Graves Disease

Graves’ disease is an autoimmune condition and one of the most common causes of an overactive thyroid (hyperthyroidism). It happens when the immune system produces antibodies that stimulate the thyroid gland to make too much thyroid hormone.

Thyroid hormones affect many body systems, including heart rate, temperature regulation, digestion, mood and energy. When hormone levels are too high, symptoms can develop gradually or sometimes quite quickly.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment to confirm the diagnosis, check for complications (including eye involvement), and agree a treatment plan tailored to your symptoms, lifestyle and medical history.

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What causes Graves’ disease?

Graves’ disease is caused by immune antibodies that “switch on” the thyroid gland. The exact reason this develops isn’t always clear, but risk factors can include:

• Family history of thyroid or autoimmune disease
• Being female (more common, but it can affect anyone)
• Stressful life events (can be a trigger for some people)
• Smoking (increases the risk of eye complications)
• Pregnancy/postpartum changes (can influence thyroid autoimmunity)

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Symptoms of Graves’ disease

Symptoms are those of hyperthyroidism and can vary between people. Common symptoms include:

General symptoms

• Weight loss despite normal or increased appetite
• Feeling hot, sweating more than usual
• Tremor (shaky hands)
• Anxiety, irritability, restlessness
• Tiredness and muscle weakness
• Difficulty sleeping

Heart and circulation symptoms

• Fast heart rate (palpitations)
• Shortness of breath on exertion
• Reduced exercise tolerance

Digestion and other symptoms

• Frequent bowel movements or diarrhoea
• Menstrual changes
• Reduced libido / erectile dysfunction
• Thinning hair or hair loss

Thyroid gland changes

• Swelling at the front of the neck (a goitre)
• Neck discomfort or a feeling of pressure (less common)

Eye symptoms (thyroid eye disease)

Some people develop eye symptoms, which may include:

• Gritty, dry, watery or red eyes
• Swollen eyelids
• Sensitivity to light
• A staring appearance or bulging eyes
• Double vision
• Blurred vision (needs urgent assessment)

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Diagnosis at Royal Buckinghamshire Hospital

Diagnosis is usually made with a combination of clinical assessment and tests, such as:

• Symptom review and examination (including pulse, blood pressure and thyroid examination)
• Blood tests to check thyroid function (typically TSH and thyroid hormones)
• Antibody testing to support Graves’ diagnosis
• ECG if palpitations or rapid heart rate are present
• Tests to assess complications where needed (for example eye assessment, or further investigations if the diagnosis is unclear)

You’ll be given a clear explanation of what the results mean and what your next steps are.

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Treatment & management

Treatment aims to:

1. bring thyroid hormone levels back to normal,
2. control symptoms, and
3. reduce the risk of relapse and complications.

Your plan will be personalised and may include one or more of the following:

Medicines to reduce thyroid hormone production

Anti-thyroid tablets are commonly used to control hormone levels. Treatment is usually continued for a period of time and monitored with repeat blood tests. Some people achieve long-term remission; others may need longer treatment or a definitive option.

Medicines to control symptoms

Beta blockers may be used short-term to reduce symptoms such as palpitations, tremor and anxiety while thyroid levels are brought under control.

Definitive treatment options (selected patients)

If Graves’ disease is difficult to control, keeps returning, or tablets are not suitable, definitive treatment may be discussed, such as:

• Radioiodine treatment (to reduce thyroid activity)
• Surgery to remove all or part of the thyroid (more likely if there is a large goitre, suspicious nodules, or specific clinical reasons)

Your consultant will explain the benefits, risks and implications of each option (including the possibility of needing lifelong thyroid hormone replacement after definitive treatment).

Eye management (if thyroid eye disease is present)

Eye symptoms are assessed carefully. Treatment can include lubricating drops, lifestyle advice (including smoking cessation support), and specialist referral where required.

Pregnancy and family planning

If you are pregnant, trying to conceive, or breastfeeding, it’s important to tell your clinician, as management and medication choices may differ. Close monitoring is typically required.

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Possible complications

Without treatment, Graves’ disease can lead to complications such as:

• Heart rhythm problems (including atrial fibrillation)
• Worsening anxiety, sleep disturbance and fatigue
• Bone thinning over time (osteoporosis risk)
• Thyroid eye disease and, rarely, vision-threatening complications
• Thyroid storm (rare but life-threatening severe hyperthyroidism)

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When to seek urgent help

Seek urgent medical advice (same day) if you have Graves’ disease or suspected hyperthyroidism and develop:

• Chest pain, fainting, severe breathlessness, or a very fast/irregular heartbeat
• Confusion, agitation, high fever, severe diarrhoea/vomiting (possible thyroid storm)
• Sudden worsening eye pain, new double vision, or reduced vision
• Severe weakness or you feel acutely unwell

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If you have symptoms of an overactive thyroid, new eye symptoms, or abnormal thyroid blood tests, contact Royal Buckinghamshire Hospital for assessment and guidance. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.