The Thyroid

The thyroid gland is the “master controller” of metabolism.

About Graves’ Disease

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 success1.

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“

  1. American Thyroid Association. Graves’ disease. Available at Last accessed February 2022
  2. Daumerie C. Epidemiology. In: Wiersinga WM, Kahaly GJ (eds): Graves’ Orbitopathy: A Multidisciplinary Approach — Questions and Answers. Basel: Karger, 2010: 33–39
  3. Mayo Clinic. Graves’ disease. Risk factors. Available at Last accessed February 2022
  4. American Thyroid Association. Hyperthyroidism. Available at Last accessed February 2022
  5. Ginsberg J. Diagnosis and management of Graves’ disease. CMAJ 2003; 168: 575–585


Date of preparation: February 2022