Graves' disease

Graves' disease

Graves' disease is an autoimmune disease that causes the body to produce too much thyroid hormone (hyperthyroidism). This disease can cause a variety of symptoms, including palpitations, weight loss , and trembling hands.

The thyroid gland is responsible for producing hormones that regulate several body functions, such as the nervous system, brain development, and body temperature. In people with Graves' disease, the thyroid gland produces more hormone than needed.

If not treated properly, excess thyroid hormone production can cause serious problems with the heart, muscles, menstrual cycle, eyes and skin. Although many other disorders can cause hyperthyroidism , Graves' disease is the most common cause of the condition.

Graves' disease is most common in women and people younger than 40 years. However, basically this disease can be experienced by anyone.

Causes and Risk Factors for Graves' Disease

Graves' disease or Graves' disease occurs due to disturbances in the function of the immune system. Under normal conditions, the immune system functions to protect the body from foreign organisms that cause disease, such as viruses and bacteria.

However, in people with Graves' disease, the immune system produces TSI ( thyroid-stimulating immunoglobulins ) antibodies, which attack the thyroid gland, triggering the thyroid gland to produce more thyroid hormone than the body needs.

However, it is not known exactly why the immune system produces antibodies that attack the thyroid gland. However, the following factors are known to increase a person's risk of developing Graves' disease:

  • Female gender
  • 20–40 years old
  • Have a family history of Graves' disease
  • Suffer from another autoimmune disease, such as rheumatoid arthritis or type 1 diabetes
  • Experiencing stress
  • Just gave birth in the span of 1 year
  • Have had infectious mononucleosis
  • Have a smoking habit

Symptoms of Graves' Disease

Graves' disease can cause a variety of symptoms. Symptoms generally appear mild at first or even invisible, then gradually develop into more severe. Some of the symptoms are:

  • Enlargement of the thyroid gland ( goiter )
  • Tremors in the hands or fingers
  • Pounding heart ( heart palpitations ) or irregular heartbeat ( arrhythmia )
  • Changes in the menstrual cycle, including missed periods
  • Erectile dysfunction
  • Lose weight without losing your appetite
  • Moods change easily
  • Decreased sexual desire
  • Difficulty sleeping ( insomnia )
  • Diarrhea
  • Hair loss
  • Easily tired
  • Easy to sweat
  • Sensitive to hot air

In addition to some of the symptoms above, about 30% of people with Graves' disease or Graves' disease experience a number of typical symptoms, namely Graves ' ophthalmopathy and Graves ' dermopathy .

Symptoms of Graves ' ophthalmopathy occur due to inflammation or disorders of the immune system, which affects the muscles and tissues around the eye. Symptoms include:

  • Protruding eyes ( exophthalmos )
  • Dry eyes
  • Pressure or pain in the eye
  • Swollen eyelids
  • Reddened eyes
  • Sensitive to light
  • Double vision
  • Loss of sight

Graves ' dermopath hy is less common. The symptom is skin that is red and thickened like an orange peel. Graves' dermopathy is most common on the shins and on the instep.

When to see a doctor

Check with your doctor if you experience the symptoms mentioned above. Early screening can improve the accuracy of the diagnosis and the effectiveness of treatment.

Immediately go to the doctor or the nearest emergency room if you experience symptoms related to the heart, such as palpitations or irregular heartbeats, or experience loss of vision.

Diagnosis of Graves' disease

To diagnose Graves' disease, the doctor will ask and answer questions about the symptoms and complaints the patient is experiencing, past medical history, and family medical history.

After that, the doctor will check the patient's vital signs, starting from pulse, blood pressure, body temperature, to respiratory rate. The doctor will also do a physical examination, especially examining the thyroid gland in the neck, and look for Graves ' ophthalmopathy and Graves ' dermopathhy .

To confirm the diagnosis, the doctor can carry out several supporting examinations, such as:

  • Blood tests , to measure thyroid hormone levels as well as pituitary hormone levels which regulate hormone production from the thyroid gland
  • Radioactive iodine test, to see the function of the thyroid gland by ingesting low doses of radioactive iodine
  • Antibody test , to determine the presence of antibodies that attack the thyroid gland
  • CT scan or MRI , to see enlargement of the thyroid gland
  • Ultrasound , to see enlargement of the thyroid gland, especially in patients who are pregnant

Treatment of Graves' Disease

Treatment of Graves' disease aims to reduce the overproduction of thyroid hormone and its effects on the body. Some of the treatment options are:


Medicines that doctors can give to treat Graves' disease include:

  • Antithyroid drugs, such as methimazole and propylthiouracil , to block thyroid hormone production
  • Beta-blockers, such as propranolol , metoprolol , atenolol , and nadolol , to reduce the effects of thyroid hormone on the body, such as irregular heartbeat, restlessness, tremors, excessive sweating, and diarrhea

Radioactive iodine therapy

Radioactive iodine therapy is done by taking pills containing low doses of radioactive iodine. These pills work to destroy overactive thyroid cells, as well as shrink the thyroid gland, so that symptoms will gradually decrease over several weeks to several months.

Radioactive iodine therapy is not recommended for people with Graves' ophthalmopathy because it can make symptoms worse. In addition, this therapy should not be used in pregnant women and nursing mothers.

Since this therapy works by destroying thyroid cells, the patient will most likely need additional thyroid hormone to make up for the amount of thyroid hormone that is reduced by this therapy.


After surgery, the patient will require further therapy in the form of synthetic thyroid hormone to improve low thyroid hormone levels due to removal of the thyroid gland.

This action risks causing damage to the nerves controlling the vocal cords. The risk of damage can also occur in the parathyroid glands , which function to produce a hormone that regulates calcium levels in the blood.

Please note, Graves' ophthalmopathy can persist even though Graves' disease itself has been successfully treated. In fact, symptoms of Graves' ophthalmopathy can still get worse 3–6 months after treatment. This condition will usually last up to a year, then start to improve on its own.

If needed, Graves' ophthalmopathy will be treated with corticosteroids or teprotumumab. In some cases, surgery may be needed to prevent blindness.

Self care

In addition to some of the treatments above, Graves' disease patients are also encouraged to change their lifestyle to be healthier, by taking the following steps:

  • Eat balanced nutritious foods, such as vegetables and fruits
  • Exercise regularly
  • Manage stress well

Meanwhile, sufferers who experience Graves' ophthalmopathy are advised to do the following:

  • Using artificial tears , which can be obtained at the pharmacy
  • Taking corticosteroid drugs, which have been prescribed by a doctor
  • Use sunglasses to protect your eyes from sun exposure
  • Put a cold compress on the eye
  • Elevating the head when going to sleep
  • Do not smoke

Patients with symptoms of Graves' dermopathy can also be treated by using corticosteroid ointment, as well as compressing the part of the leg that is experiencing complaints to reduce swelling.

Graves' disease complications

Graves' disease that is not treated immediately can lead to dangerous complications, such as:

  • Pregnancy disorders, such as premature birth , thyroid dysfunction in the fetus, decreased fetal development, high blood pressure in the mother ( preeclampsia ), heart failure in the mother, to miscarriage
  • Cardiac disorders, such as arrhythmias, changes in the structure and function of the heart, and heart failure
  • Osteoporosis
  • Thyroid crisis ( thyroid storm )

Prevention of Graves' Disease

Graves' disease is difficult to prevent because it is  an autoimmune disease . However, you can reduce your risk of developing Graves' disease by getting regular checkups if you have a history of autoimmune disease or have a family history of Graves' disease.

In addition, the risk of developing Graves' disease can also be reduced by changing lifestyles to be healthier, such as not smoking, maintaining an ideal body weight, and exercising regularly.

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