What Exactly Is Graves' Disease? An MD Explains the Thyroid Disorder

This informational guide, part of PS' Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

When it comes to thyroid disorders, hypothyroidism — that is, underactive thyroid — gets a lot of attention. Hyperthyroidism, or an overproduction of thyroid hormone, isn't talked about as much. And as a result, people with conditions that lead to hyperthyroidism, such as the autoimmune condition Graves' disease, may go undiagnosed for longer than necessary, since they're simply unaware that their symptoms are connected to their thyroid.

Graves' disease affects nearly one in 100 people in the United States, according to the Journal of Surgical Research. Daisy Ridley, Missy Elliott and Wendy Williams have all opened up about being diagnosed with Graves' disease. It occurs when the immune system disrupts thyroid functioning, causing it to produce too many thyroid hormones, and it's the leading cause of hyperthyroidism. Here, we asked a thyroid expert what causes Graves' disease, how it can be diagnosed, and how it can be treated or prevented altogether.

Joanna Klubo-Gwiezdzinska, MD, PhD, MHSc, is the acting chief of the Thyroid Tumors and Functional Thyroid Disorders Section at the National Institute of Diabetes and Digestive and Kidney Diseases.

Graves' disease occurs when the immune system begins malfunctioning, causing it to disrupt the thyroid, a gland that produces hormones that affect every cell in the body.

"Graves' disease develops when [the] immune system is over-reactive and produces autoantibodies against normal tissues. These autoantibodies communicate with thyroid cells, "telling" them to overproduce thyroid hormones, which results in so called hyperthyroidism," explains Joanna Klubo-Gwiezdzinska, MD, PhD, MHSc, the acting chief of the Thyroid Tumors and Functional Thyroid Disorders Section at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The major signs of Graves' disease range from a variety of different symptoms. Mainly, the symptoms are associated with the overproduction of thyroid hormones by the thyroid gland when responding to stimulatory autoantibodies, Dr. Klubo-Gwiezdzinska says. The most common symptoms of thyroid hormone excess including:

Experts still don't know exactly what causes the immune system behavior that leads to Graves' disease, but there are some working theories.

For one, genetics appears to be at play. "It's estimated that genetic factors [and] heritability explains 79 percent of the risk for development of Graves' disease, while environmental factors are responsible for about 21 percent," Dr. Klubo-Gwiezdzinska says. Having a family history, and a personal history, of any autoimmune disease, are also both risk factors, per the Autoimmunity Reviews journal.

Women are also more likely to develop Graves' disease; their risk is three percent, compared to men's 0.5 percent, Dr. Klubo-Gwiezdzinska says. That disparity has led researchers to believe that the sex hormone estrogen or the additional X chromosome may play a role in the risk of Graves', possibly due to their effects on the immune response, she says.

"Ethnicity has been found as one of the important risk factors. Notably, Graves' disease is more prevalent in the Asian population, while Sub-Saharan African descent is associated with a lower risk of this condition," Dr. Klubo-Gwiezdzinska says.

As for lifestyle factors that may affect the risk of developing Graves' disease, Dr. Klubo-Gwiezdzinska calls out these possible influences:

If you or your doctor suspect you have Graves' disease, diagnosis may involve a physical exam to spot symptoms such as an enlarged or vascular thyroid gland. If symptoms point to the condition, your doctor may order blood tests to measure your levels of thyroid stimulating hormone (TSH), free thyroxine (fT4), and total triiodothyronine (TT3). In people with Graves' disease, TSH will be lowered and fT4 and TT3 will be elevated, says Dr. Klubo-Gwiezdzinska.

That hormone profile, along with an enlarged thyroid and thyroid eye disease, will lead to a diagnosis of Graves', says Dr. Klubo-Gwiezdzinska. But if any one of those factors is missing, your doctor may measure for certain thyroid stimulatory antibodies via a blood test. If they're elevated, that may also lead to a diagnosis of Graves', says Dr. Klubo-Gwiezdzinska.

Graves' disease typically requires medical treatment, radioiodine therapy, or surgery, per NIDDK.

If you have a family history of the disease or have been diagnosed with the condition, Dr. Klubo-Gwiezdzinska emphasizes the importance of making lifestyle modifications and reducing excessive stress.

While it may sound overly simplistic, stress really can trigger autoimmune thyroid disease or worsen symptoms associated with it, so managing your levels via strategies like sleep hygiene, finding a healthy work-life balance, developing coping techniques to keep your mood on an even keel, and exercising regularly can go a long way.

If you suspect a thyroid issue, make sure to speak to a healthcare professional. For more information, please refer to the guide on Graves' disease from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Jade Esmeralda, MS, CSCS, is a health and fitness staff writer and a strength and conditioning specialist. A lifelong martial artist and dancer, Jade has a strong passion for strength and conditioning, sports science, and human performance. She graduated with a Master of Science degree in exercise science and strength and conditioning from George Washington University.