Graves' disease

Graves' disease is an autoimmune disease. It occurs when your immune system makes antibodies that attack your thyroid gland. This causes your thyroid gland to produce too much thyroid hormone.

Graves' disease is the most common cause of hyperthyroidism (an overactive thyroid gland).

It is important to diagnose and treat the disease early. The condition can affect your heart function, bone structure and eyes.

Graves' disease causes symptoms of hyperthyroidism, such as:

• goitre — an enlarged thyroid gland in your neck
• feeling hot and sweaty
• feeling tired
• tremor or a racing heart
• diarrhoea
• unexpected weight loss
• feeling short of breath

Other problems may include:

• feeling anxious or irritable
• irregular menstrual bleeding
• difficulties getting pregnant
• difficulty sleeping

Symptoms specific to Graves' disease may include:

• thyroid eye disease — bulging eyes, eye swelling and double vision
• Graves' dermopathy — thick and red skin on your feet and shins

About 2 in every 5 people with Graves' disease develop thyroid eye disease. This is because the antibodies that attack your thyroid can also affect the eye muscles and tissues.

Graves' disease happens when your immune system attacks your thyroid gland. This makes it produce too much thyroid hormone. It's not clear what causes your immune system to attack your thyroid gland.

You have a higher risk of getting Graves' disease if you:

• have someone in your family who has had Graves' disease
• have other autoimmune diseases
• smoke

Graves' disease is more common in females aged 20 to 50 years. They may have flare-ups after pregnancy because of immune system changes.

If you have symptoms of Graves' disease, it's important to see your doctor as soon as possible.

After you have been diagnosed with Graves' disease and begin treatment, see your doctor if you:

• develop a fever, sore throat or mouth ulcers after starting medicine
• experience a skin rash, hives, painful joints or nausea after starting medicine
• notice that your symptoms change or worsen

Your doctor will ask about your symptoms and medical history and perform a physical examination. If they suspect Graves' disease, they may refer you for:

• a blood test to measure your thyroid function
• a thyroid ultrasound to measure your thyroid's size
• a thyroid nuclear scan using a radioactive substance to detect overactive areas in your thyroid

If your thyroid blood test and scans show an overactive thyroid, your doctor may refer you to an endocrinologist.

Doctors may treat Graves' disease with anti-thyroid medicine for 18 months. This helps control the overactive thyroid gland. In about 1 in 2 people Graves' disease comes back,

usually within the first two years after stopping the medicine.

If Graves' disease returns there are a few options for further treatment, including:

• radioactive iodine therapy — this treatment uses radioactive iodine to shrink or destroy the thyroid gland
• surgery — you may need surgery to remove part or all of your thyroid gland
• long-term medicine — you may need to continue taking medicine if it helps and you can tolerate it well

Your doctor may prescribe medicines called beta-blockers. These help control symptoms such as a rapid heart rate.

Thyroid eye disease

If your eyes are affected, your doctor may refer you to an ophthalmologist. This is a specialist eye doctor.

Wearing sunglasses or using eye drops may help you. If your eyes are severely affected, your doctor may suggest steroid treatment or surgery.

Living with Graves' disease involves managing symptoms and regular check-ups with your doctor. Here are tips that may help you:

• Take your medicine — it is important to take your anti-thyroid medicine as prescribed to keep your thyroid hormone levels stable.
• Check your symptoms — if you notice new symptoms or if existing ones get worse, see your doctor.
• Follow up with your doctor — visit your doctor regularly to check your thyroid levels.
• Eye care — if you have thyroid eye disease, protect your eyes by wearing sunglasses. Use eye drops to keep your eyes moist and follow your ophthalmologist's advice.
• Healthy lifestyle — avoid smoking as it can worsen the symptoms of Graves' disease.

Graves' disease can have serious complications if not diagnosed and treated. Complications can affect your:

• heart function
• bone structure
• eyes

The Endocrine Society of Australia (Opens in new tab) has information about the symptoms, diagnosis and treatment of hyperthyroidism.

The Australian Thyroid Foundation (Opens in new tab) offers education, support and advocacy on thyroid health and thyroid cancer.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.