What is Graves’ Disease?

Graves’ disease (also known as toxic diffuse goitre) is an autoimmune condition in which your immune system mistakenly attacks your thyroid gland. This causes the thyroid to produce excessive amounts of thyroid hormones (a state called hyperthyroidism). The thyroid is a small, butterfly-shaped gland in the front of your neck that plays a key role in regulating metabolism, energy levels, body temperature, weight, and many other bodily functions.
When thyroid hormone levels become too high due to Graves’ disease, multiple body systems may be disrupted, and serious complications may arise.

Key Facts About Graves’ Disease

• One of the most common causes of an overactive thyroid (hyperthyroidism).
• Because excess thyroid hormones affect many organs, the condition can impact your heart, bones, muscles, skin, eyes, menstrual cycle, fertility and more.
• While Graves’ disease can occur at any age, it is more frequently diagnosed in:
  • Women
  • Individuals under about 40 years of age

Symptoms of Graves’ Disease

Graves’ disease may develop gradually over time or appear more suddenly, and the symptoms vary widely from person to person. Typical signs include:

• Feeling irritable or anxious
• Unintentional weight loss despite a normal or increased appetite
• Sensitivity to heat, increased sweating, warm/moist skin
• Fatigue, muscle weakness
• Fine tremors in the hands or fingers
• Rapid or irregular heartbeat (palpitations)
• Enlargement of the thyroid gland (goitre)
• More frequent bowel movements
• Difficulty sleeping
• Menstrual irregularities or changes in libido/erectile dysfunction

Additionally, some patients may develop condition-specific complications:

• Graves’ ophthalmopathy: bulging eyes, eye irritation, light sensitivity
• Graves’ dermopathy: red or thickened skin (typically on the shins or the tops of the feet)

Special Manifestations

Graves’ Ophthalmopathy

This occurs in about 30% of people with Graves’ disease, when inflammation affects the muscles and tissues around the eyes. Common features:

• Protruding or bulging eyes (exophthalmos)
• Pain or pressure around the eyes
• Swollen or retracted eyelids
• Red, irritated eyes
• Light sensitivity
• Double vision
• In rare cases, vision loss

Graves’ Dermopathy

A less common manifestation, often affecting the skin on the shins or tops of feet, characterised by:

• Redness and swelling
• Thickened, raised skin with an “orange-peel” appearance
• Caused by accumulation of mucopolysaccharides (a type of carbohydrate) in the skin

What Causes Graves’ Disease?

The root cause of Graves’ disease is an abnormal immune response, though exactly why it happens is not fully known. In a healthy person, the pituitary gland secretes thyroid-stimulating hormone (TSH) which signals the thyroid to make hormones T4 (thyroxine) and T3 (triiodothyronine). In Graves’ disease:

• The body produces antibodies called thyrotropin-receptor antibodies (TRAb) that mimic TSH.
• These antibodies bind to the thyroid’s TSH receptor, overstimulating the gland and causing excessive hormone production.
• The same immune mechanism may also affect tissues around the eyes and skin, resulting in ophthalmopathy and dermopathy.

Risk Factors for Graves’ Disease

While anyone can develop Graves’ disease, certain factors make it more likely:

• Female gender – women are much more affected than men
• Age – most commonly before age 40
• Family history – having a first-degree relative with Graves’ disease or another autoimmune disorder increases risk
• Other autoimmune conditions – e.g., type 1 diabetes, rheumatoid arthritis, celiac disease
• High levels of stress (emotional or physical) – may trigger onset in predisposed individuals
• Pregnancy or recent childbirth – hormonal changes can play a role
• Smoking – especially raises risk of eye-related complications in Graves’ disease

Complications of Untreated Graves’ Disease

If untreated, Graves’ disease may lead to serious health problems:

• Heart problems: sustained hyperthyroidism can lead to irregular heart rhythms (arrhythmia), enlarged heart (cardiomyopathy) or heart failure.
• Pregnancy risks: in pregnant women with unmanaged Graves’ disease, there is increased risk of miscarriage, pre-term birth, pre-eclampsia (high blood pressure), poor fetal growth and maternal heart complications.
• Thyroid storm (thyrotoxic crisis): a rare but life-threatening emergency characterised by extremely high thyroid levels, fever, rapid heart rate, agitation, confusion and possible multi-organ failure.
• Bone health issues: long-standing hyperthyroidism interferes with calcium and mineral metabolism, increasing the risk of osteoporosis (weakened bones).

How Is Graves’ Disease Diagnosed?

A proper diagnosis involves a combination of clinical evaluation, lab tests and imaging. Key steps include:

1. Physical examination: the physician will check for thyroid enlargement (goitre), examine the eyes for signs of ophthalmopathy, measure heart rate/blood pressure and look for tremors or other hyperthyroid indicators.
2. Blood tests:
   • TSH (typically suppressed in Graves’)
   • Free T4 and Free T3 (commonly elevated)
   • TRAb or TSI (thyroid-stimulating immunoglobulin) to confirm autoimmune cause
3. Radioactive Iodine Uptake (RAIU) test: measures how much iodine the thyroid gland absorbs – in Graves’ disease uptake is often diffusely high.
4. Thyroid ultrasound: used when radioactive testing is not advisable (e.g., pregnancy), to assess gland size, texture and nodules.
5. Imaging (CT/MRI): may be used when ophthalmopathy is suspected to determine extent and rule out other causes.

Timely diagnosis is essential, and early specialist endocrine consultation is recommended.

Treatment Options at Metro Hospitals

At Metro Group of Hospitals our endocrinology team provides comprehensive care for Graves’ disease — from diagnosis through long-term management and support. Treatment is personalised based on your age, severity of disease, presence of eye/skin involvement and overall health.

1. Anti-thyroid Medications

These drugs (e.g., methimazole, propylthiouracil – PTU) block thyroid hormone production. Methimazole is commonly first-line; PTU may be preferred during early pregnancy. Side-effects include rash, joint pain, liver toxicity and decreased white blood cells, so close monitoring is needed.

2. Beta Blockers

These medications (such as propranolol, atenolol or metoprolol) do not treat the thyroid disease itself, but relieve symptoms like rapid heart rate, tremors, heat intolerance, anxiety and sweating.

3. Radioactive Iodine Therapy (RAI)

In non-pregnant adults, a small dose of radioactive iodine is used to destroy overactive thyroid cells, reducing hormone production. Benefits appear over weeks to months. After this therapy many patients need lifelong thyroid hormone replacement. Eye complications may temporarily worsen after RAI.

4. Thyroid Surgery (Thyroidectomy)

Surgical removal of part or all of the thyroid may be recommended when medications/RAI are unsuitable, in pregnancy when urgent treatment is required, or if there is a large goitre causing compression. Risks include damage to the voice box (vocal cords) or parathyroid glands (calcium regulation). Lifelong hormone replacement is usually required after surgery.

5. Managing Eye & Skin Involvement

• Mild ophthalmopathy: artificial tears, lubricants, night gels, selenium supplementation.
• Moderate/severe ophthalmopathy: corticosteroids to reduce inflammation; prism glasses for double vision; orbital decompression surgery for vision-threatening disease; orbital radiotherapy if required.
• Dermopathy: skin care, topical treatments and in some cases specific therapies to reduce mucopolysaccharide accumulation in skin.

Our endocrinologists and multidisciplinary teams ensure a coordinated approach across thyroid, ocular and skin manifestations.

Prevention & Lifestyle Support

As the precise cause of Graves’ disease is not fully understood, there are no guaranteed prevention methods. However, the following may help reduce risk and support overall thyroid/immune health:

• If you have a family history of autoimmune thyroid conditions, share this with your endocrinologist.
• Quit smoking – especially important, as smoking significantly increases the risk of eye complications in Graves’ disease.
• Manage stress levels (physical and emotional) through healthy coping mechanisms (exercise, meditation, good sleep, counselling).
• Maintain a balanced diet, adequate sleep and regular medical checks if you have other autoimmune conditions.

When to See a Specialist

You should consult a doctor immediately if you experience:

• Unexplained and persistent weight loss or change in appetite
• Rapid or irregular heartbeat, palpitations
• Marked fatigue, muscle weakness
• Noticeable enlargement of the neck (goitre)
• Eye symptoms: bulging eyes, double vision, irritation, pain
• Red, thickened skin on shins or tops of feet
• Menstrual changes, fertility issues, changes in libido/erection

At Metro Hospitals, our Endocrinology & Diabetes department is well-equipped to evaluate and manage thyroid disorders, including Graves’ disease. Metro Group of Hospitals+1

Why Choose Metro Hospitals for Graves’ Disease?

• A large trusted multi-specialty hospital network with 12+ hospitals across India. Metro Group of Hospitals+1
• Dedicated Endocrinology team experienced in thyroid and hormone disorders. Metro Group of Hospitals+1
• Access to advanced diagnostics (blood tests, ultrasound, RAI uptake) and multidisciplinary care (endocrinology, ophthalmology, surgery, dermatology) under one roof.
• Patient-centred approach: treatment plans tailored to your age, pregnancy status, eye involvement and lifestyle.
• Emphasis on follow-up and long-term monitoring to maintain thyroid health and prevent complications.

If you or a loved one is showing symptoms of Graves’ disease or has been diagnosed, we invite you to book a consultation with our Endocrinology team at Metro Hospitals. Early diagnosis and proper management can make a significant difference in outcomes and quality of life.