The younger patients suffering from Graves’ disease usually present with the typical symptoms of thyrotoxicosis. Most of the symptoms are due to increased activation of the sympathetic system [5]. In the elderly age group, there may be no symptoms or only subtle ones.

Patients suffering from Graves' disease may have the following complaints on history:

• Weight loss
• Blurred vision, diplopia, photophobia
• Retro-orbital discomfort and painful eye movements
• Reduced visual acuity
• Amenorrhea in females; and erectile dysfunction and gynaecomastia in men
• Loose, frequent stools

• Pruritis and skin changes
• Pretibial myxedema

• Restlessness, anxiety and insomnia [6]
• Tremors
• Increased sweating
• Intolerance to heat

Physical exam may demonstrate the following findings:

• Thyroid gland: The thyroid gland is always diffusely enlarged and is non-tender. A bruit may be auscultated over it.
• Integumentary system: The hair become fine. The skin is warm. There may be areas of hyperpigmentation on it. Pretibial myxedema is often present [7].
• Opthalmologic findings: There may be lid retraction, lid lag, proptosis, ophthalmoplegia and loss of visual acuity and color vision. Eye findings are present in around 50% of the patients.
• Limbs: The limbs may show clubbing and fine tremors. Proximal myopathy can also be seen in some cases.

Graves’ disease, if left untreated, results in a state of life threatening thyrotoxicosis which is known as thyroid storm [8]. Even with early recognition and aggressive therapy, the mortality of this condition is 20% [9]. It results in various complications including weight loss with catabolism of bone and muscle, cardiac complications and psycho-cognitive complications. Graves’ disease is also associated with dermopathy, ophthalmopathy and acropathy.

• Easy Bruising

  bruising These manifestations usually progress, then stabilize within two to three years [ 15 ]. [ihealthblogger.com]

  bruising yellowing of your skin or whites of your eyes, called jaundice constant sore throat fever Thyroid surgery The least-used treatment for Graves’ disease is surgery to remove the thyroid gland. [niddk.nih.gov]

  bruising Yellowing of your skin or whites of your eyes, called jaundice Surgery for Graves' disease The least-used treatment for Graves' disease is surgery to remove the thyroid gland. [medicinenet.com]

• Generalized Lymphadenopathy

  Justine Huart, Stéphanie Grosch, Christophe Bovy, Michel Moutschen and Jean-Marie Krzesinski, IgG4-related membranous glomerulonephritis and generalized lymphadenopathy without pancreatitis: a case report, BMC Nephrology, 18, 1, (2017). Y. [doi.org]

• Goiter

  It is also unclear whether long-term prognosis differs between Graves' disease and toxic nodular goiter. [ncbi.nlm.nih.gov]

  Radioiodine for nontoxic multinodular goiter. Thyroid. 1997 b; 7 235-239 10 Kraiem Z, Glaser B, Yigla M, Pauker J, Sadeh O, Sheinfeld M. Toxic multinodular goiter: a variant of autoimmune hyperthyroidism. [doi.org]

• Weight Loss

  The signs and symptoms of Graves' disease include insomnia, tremor, hyperactivity, hyperhidrosis, heat intolerance, weight loss despite increased appetite, diarrhea, frequent defecation, palpitations and muscle weakness. [symptoma.com]

  loss, poor tolerance of heat Classification D ICD-10: E05.0 ICD-9-CM: 242.0 OMIM: 275000 MeSH: D006111 DiseasesDB: 5419 External resources Curlie: Graves' disease MedlinePlus: 000358 eMedicine: med/929 ped/899 [en.wikipedia.org]

  Abstract A 37-year-old housewife presented with generalised fatigue, palpitations and weight loss over the past 3 months. Physical examination revealed signs of hyperthyroidism. Thyroid function tests confirmed the presence of thyrotoxicosis. [ncbi.nlm.nih.gov]

  \ ˈgrāvz- \ Definition of Graves' disease : a common form of hyperthyroidism that is an autoimmune disease characterized by goiter, rapid and irregular heartbeat, weight loss, irritability, anxiety, and often a slight protrusion of the eyeballs First [merriam-webster.com]

• Weakness

  On neurological examination the patient was presented with muscle weakness, muscle atrophy (in face and sternocleidomastoid muscles), features of myotonia and apocamnosis (orbicular muscles). [ncbi.nlm.nih.gov]

  Graves' disease Other names Toxic diffuse goiter, Flajani–Basedow–Graves disease The classic finding of exophthalmos and lid retraction in Graves' disease Specialty Endocrinology Symptoms Enlarged thyroid, irritability, muscle weakness, sleeping problems [en.wikipedia.org]

  [3] Graves’ disease accounts for 85% of all cases of hyperthyroidism. [4] Characteristics/Clinical Presentation Goiter, Exophthalmos, tremors, dermopaty, tachycardia with palpitations, heat intolerances, weight loss, increased deep tendon reflexes, weakness [physio-pedia.com]

• Fatigue

  She suffered from thirst and fatigue for one month. Her serum calcium (a) levels were 19.0 mg/dL, and she was diagnosed with hypercalcemic crisis. Circulating levels of parathyroid and thyroid hormones were elevated. [ncbi.nlm.nih.gov]

• Heat Intolerance

  Anemarrhena Bunge has been used in many herbal decoctions for patients who had hyperthyroidism-like symptoms, such as sweating, heat intolerance, and anxiety. [ncbi.nlm.nih.gov]

  The signs and symptoms of Graves' disease include insomnia, tremor, hyperactivity, hyperhidrosis, heat intolerance, weight loss despite increased appetite, diarrhea, frequent defecation, palpitations and muscle weakness. [symptoma.com]

  It is characterized by hyperthyroidism associated with goiter, heart palpitations, bulging eyes, sweating, heat intolerance, tremor, anxiety and weight loss. [kashilab.com]

  Hallmarks of the condition are bulging eyes (exophthalmos), heat intolerance, increased energy, difficulty sleeping, diarrhea and anxiety, although not all patients will exhibit bulging eyes. Symptoms can wax and wane over time. [livingwithgravesdisease.com]

• Dyspnea

  We report a 17-year-old male patient who presented with chest pain, dyspnea, and tachycardia. He was found to have diffuse ST-segment elevation consistent with pericarditis. At presentation, he was noted to have bilateral proptosis. [ncbi.nlm.nih.gov]

  […] involving joint site unspecified 728.2 Muscular wasting and disuse atrophy, not elsewhere classified 728.89 Other disorders of muscle, ligament, and fascia 729.9 Other and unspecified disorders of soft tissue 781.2 Abnormality of gait 782.3 Edema 786.0 Dyspnea [accessphysiotherapy.mhmedical.com]

  In patients with Graves’ disease, the following symptoms and signs may be present: Symptoms weight loss heat intolerance fatigue hair loss irritability restlessness lack of concentration insomnia labile emotion palpitations exertional dyspnea increased [endocrinologyadvisor.com]

  […] presentation A 40-year-old Caucasian American man with reactive arthritis, Graves' disease, type 2 diabetes mellitus, mitral valve prolapse, and Gilbert's disease was admitted with one month of progressive jaundice, fatigue, lightheadedness, and exertional dyspnea [casesjournal.biomedcentral.com]

  A 35-year-old woman presented with a two-week history of dyspnea, palpitations, and edema. She had a raised jugular venous pressure, goiter, and exophthalmos. [hindawi.com]

• Exertional Dyspnea

  In patients with Graves’ disease, the following symptoms and signs may be present: Symptoms weight loss heat intolerance fatigue hair loss irritability restlessness lack of concentration insomnia labile emotion palpitations exertional dyspnea increased [endocrinologyadvisor.com]

• Tachypnea

  One infant developed thyroid storm characterized by tachypnea, tachycardia, cardiac failure, and pulmonary edema. [pediatrics.aappublications.org]

• Diarrhea

  Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. [ncbi.nlm.nih.gov]

  Increased energy (hyperactivity) Fatigue Unexplained weight loss Trouble sleeping Inability to tolerate heat Trouble concentrating in school Diarrhea Fast, pounding heartbeat Bulging eyes Irregular periods Shaking Hyperthyroidism can be treated by taking [cincinnatichildrens.org]

  You may experience hair loss and diarrhea is common. Women may find that the menstrual flow will lighten and the time between periods grow longer. Depression can also enter the picture. [thyroid-info.com]

  However, the disorder may occur at any age and can affect males as well. [1] [2] More common signs and symptoms of hyperthyroidism due to Graves' disease include irritability, a fast and irregular heartbeat, hand tremors, diarrhea, increased sweating, [rarediseases.info.nih.gov]

  Hallmarks of the condition are bulging eyes (exophthalmos), heat intolerance, increased energy, difficulty sleeping, diarrhea and anxiety, although not all patients will exhibit bulging eyes. Symptoms can wax and wane over time. [livingwithgravesdisease.com]

• Increased Appetite

  Patients with Graves' disease may have some of the common symptoms such as anxiety, difficulty in sleeping, fatigue, muscle weakness, nervousness, hand tremors, frequent bowel movements, increased appetite, rapid and irregular heartbeat, weight loss, [melbournethyroidcentre.com.au]

  appetite Menstrual disturbance, irregularity Increased bowel frequency Breast development in men Clammy skin Diarrhea Hair loss Hand tremor Itching Nausea and vomiting Skin blushing or flushing Difficulty sleeping Osteoporosis Nervousness/anxiety Severe [accessphysiotherapy.mhmedical.com]

  Symptoms of Graves' disease may include: Swelling, bulging, or inflammation around the eyes Weight loss Restlessness or anxiety Increased appetite Rapid heart beat Changes in sex drive Fatigue and/or muscle weakness Frequent bowel movements Double vision [dartmouth-hitchcock.org]

  Symptoms that can indicate whether you have Graves’ disease are: insomnia and hyperactivity hand tremor hair loss excessive sweating and heat intolerance weight loss despite increased appetite diarrhoea palpitations (heartbeat sensations that feel like [in.optelec.com]

• Palpitations

  Abstract A 37-year-old housewife presented with generalised fatigue, palpitations and weight loss over the past 3 months. Physical examination revealed signs of hyperthyroidism. Thyroid function tests confirmed the presence of thyrotoxicosis. [ncbi.nlm.nih.gov]

• Tachycardia

  We report a 17-year-old male patient who presented with chest pain, dyspnea, and tachycardia. He was found to have diffuse ST-segment elevation consistent with pericarditis. At presentation, he was noted to have bilateral proptosis. [ncbi.nlm.nih.gov]

• Hypertension

  She was found to have pulmonary artery hypertension resulting in obstructive shock. Thyroid storm was diagnosed according to Burch and Wartofsky score. [ncbi.nlm.nih.gov]

  Autoimmunity and pulmonary hypertension in patients with Graves' disease. Heart Vessels. 2015;30(5):642–646. doi:10.1007/s00380-014-0518-3 Bahn RS. Graves' ophthalmopathy. [verywellhealth.com]

• Mitral Valve Prolapse

  A 40-year-old man with reactive arthritis, Graves' disease, type 2 diabetes mellitus, mitral valve prolapse, and Gilbert's disease presented with a one month history of jaundice, fatigue, and black stools. [casesjournal.biomedcentral.com]

• Systolic Murmur

  murmur could be heard Herman Snellen (1834–1908), David Riesman, American physician (1867–1940) Stellwag's sign Incomplete and infrequent blinking Karl Stellwag (1823–1904) Suker's sign Inability to maintain fixation on extreme lateral gaze George Francis [en.wikipedia.org]

• Sweating

  If for some reason, there is an excessive production of hormones, the body metabolism is enhanced to very higher levels producing symptoms like sweating, trembling, weight loss in hyperthyroid individuals. [symptoma.com]

  A 33 year-old, 8-week pregnant woman with hypothyroidism, presents with a 2-week history of palpitations, sweating, nervousness and fatigue. Physical examination shows tachycardia (108 bpm), distal tremors and diffuse goiter. [ncbi.nlm.nih.gov]

  It is characterized by hyperthyroidism associated with goiter, heart palpitations, bulging eyes, sweating, heat intolerance, tremor, anxiety and weight loss. [kashilab.com]

• Increased Sweating

  The symptoms seen in Graves’ disease include protuberance of eyes, heat intolerance, muscular weakness, increased sweating and anxiety. It most commonly occurs in young individuals. There is no definitive prevention to this disease. [symptoma.com]

  However, the disorder may occur at any age and can affect males as well. [1] [2] More common signs and symptoms of hyperthyroidism due to Graves' disease include irritability, a fast and irregular heartbeat, hand tremors, diarrhea, increased sweating, [rarediseases.info.nih.gov]

  sweating Rapid pulse felt as palpitations of the heart Fine tremor of the fingers Weakness Miscarriage of a pregnancy if uncontrolled Increased bowel movements and sometimes diarrhea Increased appetite, but weight loss because of the increased metabolism [dummies.com]

  These include nervousness or anxiety, extreme tiredness (fatigue), a rapid and irregular heartbeat, hand tremors, frequent bowel movements or diarrhea, increased sweating and difficulty tolerating hot conditions, trouble sleeping, and weight loss in spite [ghr.nlm.nih.gov]

  Graves disease patients may present with heat intolerance, increased sweating, insomnia, frequent loose stools, fatigue, dysmenorrhea, arrhythmia, tremor, weight loss, and neuropsychological symptoms, such as anxiety. [clinicaladvisor.com]

• Pruritus

  A 54-year-old woman suffering from pruritus for five years was diagnosed to have Graves' disease and immune thrombocytopenia (ITP) associated with primary biliary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap syndrome, which was confirmed histologically [ncbi.nlm.nih.gov]

  Darkening of the skin may occur, most noticeably in darker-skinned individuals, and intense pruritus may also occur. The skin is typically very fine and moist. Sweating is increased. [emedicine.com]

  Urticaria, pruritus. Brisk reflexes. Goitre. Proximal myopathy (muscle weakness wasting). Gynaecomastia. Lid lag (may be present in any cause of hyperthyroidism). [patient.info]

• Alopecia

  Patches of complete hair loss indicate associated alopecia areata. Loss of secondary sexual hair may occur in gonadotropin deficiency. Pretibial myxoedema may occur with any auto-immune thyroid disease. [endobible.com]

  […] present Diplopia – double vision caused by weakened ocular muscles from long periods of inflammation Photophobia Pretibial myxedema – “orange peel”, thickened, erythematous, lumpy and painless skin, usually found along the shins Fine and brittled hair Alopecia [ihealthblogger.com]

  Other autoimmune disorders can be associated with Graves disease, including type 1 diabetes mellitus, Addison disease, vitiligo, alopecia, and lupus. [emedicine.com]

  Hair thinning or diffuse alopecia. Urticaria, pruritus. Brisk reflexes. Goitre. Proximal myopathy (muscle weakness wasting). Gynaecomastia. Lid lag (may be present in any cause of hyperthyroidism). [patient.info]

• Urticaria

  Urticaria, pruritus. Brisk reflexes. Goitre. Proximal myopathy (muscle weakness wasting). Gynaecomastia. Lid lag (may be present in any cause of hyperthyroidism). [patient.info]

  Most common side effects of thionamides are pruritus, skin rash, urticaria, fever and arthralgia. These may resolve spontaneously or after substituting another drug. [intechopen.com]

• Muscle Weakness

  On neurological examination the patient was presented with muscle weakness, muscle atrophy (in face and sternocleidomastoid muscles), features of myotonia and apocamnosis (orbicular muscles). [ncbi.nlm.nih.gov]

  Graves' disease Other names Toxic diffuse goiter, Flajani–Basedow–Graves disease The classic finding of exophthalmos and lid retraction in Graves' disease Specialty Endocrinology Symptoms Enlarged thyroid, irritability, muscle weakness, sleeping problems [en.wikipedia.org]

• Diplopia

  […] far more likely to develop new-onset worsening diplopia following medial wall and floor decompression. [ncbi.nlm.nih.gov]

  Surgery may also be necessary to correct diplopia when this problem has not improved either spontaneously or with prism lenses. [columbiasurgery.org]

  Bloodshot appearance to eyes Double vision (diplopia) Impaired vision Treatments for Dry Eyes in Graves’ Disease Your clear choice is TheraLife Autoimmune. [theralife.com]

  Lid width and diplopia were comparable between the two groups at 6-month and 1-year follow-up. [doi.org]

  Patients suffering from Graves' disease may have the following complaints on history: Weight loss Blurred vision, diplopia, photophobia Retro-orbital discomfort and painful eye movements Reduced visual acuity Amenorrhea in females; and erectile dysfunction [symptoma.com]

• Red Eye

  Less severe—but still bothersome—eye symptoms include red eye, tearing, a feeling of sand or dust in the eye(s), and sensitivity to light. Eye disease related to Graves’ disease is called Graves’ ophthalmopathy. [endocrineweb.com]

• Bilateral Proptosis

  At presentation, he was noted to have bilateral proptosis. Abnormal thyroid function studies and an elevated thyroid-stimulating hormone receptor antibody level confirmed the diagnosis of Graves thyrotoxicosis. [ncbi.nlm.nih.gov]

  An exam is notable for mild bilateral proptosis, thin hair, and moist skin. A goiter is visible; it has increased consistency on palpation with an audible bruit over it. She has hyperreflexia and fine tremors. An EKG reveals sinus tachycardia. [the-hospitalist.org]

• Infrequent Blinking

  Note her thyrotoxic stare (infrequent blinking with exophthalmos) and enlarged thyroid gland (goiter). Neonate with thyrotoxicosis secondary to transplacental passage of maternal thyroid-stimulating immunoglobulins (TSI). [emedicine.com]

  blinking Karl Stellwag (1823–1904) Suker's sign Inability to maintain fixation on extreme lateral gaze George Francis "Franklin" Suker, American ophthalmologist (1869–1933) Topolanski's sign Around insertion areas of the four rectus muscles of the eyeball [en.wikipedia.org]

• Lacrimation

  The eye muscle involvement pattern raised suspicion, and the high IgG4 level with positive histology of the lacrimal gland confirmed the diagnosis of immunoglobulin G4-related orbitopathy. [ncbi.nlm.nih.gov]

  It is characterized by orbital pain, lacrimation, irritation, photophobia, increased retro-orbital tissue, exophthalmos, and lymphocytic infiltration of the extraocular muscles, causing ocular muscle weakness that frequently leads to double vision. [msdmanuals.com]

  The patients also have a dysfunction of the lacrimal gland with a decrease of the quantity and composition of tears produced. Non-specific symptoms with these pathologies include irritation, grittiness, photophobia, tearing, and blurred vision. [en.wikipedia.org]

• Psychiatric Manifestation

  The hyperthyroidism that develops is one of many somatic and psychiatric manifestations of the disease that can affect the quality and length of life. [doi.org]

  Other symptoms associated with the disease are goitre, ophthalmopathy, and psychiatric manifestations such as mood and anxiety disorders and, sometimes, cognitive dysfunction. [ncbi.nlm.nih.gov]

  Psychiatric manifestations of Graves' hyperthyroidism: pathophysiology and treatment options. CNS Drugs. 2006. 20(11):897-909. [Medline]. Vogel A, Elberling TV, Hørding M, Dock J, Rasmussen AK, Feldt-Rasmussen U. [emedicine.com]

• Mood Swings

  swings Lack of concentration Emotional outbursts, like crying or yelling Rapid growth rate that slows and may ultimately lead to short stature Mothers who have Graves’ disease may pass certain antibodies to their unborn babies, causing them to develop [stanfordchildrens.org]

  Side effects may include fluid retention, weight gain, elevated blood sugar levels, increased blood pressure and mood swings. Prisms. You may have double vision either because of Graves' disease or as a side effect of surgery for Graves' disease. [mayoclinic.org]

  The star also suffered severe mood swings, dizzy spells and hair loss; ending up undergoing radiation treatment which improved her condition, along with medication. [dailymail.co.uk]

  It causes heart palpitations, mood swings and hair loss; sometimes for women, it can make their eyes bulge. Now, there is a surgical solution for patients. Graves' disease caused Tracy Farrow's thyroid to be overactive. [ksat.com]

  swings or aggressive behaviour looseness of the bowels and occasionally nausea warm, moist hands thirst passing larger than usual amounts of urine itchiness enlarged thyroid gland thyroid eye disease Sometimes the symptoms are so subtle that they go [btf-thyroid.org]

• Loss of Libido

  Loss of libido. Oligomenorrhoea or amenorrhoea. Palmar erythema. Sweaty and warm palms. Fine tremor. Tachycardia - may be atrial fibrillation and/or heart failure (common in the elderly). Hair thinning or diffuse alopecia. Urticaria, pruritus. [patient.info]

  […] of libido Table 2. [intechopen.com]

• Emotional Outbursts

  outbursts, like crying or yelling Rapid growth rate that slows and may ultimately lead to short stature Mothers who have Graves’ disease may pass certain antibodies to their unborn babies, causing them to develop hyperthyroidism. [stanfordchildrens.org]

• Amenorrhea

  The most common presentation is the absence of lactation and amenorrhea. Hypothyroidism rather than hyperthyroidism is the usual expected phenomenon in SS. [ncbi.nlm.nih.gov]

  Patients suffering from Graves' disease may have the following complaints on history: Weight loss Blurred vision, diplopia, photophobia Retro-orbital discomfort and painful eye movements Reduced visual acuity Amenorrhea in females; and erectile dysfunction [symptoma.com]

  […] dermopaty, tachycardia with palpitations, heat intolerances, weight loss, increased deep tendon reflexes, weakness and muscle atrophy, increased cardiac output, myasthenia gravis, thin hair, warm moist skin, sensitivity to light, dysphasia, diarrhea, amenorrhea [physio-pedia.com]

• Sexual Dysfunction

  Have you experienced any sexual dysfunction? Are you having trouble sleeping? Jan. 07, 2020 [mayoclinic.org]

• Irregular Menstruation

  menstruation – less frequent and less in amount of blood flow Gynecomastia Impotence Increased heart rate Palpitations – fluttering of the chest Chest pain Difficulty of breathing Hand tremors Muscle cramps Muscle weakness Periodic paralysis Frequent [ihealthblogger.com]

• Oligomenorrhea

  […] adipogenesis, the eyeball is displaced resulting in malfunction of the extraocular muscles as well as the venous drainage Clinical features Features of hyperthyroidism: goiter / enlarged thyroid, muscle weakness, tremors, sweating, heat intolerance, oligomenorrhea [pathologyoutlines.com]

• Irritability

  Graves' disease Other names Toxic diffuse goiter, Flajani–Basedow–Graves disease The classic finding of exophthalmos and lid retraction in Graves' disease Specialty Endocrinology Symptoms Enlarged thyroid, irritability, muscle weakness, sleeping problems [en.wikipedia.org]

  It can cause irritability, sleeplessness and absence of voluntary muscle movements. Elliot was detected with Graves’ disease in 2008. [healthresearchfunding.org]

  \ ˈgrāvz- \ Definition of Graves' disease : a common form of hyperthyroidism that is an autoimmune disease characterized by goiter, rapid and irregular heartbeat, weight loss, irritability, anxiety, and often a slight protrusion of the eyeballs First [merriam-webster.com]

  Your doctor will look for enlargement of your thyroid gland (a goiter) and irritation of your eyes, check your pulse, look for signs of trembling, and ask about your symptoms and your personal and family medical histories. Blood tests. [academic.oup.com]

  Eyes can feel irritated and be tearing. Double vision may be present. [ufhealth.org]

• Tremor

  The signs and symptoms of Graves' disease include insomnia, tremor, hyperactivity, hyperhidrosis, heat intolerance, weight loss despite increased appetite, diarrhea, frequent defecation, palpitations and muscle weakness. [symptoma.com]

  One week after the treatment, she presented with severe pain in the anterior neck with radiation to the angle of the jaw associated with fatigue, tremor and odynophagia. [ncbi.nlm.nih.gov]

• Insomnia

  The signs and symptoms of Graves' disease include insomnia, tremor, hyperactivity, hyperhidrosis, heat intolerance, weight loss despite increased appetite, diarrhea, frequent defecation, palpitations and muscle weakness. [symptoma.com]

  However, in the longer term, less desirable symptoms, such as muscle weakness, insomnia and trembling can also result. The pulse will likely increase, along with an inability to tolerate heat and abnormally high sweating. [thyroid-info.com]

  High levels of T4 and T3 lead to HYPERthyroidism with characteristic HYPERthyroidism signs and symptoms including tachycardia, insomnia, anxiety and agitation, increased bowel movements and weight loss. [youtube.com]

  Symptoms that can indicate whether you have Graves’ disease are: insomnia and hyperactivity hand tremor hair loss excessive sweating and heat intolerance weight loss despite increased appetite diarrhoea palpitations (heartbeat sensations that feel like [in.optelec.com]

  Some of the more common symptoms include: Weight loss—despite increased appetite Anxiety, restlessness, tremors, irritability, difficulty sleeping (insomnia) Heat intolerance, sweating Chest pain, palpitations Shortness of breath, difficulty breathing [endocrineweb.com]

• Confusion

  Ocular signs in both diseases may cause diagnostic confusion although ptosis suggests coexisting MG. In both cases, the thyrotoxicosis delayed the diagnosis of MG. [ncbi.nlm.nih.gov]

  Symptoms of this thyroid crisis include fever, vomiting, elevated heart rate, confusion and profuse sweating and requires immediate emergency attention. (Visited 15,868 times, 26 visits today) « Back to Glossary Index [aarda.org]

  Common symptoms of hyperthyroidism include: Nervousness Irritability Perspiration Fine, brittle hair Weak muscles and shaky hands Fast heartbeat and high blood pressure Difficulty sleeping and fatigue Weight loss Increased bowel movements Confusion Irregular [nm.org]

  Sometimes the antibodies can instead block thyroid hormone production, leading to a confusing clinical picture. [gdatf.org]

• Hyperactivity

  […] or a toxic nodule (when just one nodule is hyperactive). [sharecare.com]

  Increased energy (hyperactivity) Fatigue Unexplained weight loss Trouble sleeping Inability to tolerate heat Trouble concentrating in school Diarrhea Fast, pounding heartbeat Bulging eyes Irregular periods Shaking Hyperthyroidism can be treated by taking [cincinnatichildrens.org]

  In Graves', the body's hyperactive immune system produces an antibody that attaches to the TSH receptors on the thyroid gland. [study.com]

  Prolonged exposure to high levels of thyroid-stimulating hormone (characteristic of hyperthyroidism) can pose serious health problems to a child, including the following: Premature closing of bones in the skull (fontanelles) Intellectual disability Hyperactivity [stanfordchildrens.org]

  […] type II hypersensitivity anti-microsomal, anti-thyroglobulin antibodies also present Female dominant HLA-B8, Dr3 association Often incited during stress e.g. childbirth, infection, steroid withdrawal Presentation Symptoms heat intolerance weight loss hyperactive [step2.medbullets.com]

Various tests are helpful in establishing any diagnosis related to the thyroid gland.

• In Graves’ disease, free T4 and T3 levels are usually elevated. There are certain conditions (such as toxic nodular goiter) in which only T3 levels are elevated. Such conditions are called T3 toxicosis.
• TSI (thyrotropin receptor anti-bodies) are mostly used as diagnostic test for Graves’ disease. Assays for TSI are mostly positive.
• Serum antibodies against collagen XIII are high in active Graves’ ophthalmopathy [11].
• Other markers include antithyroglobulin antibodies and antithyroidal peroxidase antibodies.

• Nephrolithiasis

  Reduction of refractory hypercalciuria If the patient has refractory hypercalciuria (as is mainly seen in pre-existing renal insufficiency or nephrolithiasis), hydrochlorothiazide can be given at a high dose (25 to 10 mg daily). [doi.org]

• Abnormal Thyroid Function Test

  The prevalence of affective disorder and in particular of a rapid cycling of bipolar disorder in patients with abnormal thyroid function test. Clin Endocrinol 1996 Aug; 45(2): 215–23 CrossRef Google Scholar 50. Thomsen AF, Kessing LV. [oadoi.org]

• Lymphocytes Increased

  Lymphocytes increased to 50 %, with 9 % atypical lymphocytes. The patient was anemic and had slight liver dysfunction. [ncbi.nlm.nih.gov]

• HLA-DR3

  […] thyroglobulin, which are also present in Hashimoto’s thyroiditis Epidemiology Affects 2% of women in US, 0.3% of men 85% of patients are women, usually ages 20 - 40 years; men are usually older 60% concordance in identical twins; associated with HLA-B8 and HLA-DR3 [web.archive.org]

  […] cause of hyperthyroidism in United States, affecting 2% of women and 0.3% of men 85% of patients are women (female to male ratio is 4:1), usually ages 20 - 40 years; men are usually older 60% concordance in identical twins; associated with HLA-B8 and HLA-DR3 [pathologyoutlines.com]

  Various genes have been identified that are linked to Graves’ disease including genes that weaken or modify the response of the immune system (immunomodulators) such as the CD25, CD40, CD40, CTLA-4, FOXP3, and various HLA genes, particularly HLA-DR3. [rarediseases.org]

  HLA-DR3 (HLA-DRB1*03), HLA-DQA1*0501 and HLA-B8 gives a risk ratio of three fold to fourfold in white population. HLA-DQ3 is involved in patients with African descent whereas HLA-BW46 is involved in patients with Asian descent. [intechopen.com]

• HLA-B8

  […] and thyroglobulin, which are also present in Hashimoto’s thyroiditis Epidemiology Affects 2% of women in US, 0.3% of men 85% of patients are women, usually ages 20 - 40 years; men are usually older 60% concordance in identical twins; associated with HLA-B8 [web.archive.org]

  Introduction Most common cause of hyperthyroidism An autoimmune disease with stimulating anti-TSH receptor antibodies a type II hypersensitivity anti-microsomal, anti-thyroglobulin antibodies also present Female dominant HLA-B8, Dr3 association Often [step2.medbullets.com]

  Most common cause of hyperthyroidism in United States, affecting 2% of women and 0.3% of men 85% of patients are women (female to male ratio is 4:1), usually ages 20 - 40 years; men are usually older 60% concordance in identical twins; associated with HLA-B8 [pathologyoutlines.com]

  HLA-DR3 (HLA-DRB1*03), HLA-DQA1*0501 and HLA-B8 gives a risk ratio of three fold to fourfold in white population. HLA-DQ3 is involved in patients with African descent whereas HLA-BW46 is involved in patients with Asian descent. [intechopen.com]

The treatment of Graves’ disease depends upon symptoms and thyrotoxic states. Treatment options include drugs, surgery and radiation.

Medication

• Anti-thyroid drugs such as carbimazole and propylthiouracil interfere with the normal functioning of the thyroid gland.
• beta-blockers are used to treat the symptoms caused by hyper-functioning of the sympathetic system.

Surgery

Either total or subtotal thyroidectomy is performed to reduce the mass of the active thyroid gland.

Radioactive Iodine

In the United States, radioactive iodine is given as first line therapy. Its dose usually ranges from 5-15 mCi. Thyroid function tests usually show improvement after 6 to 8 weeks of therapy. Radioactive iodine is absolutely contraindicated in pregnancy.

Many patients remain well after a single course of anti-thyroid drugs, but recurrence can happen at any time. Radioactive iodide is very effective, but often results in abnormally low levels of thyroid hormones (hypothyroidism). Surgery can also cause low levels of thyroid hormones.

The eye signs of Graves' disease tend to improve with anti-thyroid drug treatment. However, some element of the staring appearance often remains.

Normally thyroid gland releases its hormones (T3 and T4) under actions of thyroid stimulating hormone (TSH) that is produced by the pituitary gland in brain. In Graves' disease, abnormal antibodies are produced that are capable of mimicking the action of thyroid stimulating hormone. As a result, the levels of thyroid hormones T3 and T4 are increased. All these conditions collectively result into condition like Graves’ disease.

Moreover there are various other etiological factors that trigger increased thyroid hormone release such as thyroid surgery, trauma to thyroid gland, thyroid adenoma and thyroid carcinoma.

The prevalence of Graves’ disease varies in different areas around the world. Graves’ disease is most common cause of hyperthyroidism in the United States. These patients often have a family history of autoimmune diseases involving the thyroid gland which include Hashimoto thyroiditis, postpartum thyroiditis, Riedel thyroiditis and others [1]. Graves' disease is also commonly associated with non-thyroid conditions including diabetes mellitus type 1, myasthenia gravis, pernicious anemia, systemic lupus erythematosus, vitiligo and Sjogren syndrome [2].

The prevalence of maternal thyrotoxicosis is 1 case per 500 persons approximately in United States. In the United Kingdom, the incidence was reported to be 80 cases 100,000 per year in women [3].

Worldwide, Graves’ disease represents 60 to 90% of all causes of thyrotoxicosis. In one study, the incidence was reported to be around 100 to 200 cases per 100,000 population annually.

The hormones released by thyroid gland regulate the body metabolism and control the rate at which food is converted into energy form. The rate of metabolism is directly dependent on the amount of thyroid hormones released. If for some reason, there is an excessive production of hormones, the body metabolism is enhanced to very higher levels producing symptoms like sweating, trembling, weight loss in hyperthyroid individuals.

Graves’ disease is an autoimmune disorder mediated by autoantibodies that are capable of binding and stimulating the receptor for thyroid stimulating hormone on the thyroid gland [4]. Continued stimulation of the thyroid gland results in hypertrophy of the gland and overproduction of its hormones.

Binding of these antibodies to similar antigen retro-orbital connective tissue causes the ocular symptoms of Graves' disease.

There is no way to prevent Graves' disease as it is genetically mediated.

Graves’ disease is an autoimmune disorder characterized by hyperthyroidism due to circulating autoantibodies that are capable of stimulating the thyroid gland. It most commonly results in increased thyroid gland (twice or more of its size) due to increased synthesis of thyroid hormones by hyperfunctioning thyroid follicles.

Graves’ disease is a disorder in which the thyroid gland becomes overactive because bof stimulation by the body’s own antibodies. The symptoms seen in Graves’ disease include protuberance of eyes, heat intolerance, muscular weakness, increased sweating and anxiety.

It most commonly occurs in young individuals. There is no definitive prevention to this disease. Treatment can be done through drugs, surgery or radiation with favorable results.

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