone to compensate for the necessary hormones the body requires, which it no longer can produce. Most importantly, RAIs have been used for a long time where side effects like infertility or birth defects does not occur.
  • Surgery- this results in the removal of the thyroid. This procedure too cures the overactive thyroid and requires one to take the hormone to compensate for the ones your body cannot produce.

In addition to these three types of treatments, there is another type of drug called the beta blocker. This do not affect the production of the thyroid hormone. They function to block or inhibit the thyroid hormone action on the body. As a result, the heart rate, tremor and anxiety are all reduced. Beta blockers act quickly once in the body and can make one feel better until the main treatment is received.

The best available treatment for a patient is dependant on many factors. Generally,  antithyroid drugs and RAI, or a combination of both, are the  preferred treatments. Monitoring the hormone levels during and after treatment is crucial. Thus, your doctor will monitor them vigilantly and will ask you to come for follow-up visits.

Complications that arise if not treated

When Grave’s disease go untreated there is a chance that it could result in heart problems, fragile bones and even death. Thyroid Storm is a very rare and life threatening condition that arise when overactive thyroid is left untreated. Acute stress (trauma, surgery, or infection) triggers the condition. In a pregnant woman,who hasn’t received the appropriate treatment for Grave’s disease, the disease can endanger the life of the mother and the baby.


Video of Grave´s disease


 Thyroid Disease and Pregnancy

During pregnancy, the normal hormonal changes that occur alters the levels of thyroid hormones. The thyroid hormone level increases and the gland may enlarge a little in healthy pregnant women. On an important note, these alterations does not affect the baby or the pregnancy in general. But, an overactive thyroid that is left untreated can complicate the pregnancy. Fatigue and feeling hot are normal symptoms of pregnancy which arise in hyperthyroidism too, making it difficult to differentiate the two. Thus, it is crucial for a pregnant woman to report to her doctor when she notices symptoms related to an overactive thyroid or goitre.

Specialists in the related field have still not come to an agreement if a screening test for thyroid problems during pregnancy is required. Grave’s disease does not start during pregnancy, even if it does it is very rare. Pregnant women who were diagnosed with Grave’s disease generally had symptoms related to the disease even before getting pregnant.

Guidelines for those who have Grave’s disease and want to become pregnant

Women who are suffering from Grave’s disease can get pregnant, given that they have been treated for the disease. Importantly, the pregnancy should be pre planned and the disease controlled well before getting pregnant as untreated or inadequately treated Grave’s disease can lead to complications for the mother, like:

  • Preeclampsia
  • Premature or Preterm birth
  • Miscarriage
  • Heart failures
  • Placental abruption

The health related problems that may arise in the baby  due to untreated or inadequately treated Grave’s disease include:

  • Preterm birth
  • Thyroid problems
  • Low birth weight
  • Stillbirth

Thus, those who have been diagnosed with Grave’s disease should talk to a doctor and learn how to go about the pregnancy and the one’s who do not want to get pregnant should talk to a doctor about birth control. If antithyroid drugs have been prescribed for you, you should consult your doctor about RAI if you want to get pregnant. Statistics have shown that women who underwent RAI (around 6 months before pregnancy)  did not require antithyroid drugs. The doctor will monitor you and the baby for thyroid problems that may arise later on in the pregnancy.

 Management of Grave’s Disease during Pregnancy

During pregnancy, it will be crucial for you to consult your OB/GYN and an endocrinologist who will monitor your hormone problems. You will have to inform the doctor if you underwent RAI or surgery to treat Grave’s disease prior to the pregnancy. In addition  the baby will be watched and monitored for thyroid problems that can arise in the late stages of pregnancy. Thus, the pregnancy should be planned in order to properly treat Grave’s disease before conceiving.

As mentioned before, pregnancy can cause changes in the hormones which in turn will bring about problems in the thyroid glands.  The problems of the thyroid can cause an impact on the growing foetus. Sometimes, the symptoms of Grave’s disease in pregnant women worsen in the first trimester and may get better later on in the pregnancy. After delivery, the symptoms may worsen. Due to this fluctuations and variations, the treatment plan given to the pregnant women with Grave’s disease often differ. Hence, a medical doctor will ascribe a treatment plan during pregnancy and after pregnancy.

Regular check up of thyroid hormones are required during pregnancy. If the pregnant woman is prescribed antithyroid medications, then PTU will be prescribed for the first trimester and MMI afterwards until delivery. Thyroid surgery during pregnancy is rarely an option and pregnant women cannot be given RAI. Beta-blockers may be prescribed and is often for a short term (first few weeks of pregnancy) to manage symptoms.

Breastfeeding while on antithyroid drugs is common and many women choose to do so as only very small amounts of the drug get into breast milk. Your doctor will talk you through the benefits and the possible risks of breastfeeding; therefore you will be to decide for yourself what is the best course of action for you and  for your baby.


Grave’s disease is an autoimmune disease that affects thyroid glands resulting in hyperthyroidism. Many factors are related to the cause of the disease some of them being: genetics, gender, stress, pregnancy as well as infections. Common symptoms of Grave’s disease include goitre, weight loss, increased heart rate, changes in menstrual cycle, eye changes, etc. Women are more affected by the disease than men. Thyroid function tests and RAIU are common tests used to diagnose the disease. Treatment may include antithyroid drugs, beta blockers and in some surgery may be performed. When left untreated the disease may cause fragile bones, heart problems and even death. Pre planned pregnancy is very important in the case of women  who are sufferers Grave’s disease as pregnancy in women who have this condition can bring about adverse effects to both the mother and the baby.



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