Like Hashimoto’s thyroiditis, Graves’ disease is an autoimmune disease that leads to a generalised overactivity of the entire thyroid gland.¹ About 25–40% of Graves’ disease patients show signs of a clinically relevant Graves’ ophthalmopathy (inflammation and bulging of the eyes).³ However, Graves’ disease accompanied by moderate to severe Graves’ ophthalmopathy, only occurs in fewer than 5% of patients.²

Who is at risk?

Women under 40 years of age are especially prone to developing Graves’ disease.³ Smokers are more likely to have Graves’ disease and are more likely to have eye problems than non-smokers.³

Symptoms of Graves’ disease

This disease can go unnoticed for a long time, but you may experience some of the following symptoms:¹,⁴

• Fast heart rate
• Nervousness and/or irritability
• Anxiety
• Difficulty sleeping
• Weight loss without dietary change
• Muscle weakness, especially of the upper arms and thighs
• Increased sweating
• Frequent bowel movements
• Lighter or less frequent menstrual periods
• Trembling hands
• Thinning of the skin
• Fine brittle hair

Symptoms of Graves’ ophthalmopathy include:¹

• Red or inflamed eyes
• Tissue swelling around the eyes
• Bulging eyes
• Very rarely, diminished or double vision

Diagnosing Graves’ disease

Your doctor cannot tell from the symptoms alone whether you have Graves’ disease. Physical examinations and blood tests are needed for a definite diagnosis.¹ Indicators include low levels of TSH and elevated levels of free thyroxine.⁵ In order to determine the extent of your hyperthyroidism, a triiodothyronine test will also be performed. If hyperthyroidism, enlarged thyroid gland, and eye problems described above coexist, the diagnosis of Graves’ disease appears self-evident.⁵

Treatment of Graves’ disease

Your doctor will discuss with you the best treatment options to prevent the thyroid gland from producing excess thyroid hormones.

• Anti-thyroid drugs allow control of hyperthyroidism by inhibiting the thyroid hormones’ synthesis in thyroid glands. They should be taken for at least 6 months to 2 years.⁵ In a small number of patients, the disease may permanently resolve.⁵
• Destroying thyroid tissue by radioactive iodine radiation is another option, but it will take 6–18 weeks before the benefit is reached.⁵
• The third option is to remove parts of or the whole thyroid gland by surgery.⁵

The last two options may provoke hypothyroidism in the long run.⁵ Your thyroid hormone levels will then be restored to normal by taking appropriate medication.¹ If you suffer from the symptoms of Graves’ disease (such as fast heart rate, anxiety, heat intolerance and trembling hands) then your doctor may temporarily prescribe beta-blockers, which will make you feel better within a short time.⁴,⁵ Regular check-ups guarantee long-lasting treatment success.¹

Useful websites

Patient information on thyroid health published by the American Thyroid Association.

Patient information from Thyroid Federation International.

Therapiegebiete/Endokrinologische Erkrankungen/Schilddrüse/Broschüren „Ihr Hashimoto Ratgeber“ und „Ihr Basedow Ratgeber“

• American Thyroid Association. Graves’ disease. Available at http://www.thyroid.org/what-is-graves-disease/. Last accessed February 2025.
• Daumerie C. Epidemiology. In: Wiersinga WM, Kahaly GJ (eds): Graves’ Orbitopathy: A Multidisciplinary Approach — Questions and Answers. Basel: Karger, 2010: 33–39
• Mayo Clinic. Graves’ disease. Risk factors. Available at https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240. Last accessed February 2025.
• American Thyroid Association. Hyperthyroidism. Available at http://www.thyroid.org/wp-content/uploads/patients/brochures/ata-hyperthyroidism-brochure.pdf. Last accessed February 2025.
• Ginsberg J. Diagnosis and management of Graves’ disease. CMAJ 2003; 168: 575–585

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Date of Prep: February 2025