Graves Disease – Diagnosis and Treatment
Diagnosis
Doctors usually begin diagnosing Graves’ disease with a physical exam and by reviewing personal and family medical history.
They look for signs such as goiter (swelling of the thyroid gland), hand tremors, nervousness, sweating, weight loss, muscle weakness, shortness of breath, palpitations, and emotional swings.
Doctors also check for eye symptoms.
Lab Tests Used
| Test | Purpose | What It Shows |
|---|---|---|
| Blood test | Measures TSH and thyroid hormone levels | Graves’ disease often shows low TSH and high thyroid hormones |
| Antibody assessment | Detects abnormal immune proteins | High levels suggest autoimmune disorders like Graves’ disease |
| Radioactive iodine uptake | Measures iodine absorption in thyroid gland | Increased uptake is common in Graves’ disease |
Doctors use blood tests to check thyroid function by measuring TSH and thyroid hormone levels. They may also test for immunoglobulins to see if the immune system is causing the problem.
For a radioactive iodine uptake scan, patients swallow a small amount of radioactive iodine. Doctors then take images to see how much iodine the thyroid absorbs. High uptake often confirms Graves’ disease as the source of hyperthyroid symptoms.
Treatment
Radioactive Iodine Treatment
Patients take radioactive iodine by mouth, and the thyroid gland absorbs it. This treatment gradually destroys thyroid cells that make hormones.
As thyroid cells shrink, symptoms of Graves’ disease usually fade over several weeks or months. Some people may feel mild neck discomfort or notice a short-term increase in thyroid hormone levels after treatment.
Doctors do not recommend radioactive iodine for pregnant or breastfeeding patients. Eye problems linked to Graves’ disease can sometimes get worse with this therapy, especially if those issues are already moderate or severe.
Most people who receive this treatment need daily thyroid hormone replacement afterward to keep hormone levels stable.
Key Points:
| Benefit | Drawback |
|---|---|
| Reduces hormone production | Can make eye problems worse |
| Simple, non-surgical option | Not for pregnant patients |
| Long-term control possible | May need long-term hormone pills |
Medicines That Block Thyroid Hormone Production
Doctors may prescribe antithyroid medications to reduce the amount of hormone produced by the thyroid gland.
One type is generally preferred because it carries a lower risk of severe liver complications. However, during early pregnancy, another antithyroid drug may be used, as the first option may slightly raise the risk of birth defects during the first trimester.
Later in pregnancy, doctors often switch back to the preferred antithyroid medication. These drugs can sometimes cause side effects such as rashes, joint pain, reduced white blood cell counts, and, in rare cases, liver problems.
Doctors monitor patients closely throughout treatment. If someone stops taking these medications without supervision, the condition may come back.
Using antithyroid drugs for longer than a year can lead to better treatment outcomes. These medications may also be used before or after radioactive iodine therapy.
Medicines That Reduce Thyroid Hormone Effects
Beta blockers help by blocking thyroid hormones from affecting the body’s organs, though they do not lower hormone production. These medications control fast heartbeat, shaking, sweating, diarrhea, and anxiety that often come with Graves’ disease.
Patients with asthma may notice worse breathing symptoms, and those with diabetes might have more trouble managing blood sugar. Doctors help decide if beta blockers are a good option and often use them with other treatments.
Thyroid Removal Surgery
Doctors may recommend thyroidectomy, which removes all or part of the thyroid, for some patients. After surgery, patients take thyroid hormone pills every day for life.
Surgery carries risks, such as damage to nerves that control the voice and harm to the small parathyroid glands that manage blood calcium. Skilled surgeons keep these problems rare.
Risks and Benefits Table:
| Advantage | Possible Complication |
|---|---|
| Lasting solution | Nerve damage (voice) |
| Quick hormone control | Parathyroid gland injury |
| Useful for severe cases | Need lifelong hormone pills |
Managing Eye Problems from Graves’ Disease
Thyroid eye disease can cause dry, red, swollen eyes, and sometimes double vision. Treatment depends on how severe the symptoms are.
For mild symptoms, people can use artificial tears during the day and lubricating gel at night. These products are available without a prescription.
For more severe symptoms, doctors may suggest:
| Treatment Type | Main Purpose | Possible Side Effects |
|---|---|---|
| Artificial tears and gels | Comfort, moisture | Minimal |
| Corticosteroids | Reduce swelling | Weight gain, high blood sugar |
| Insulin-like growth factor-1 receptor (IGF-1R) inhibitor | Decrease swelling | Muscle spasms, hearing loss |
| Prisms in glasses | Improve vision | May not help everyone |
| Surgery (decompression) | Protect eyesight | Double vision risk |
| Radiation | Shrink tissues | Uncertain benefit |
- Corticosteroids: Given by vein to reduce swelling behind the eyes. Side effects can include weight gain, higher blood sugar, higher blood pressure, and mood changes.
- Insulin-Like Growth Factor-1 Receptor (IGF-1R) Inhibitor: Given by IV every three weeks for eight doses. Side effects may include hearing changes, muscle spasms, nausea, diarrhea, and high blood sugar.
- Special Glasses (Prisms): Prisms in glasses can help correct double vision for some, though not everyone benefits.
- Eye Socket Surgery (Orbital Decompression): If vision is at risk, surgery removes some bone to make more space behind the eyes. This can help the eyes move back and reduce pressure, but double vision can occur afterward.
- Radiation Therapy to the Eye Area: X-rays target tissues behind the eyes to shrink them. Doctors use this mainly when other treatments have not worked well or have caused side effects.
Graves’ eye problems may worsen for a few months even with treatment, but symptoms usually level out and then improve.
Daily Habits and At-Home Care
Caring for Your Eyes with Graves’ Ophthalmopathy
People with Graves’ eye disease can take several steps at home to ease discomfort and reduce symptoms like dryness, swelling, or double vision.
| Situation | Home Remedy |
|---|---|
| Eye discomfort or swelling | Cool compresses |
| Sun/bright light sensitivity | Wraparound sunglasses |
| Dry or scratchy eyes | Lubricating eye drops/gels |
| Swelling, especially at night | Raise head while sleeping |
| Eyelids don’t close fully | Tape them or use a sleep mask |
| Smoking | Quit completely |
- Soothing the Eyes: Apply cool, wet washcloths over the eyes to reduce swelling.
- Eye Protection: Use wraparound sunglasses to protect eyes from sunlight, wind, and dust.
- Moisturizing: Artificial tears can ease dryness and help the eyes feel better. At night, thicker gels may provide longer-lasting comfort.
- Elevating the Head: Sleep with the head higher than the body to reduce swelling around the eyes. Use an extra pillow or raise the head of the bed.
- Eyelid Care: If eyelids do not close fully, gently tape them shut or use a sleep mask to prevent dryness while sleeping.
- Avoiding Smoking: Stopping smoking is important because smoking can make Graves’ eye disease worse.
Skin Changes Linked to Graves’ Disease
Some people notice skin thickening, usually over the shins. Doctors call this Graves’ dermopathy.
- Topical Treatments: Use non-prescription creams with hydrocortisone to soothe swelling and redness.
- Compression: Special wraps or bandages can apply gentle pressure to the skin to manage swelling.
For ongoing issues, patients should stay in touch with a healthcare provider.
Getting Ready for Your Visit
Steps You Can Take
Patients can make a doctor’s visit easier by being organized. Write down any symptoms, even if they seem unimportant or unrelated. Note when each symptom first appeared.
Prepare a list of personal health details, such as family illnesses and recent major life events or stresses. Bring a record of all medications, vitamins, and supplements, including the amount taken for each.
Questions to discuss with your provider:
| Topic | Example Questions |
|---|---|
| Causes and diagnosis | What could be causing my symptoms? What testing is needed? |
| Treatment options | What are the treatment choices? What do you suggest? |
| Managing side effects | What side effects might I experience? |
| Overall health management | How should I handle this along with my other health issues? |
Writing these questions in advance can help the appointment go smoothly.
What Your Healthcare Team May Ask
Doctors, nurses, or specialists may ask for more information to better understand your problem.
They might ask about:
- How long and how often your symptoms appear
- Any recent new medications you started
- Sudden or unexplained weight changes
- Changes in your menstrual cycles
- Issues with sexual health
- Trouble sleeping
Try to answer as clearly as you can. Having details ready helps your care team make informed choices.
