How to Manage 4 Symptoms of Graves’ Disease

Graves’ disease, an autoimmune disorder, is the most common cause of hyperthyroidism, or overactive thyroid, which occurs when the body makes too much thyroid hormone.

In people with Graves’ disease, the immune system produces proteins called antibodies — substances that are usually produced to destroy foreign bodies, such as bacteria and viruses — which bind to the surface of the thyroid, the butterfly-shaped gland in the front of the lower neck, explains Alexandra Mikhael, MD, an endocrinologist at Cleveland Clinic in Weston, Florida.

Fortunately, treatment can help you control hyperthyroidism and symptoms of Graves’ disease and reduce the likelihood of complications. Here, we explore some  signs and symptoms of Graves’ disease, why they occur, and tips on how to manage them.

1. Bulging Eyes (Graves’ Ophthalmopathy)

• Dry, gritty eyes
• Double vision
• Sensitivity to light
• Pain, pressure, or trouble moving the eyes
• Swelling around the eyes

In severe cases, inflammation can cause pressure on the optic nerve between the eyes and brain, causing vision loss.

Graves’ ophthalmopathy symptoms generally appear within six months of — before or after — a Graves’ disease diagnosis, says Dr. Mikhael. The condition may remain stable, worsen, improve, or come and go. Rarely, the condition appears after Graves’ disease has been treated; it can also occur in people who don’t have hyperthyroidism.

“Treatment of the hyperthyroidism does not improve the underlying inflammation but improves the eye signs related to hyperthyroidism alone like the thyroid stare,” says Mikhael.

After the hyperthyroidism is under control, treatments for Graves’ ophthalmopathy depend on the severity of the disease, based on an evaluation by an ophthalmologist and an endocrinologist, says Mikhael.

• Eye drops to soothe eye irritation
• Sunglasses to help ease sensitivity to light
• Special eyeglasses to improve double vision
• Sleeping with your head elevated to reduce swelling around the eyes
• Selenium supplementation has been shown to reduce ocular involvement and slow the progression of the disease in patients with mild Graves' opthalmopathy

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• Oral or intravenous corticosteroids
• An immune suppressing medication to quiet your body’s underlying inflammatory response
• Teprotumumab, a disease-modifying intravenous medication for the treatment of active moderate-to-severe Graves’ ophthalmopathy
• Surgery, if pressure on your optic nerve poses a risk of vision loss or severe disease doesn’t respond to other treatments
• Radiation therapy, though this is less commonly used and usually done in conjunction with corticosteroids

2. Hyperthyroidism

“Thyroid hormone controls how the body uses energy and affects all your organs. Too much thyroid hormone can overactivate your metabolism,” says Mikhael.

Common symptoms of hyperthyroidism in people with Graves’ disease include:

• Nervousness or anxiety
• Insomnia
• Unintended weight loss
• Intolerance to heat
• Increased sweating
• Irregular heartbeat (tachycardia)
• Muscle weakness
• Hand tremors
• Frequent bowel movements or diarrhea

• Antithyroid Medications Medications for hyperthyroidism decrease the thyroid’s hormone production. “This medication is not curative but is effective in controlling hyperthyroidism,” says Mikael. Hyperthyroidism will sometimes go into remission within 12 to 18 months of treatment, she says; other times, it’s used until a patient begins radioiodine therapy or has surgery.
• Radioiodine Therapy This oral treatment for hyperthyroidism destroys cells in the thyroid gland that are overproducing thyroid hormone. It often leads to hypothyroidism, or underproduction of thyroid hormone, which your doctor will monitor you for. Hypothyroidism is easier than hyperthyroidism to treat and less likely to lead to long-term health problems.
• Beta-Blockers These medications rapidly ease hyperthyroidism symptoms such as rapid heartbeat and nervousness, but they don’t address the underlying cause of the condition. “Beta-blockers improve symptom control until thyroid hormone levels normalize” as other medications take effect, says Mikhael.
• Surgery In people with larger goiters (enlarged thyroid glands), who have nodules on the thyroid, or who are pregnant or planning to become pregnant, surgically removing the thyroid gland may be recommended. A thyroidectomy may be preferred by those who do not want exposure to radiation, those who don’t achieve remission with antithyroid drugs, or those who develop side effects from taking these drugs. A thyroidectomy completely treats hyperthyroidism, but you’ll need to take thyroid replacement medication for the rest of your life.

3. Goiter (Enlarged Thyroid)

Graves’ disease can cause a goiter, or enlarged thyroid gland. (Goiters can also be linked to an iodine deficiency.) Larger goiters can sometimes make it difficult to breathe or swallow.

In people with Graves’ disease, a goiter is linked to hyperthyroidism: the overproduction of thyroid hormone. Radioiodine therapy will shrink the goiter and surgery will completely get rid of it.

4. Skin Disease (Graves’ Dermopathy)

Graves’ dermopathy causes the skin on the lower legs and sometimes the tops of the feet to become thick, lumpy, and discolored. Similar to thyroid eye disease, it may or may not happen at the same time as hyperthyroidism symptoms, since it’s linked to an overactive autoimmune response, not an overproduction of thyroid hormone. While it’s usually mild and clears up on its own, Graves’ dermopathy can sometimes be painful and require more extensive treatment.

Lifestyle Tips to Manage Graves’ Disease

In many cases, medications that help normalize your thyroid function will help with Graves’ disease symptoms. Here are a few more ways to protect your health.

• Quit smoking. Smoking increases the risk of Graves’ ophthalmopathy, Graves’ dermopathy, and hyperthyroidism, says Mikhael, so it’s important to get help quitting if you currently smoke.
• Maintain a healthy weight. Because hyperthyroidism can cause weight loss due to an increased metabolic rate, treating the condition may also lead to weight gain. “We counsel patients to watch for this rebound weight gain and to watch their dietary habits and increase their exercise,” says Mikhael.

Otherwise, Mikhael says that eating well and managing stress with self-care can help address symptoms linked to hyperthyroidism. People with uncontrolled hyperthyroidism should not exercise vigorously, as it could increase the risk of cardiac problems. Stick to light activity until your hyperthyroidism is controlled; then you can resume regular exercise.