What Is Graves’ Disease?

Graves’ disease is an autoimmune disease which most commonly causes hyperthyroidism, or an overactive thyroid. When you have Graves’ disease, your immune system makes thyroid antibodies which cause your thyroid gland to produce more thyroid hormones than needed by the body.

Hyperthyroidism increases a person’s metabolism and causes symptoms such as anxiety, weight loss, intolerance to heat, and sleep problems.

Left untreated, Graves’ disease can cause serious health problems, including an irregular heartbeat and osteoporosis. Approximately one out of three people with Graves’ disease also experience eye problems, such as bulging eyes, eye swelling, and red or inflamed eyes.  Occasionally, Graves’ disease causes eye problems without causing hyperthyroidism.

Although Graves’ disease can affect anyone, it most commonly occurs between 30 and 50 years of age. You are more likely to develop Graves’ disease if you:

  • Have a family history of Graves’ disease
  • Have a personal or family history of other autoimmune disorders, such as rheumatoid arthritis or lupus
  • Are a smoker
  • Are female, although it’s unclear whether the increased risk is related to hormonal or genetic differences
  • Have been pregnant within the last 12 months
  • Recently experienced a stressful life event

Graves’ disease is the most common cause of hyperthyroidism in the U.S. It affects about 1 in every 200 people.

The Role of Graves’ Disease Testing

If you have signs or symptoms that suggest Graves’ disease, your doctor may begin by ordering thyroid function testing such as TSH and free T4, to determine whether the thyroid is producing excess thyroid hormones.

If hyperthyroidism is confirmed by thyroid function testing, additional tests are conducted to determine the cause of your overactive thyroid gland and to select the appropriate treatment. In some cases, additional testing will not be needed because a patient’s medical history and physical examination provide strong enough evidence of Graves’ disease.

Although most cases of hyperthyroidism are due to Graves’ disease, an overactive thyroid gland can also be caused by other medical problems, such as certain medications, too much iodine in the diet, and thyroid tumors.

During and after treatment for Graves’ disease, patients have periodic testing to monitor the effectiveness of their treatment.

Who should get testing?

To diagnose Graves’ disease, tests may be ordered if you have certain abnormalities on a physical exam or if you report symptoms that may be related to an overactive thyroid gland.

Many symptoms of Graves’ disease are nonspecific, meaning that they can be caused by a number of different medical conditions. Some patients have severe symptoms, while other patients have only mild ones. Symptoms of Graves’ disease include:

  • Anxiety
  • Insomnia or trouble sleeping
  • Irritability or moodiness
  • Hair loss
  • Difficulty concentrating
  • Fatigue
  • Frequent bowel movements
  • Increased sweating and feeling overheated
  • Weight loss, despite increased appetite
  • Irregular menstrual periods
  • Rapid or irregular heartbeat
  • A swollen neck, caused by enlargement of the thyroid gland

Your doctor may also order Graves’ disease testing if you have symptoms suggestive of eye problems caused by Graves’ disease, known as Graves’ ophthalmopathy or Graves’ orbitopathy. Symptoms of eye problems caused by Graves’ disease include:

  • Sensation of itching or irritation of the eyes
  • Increased tearing
  • Eye pain
  • Eye swelling
  • Bulging eyes
  • Blurred vision
  • Double vision

Getting test results

It can take several business days to receive the results of tests for Graves’ disease. Your results may be communicated during a follow-up appointment and, in some cases, you may receive a test report that shows your test results.

Interpreting the results of Graves’ disease testing can be complex as Graves’ disease can affect patients differently. For example:

  • Not all patients have the same patterns of elevated thyroid hormones typical of hyperthyroidism.
  • Patients with mild Graves’ disease may test negative for thyroid antibodies.
  • A small minority of patients with Graves’ disease have eye problems without an overactive thyroid.

Because of these factors, doctors may consider a number of test results in making a diagnosis of Graves’ disease, and some patients will require more tests than others.

Types of Graves’ Disease Tests

Patients being evaluated for Graves’ disease may have tests that measure thyroid hormone levels, tests that detect the presence of thyroid antibodies, and imaging tests. Some patients will require more tests than others before a diagnosis can be established.

The table below lists tests that may be used to diagnose or rule out Graves’ disease.

Imaging tests can often reveal the cause of hyperthyroidism, including Graves’ disease. The following imaging tests may be ordered:

  • Radioactive Iodine Uptake
  • Thyroid Scan
  • Ultrasound

Getting Tested for Graves’ Disease

Blood tests will usually be ordered by your doctor. A blood sample may be drawn at your doctor’s office, clinic, a laboratory, or other medical setting. Imaging tests are conducted at hospitals, imaging centers, and medical clinics.

At-home testing

Thyroid function tests that detect if your thyroid is overactive may be performed using commercially available at-home tests. However, the antibody and imaging tests that establish Graves’ disease as the cause of hyperthyroidism cannot be done at home.

If an at-home thyroid test indicates an overactive thyroid gland, it is important to discuss your concerns and test results with a doctor. A doctor can help you determine what is causing the problem and plan appropriate treatment.

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