Graves’ disease, a type of hyperthyroidism, is caused by a generalized overactivity of the entire thyroid gland. It is named for Robert Graves, an Irish physician, who was the first to describe this form of hyperthyroidism about 150 years ago.  Because Graves’ disease is an inherited condition, examinations of the members of your family may reveal other individuals
with thyroid problems.

SYMPTOMS

• Hyperthyroidism:  The hyperthyroid symptoms of Graves’ disease are often the same as those caused by other types of hyperthyroidism.

• Eye disease:  Graves’ disease is the only kind of hyperthyroidism that has inflammation of the eyes, swelling of the tissues around the eyes, and bulging of the eyes (called Graves’ opthalmopathy).  The cause of these problems is unknown. Although many patients with Graves’ disease have redness and irritation of the eyes at some time, less than 1% ever develop enough inflammation of the eye tissues to cause serious or permanent trouble.  Patients who have severe eye symptoms may benefit from visiting an eye doctor (an ophthalmologist). 

Eye symptoms generally begin about 6 months before or after the diagnosis of Graves’ disease has been made.  Seldom do eye problems occur long
after the disease has been treated. In some patients with eye symptoms,
hyperthyroidism never develops. The severity of the eye problems is not
related to the severity of the hyperthyroidism. Early signs of trouble
might be red or inflamed eyes or a bulging of the eyes due to inflammation
of the tissues behind the eyeball.  Diminished or double vision are rare
problems that usually occur later. We do not know why, but problems with
the eyes occur much more often in people with Graves’ disease who smoke cigarettes than in those who don’t smoke.

• Skin disease:  Rarely, patients with Graves’ disease develop a lumpy reddish thickening of the skin in front of the shins known as pretibial myxedema. This skin condition is usually painless and is not serious. Like the eye trouble of Graves’ disease, the skin problem does not necessarily begin precisely when the hyperthyroidism starts. Its severity is not related to the level of thyroid hormone. We don’t know why this problem is usually limited to the lower leg or why so few people have it.

CAUSES

Graves’ disease is triggered by some process in the body’s immune system,
which normally protects us from foreign invaders such as bacteria and viruses. The immune system destroys foreign invaders with substances called antibodies produced by blood cells known as lymphocytes. Many people inherit an immune system that can cause problems.  Their  Lymphocytes make antibodies against their own tissues that stimulate or
damage them.

In Graves’ disease, antibodies bind to the surface of thyroid
cells and stimulate those cells to overproduce thyroid hormones. This
results in an overactive thyroid. Physicians have long suspected that severe emotional stress, such as the death of a loved one, can set off Graves’ disease in some patients. Dr. Graves himself commented on stressful events in his patients’ lives that came several months before the
development of hyperthyroidism. However, many patients who develop Graves’ disease report no stress in theirlives.