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.

• 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

  Advertisement Thyroid gland Hyperplasia / goiter Graves disease Topic Completed: 1 November 2017 Revised: 14 March 2019 Copyright: 2003-2018, PathologyOutlines.com, Inc. [pathologyoutlines.com]

  The consistency of the goiter varies from soft to firm but softer than the goiter of Hashimoto's thyroiditis. Thrill and bruit can be present over goiter in severe cases and it is due to increased vascularity of the gland. [intechopen.com]

  A goiter or nodule may be present. [msdmanuals.com]

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

  Goiter is an enlarged thyroid gland and is of the diffuse type (i.e., spread throughout the gland). Diffuse goiter may be seen with other causes of hyperthyroidism, although Graves' disease is the most common cause of diffuse goiter. [en.wikipedia.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]

  You may see these symptoms of Graves’ disease in children: An enlarged thyroid gland (this is located in the neck, just above the collarbone) Difficulty swallowing Prominent or bulging eyes Weight loss or poor weight gain Rapid pulse Hair loss Weakness [stanfordchildrens.org]

  Body habitus, weight and BMI Weight loss is common with thyrotoxicosis and should improve rapidly with treatment. Weight loss will also occur with the development of Addison's disease or with type 1 diabetes mellitus. [endobible.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]

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

• Weakness

  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]

  [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]

  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]

  […] medical diagnostic testing May cause pathology in multiple organ systems GI: liver Cardiovascular: heart, peripheral circulation, blood pressure Integumentary May result in secondary problems Aerobic capacity and muscle endurance impairment Sarcopenia Weakness [accessphysiotherapy.mhmedical.com]

  Older people may have these symptoms: Rapid or irregular heartbeat Chest pain Memory loss Weakness and fatigue Exams and Tests The health care provider will do a physical exam and may find that you have an increased heart rate. [ufhealth.org]

• Fatigue

  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]

  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]

  Possible Signs and Symptoms of Graves’ Disease •Goiter (enlarged thyroid gland) •Bulging, itchy or swollen eyes •Difficulty breathing •Anxiety, irritability •Difficulty sleeping, fatigue •Rapid or irregular heartbeat, trembling fingers •Excess perspiration [academic.oup.com]

  If left untreated, hyperthyroidism may cause weight loss, emotional liability (uncontrollable crying, laughing, or other emotional displays), depression, and mental or physical fatigue. [healthline.com]

• Heat Intolerance

  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]

  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]

  […] affecting more women than men, between the ages of 30 and 60. [2] [3] Graves’ disease accounts for 85% of all cases of hyperthyroidism. [4] Characteristics/Clinical Presentation Goiter, Exophthalmos, tremors, dermopaty, tachycardia with palpitations, heat [physio-pedia.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]

• 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]

• 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

  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]

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

  […] fingers An increase in perspiration or warm, moist skin Sensitivity to heat Weight loss, despite normal eating habits Enlargement of your thyroid gland (goiter) Change in menstrual cycles Erectile dysfunction or reduced libido Frequent bowel movements or diarrhea [empoweryourhealth.org]

  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]

  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]

  […] 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]

  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]

• Palpitations

  Caucasian race affecting more women than men, between the ages of 30 and 60. [2] [3] Graves’ disease accounts for 85% of all cases of hyperthyroidism. [4] Characteristics/Clinical Presentation Goiter, Exophthalmos, tremors, dermopaty, tachycardia with palpitations [physio-pedia.com]

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

  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

  Therapists should be aware of these signs and symptoms of Thyroid Storm: Severe tachycardia with heart failure Hyperurthemia (up to 105 degrees) Reselessness and agitation Abdominal pain, nausea, and vomiting Possible coma Immediate referral is necessary [physio-pedia.com]

  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]

  Signs may include warm, moist skin; tremor; tachycardia; widened pulse pressure; and atrial fibrillation. [msdmanuals.com]

• 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]

  Hypertension is also commonly seen with thyrotoxicosis. Orthostatic hypotension may occur, but may also indicate glucocorticoid deficiency with Addison’s disease. [endobible.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]

• Diplopia

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

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

• Conjunctival Injection

  Swelling of the soft tissue around the eyes, redness of the whites of the eyes (conjunctival injection) or protrusion, lid asymmetry or muscle tethering all indicate Graves' ophthalmopathy. Examine the open and closed eyes from the side and above. [endobible.com]

  Previous studies have attempted to use multiple sub-conjunctival injections of triamcinolone acetonide. While this treatment was helpful, Funaki noted that it came with a cost of transient intraocular pressure increases. [medpagetoday.com]

  injection periorbital edema Key laboratory findings suppressed serum TSH concentrations elevated serum total T4 and free T4 concentrations elevated serum total T3 and free T3 concentrations elevated thyroid stimulating immunoglobulin (TSI) titers In [endocrinologyadvisor.com]

  Eye signs include stare, eyelid lag, eyelid retraction, and mild conjunctival injection and are largely due to excessive adrenergic stimulation. They usually remit with successful treatment. [msdmanuals.com]

• 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]

• Eye Pain

  Dry Eye Symptoms in Graves’ Disease Pain in the eyes, pain when looking up, down or sideways Dryness, itching, dry eyes, difficulty wearing contact lenses Inflammation and swelling of the eye, and its surrounding tissues Swelling in the orbital tissues [theralife.com]

  (Graves' ophthalmopathy) Chest pain Difficulty sleeping/insomnia Erectile dysfunction or reduced libido Eye problems (blurred vision, light sensitivity, grittiness sensation, eye pain) Fatigue Frequent bowel movements or diarrhea Hand tremors Heart palpitations [cooperhealth.org]

  This will correct issues such as orbital congestion, pain, eye bulging, and eyelid disfigurement. In extreme cases, optic nerve damage, corneal breach, and eye dislocation are prevented. With Dr. [advancedreconstruction.com]

  Symptoms Besides bulging eyes, other GO symptoms are dry, gritty, and irritated eyes puffy or retracted eyelids double vision light sensitivity pressure or pain in the eyes trouble moving the eyes About one in three people with Graves’ disease develop [niddk.nih.gov]

  This skin problem is usually painless and mild, but it can be painful for some. Graves' ophthalmopathy (Graves' orbitopathy) can cause retracted eyelids, meaning the eyelids are pulled back from the eye. [medicinenet.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]

• 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]

  Deconditioning and muscle weakness are secondary ailments that is seen in this population and can be managed by a physical therapist. [4] Perferred Practice Patterns [4] 4C: Impaired Muscle performance 4D: Impaired joint mobility, motor function, muscle [physio-pedia.com]

  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]

  Symptoms of hyperthyroidis m include rapid heartbeat, muscle weakness, disturbed sleep, and irritability. [quidel.com]

• 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]

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

  Medicines called beta-blockers are often used to treat symptoms of rapid heart rate, sweating, and anxiety until the hyperthyroidism is controlled. [ufhealth.org]

• 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]

  Symptoms Younger people may have these symptoms: Anxiety or nervousness, as well as problems sleeping Breast enlargement in men (possible) Problems concentrating Fatigue Frequent bowel movements Hair loss Heat intolerance and increased sweating Increased [ufhealth.org]

  Younger people may have these symptoms: Anxiety or nervousness, as well as problems sleeping Breast enlargement in men (possible) Problems concentrating Fatigue Frequent bowel movements Hair loss Heat intolerance and increased sweating Increased appetite [medlineplus.gov]

• 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.medscape.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.medscape.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]

• 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.medscape.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]

  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]

  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]

  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]

  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]

• 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]

  […] despite polyphagia Lid lag, Lid tremors Hyperdefecation, Polyuria Gynaecomastia Oligomenorrhoea Loss 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]

• 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]

• Sexual Dysfunction

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

• 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

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

  Sometimes, prednisone (a steroid medication that suppresses the immune system) is needed to reduce eye irritation and swelling. You may need to tape your eyes closed at night to prevent drying. Sunglasses and eye drops may reduce eye irritation. [medlineplus.gov]

  Symptoms in babies include: Rapid heartbeat Irritability Swollen thyroid gland Bulging eyes Excessive hunger Learn about Hyperthyroidism (Grave's disease) - Neonatal > Diagnosing Graves’ disease Health care providers can sometimes make a diagnosis of [stanfordchildrens.org]

  Sometimes prednisone (a steroid medication that suppresses the immune system) is needed to reduce eye irritation and swelling. You may need to tape your eyes closed at night to prevent drying. Sunglasses and eyedrops may reduce eye irritation. [en.wikibooks.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]

  Hands and tremor Examine the palms - hot, red and sweaty hands occur in hyperthyroidism. Ask the patient to hold out their hands in front of them. [endobible.com]

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

  ’ disease is more prevalent in the Caucasian race affecting more women than men, between the ages of 30 and 60. [2] [3] Graves’ disease accounts for 85% of all cases of hyperthyroidism. [4] Characteristics/Clinical Presentation Goiter, Exophthalmos, tremors [physio-pedia.com]

  Another medication, propranolol, is a beta-blocker that helps relieve the symptoms of Graves' disease including rapid heart rate, tremor, sweating and anxiety. [healthcentral.com]

• 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]

  […] anxiety or nervousness intolerance to heat sweating more than usual weight loss even with increase in appetite difficulty concentrating bulging or irritated eyeballs; vision problems palpitations or faster heartrate fatigue insomnia frequent bowel movements [stopthethyroidmadness.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]

• Hyperactivity

  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]

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

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

  This is eventually followed by a period of immune hyperactivity, and consequently, autoimmune thyroid disease. [ 9 ] The most common cause of hyperthyroidism during pregnancy is Graves Disease. [ihealthblogger.com]

  Parents may mistake their children’s behavior for hyperactivity or even a psychiatric condition. [stanfordchildrens.org]

• Hand Tremor

  A 43-year-old female patient presented to our hospital on November 2014, with a 1-year history of palpitation, fatigue, and hand tremor. Her situation was getting worse within 2 months. The thyroid function tests were suggestive of thyrotoxicosis. [ncbi.nlm.nih.gov]

  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]

  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]

  Difficulty swallowing Change in voice Heart disease Dyspnea, shortness of breath with exertion Airway obstruction Increased appetite Menstrual disturbance, irregularity Increased bowel frequency Breast development in men Clammy skin Diarrhea Hair loss Hand [accessphysiotherapy.mhmedical.com]

  Symptoms can run the gamut from weight loss and fatigue to period changes and hand tremors. In addition to the general symptoms of hyperthyroidism, Graves' disease can also cause eye and skin issues. [health.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. [dx.doi.org]

• Hypoglycemia

  […] or Struma ovarii) - Thyroiditis (De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis) - Euthyroid sick syndrome Pancreas Diabetes mellitus (type 1, type 2, coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy) - Hypoglycemia [wikidoc.org]

  Patients with diabetes may also rarely have hypoglycemia during Graves’ disease. F. [cancertherapyadvisor.com]

  In the patient with diabetes, hyperthyroidism is usually associated with further glucose intolerance or, rarely, hypoglycemia.12 Hyperthyroidism may also precipitate an adrenal crisis in patients so predisposed. [cmaj.ca]

• Neutropenia

  There was leukopenia with neutropenia, some toxic features, a few reactive lymphocytes, and minor platelet clumps. [hindawi.com]

  To the best of our knowledge, only a single case report described the development of neutropenia in a preterm (GA 30 weeks) neonate treated with MMI who recovered after decreasing the dose. 71 Prematurity is not a contraindication to ATD use. [pediatrics.aappublications.org]

  Parvovirus B19 is known for causing a childhood exanthem but it has also been associated with autoimmune diseases: autoimmune neutropenia, thrombocytopenia, hemolytic anemia and rheumatoid arthritis [ 102 ]. [doi.org]

• Hyperglycemia

  In addition, patients with thyroid storm might present with hyperglycemia, hypercalcemia, hypocortisolism, and hypokalemia.10 Thyroid storm requires prompt treatment of both the clinical manifestations and the underlying condition. [the-hospitalist.org]

  Patients with diabetes mellitus may have hyperglycemia that is difficult to control. Patients with diabetes may also rarely have hypoglycemia during Graves’ disease. F. [cancertherapyadvisor.com]

• Lymphocytosis

  Leukopenia with a relative lymphocytosis is not an uncommon blood abnormality in GD, named “Kocher’s blood picture.” [11]. [hindawi.com]

  There is more chance of relapse in patients with persistently high TSHR-Ab level after cessation of antithyroid drug. [ 47 ] Associated hematological abnormalities include increased RBC mass, leucopenia with relative lymphocytosis, monocytosis and eosinophilia [intechopen.com]

• HLA-DR3

  […] and HLA-DR3 Laboratory Increased T3 / T4, increased uptake of radioactive iodine, decreased TSH Clinical Images Images hosted on other servers: Rodney Dangerfield Marty Feldman Gross Description Diffusely enlarged thyroid gland up to 150g, red and succulent [web.archive.org]

  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 Sites Global involvement of thyroid gland Pathophysiology Exact [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]

  Polymorphism in HLA-DR, CTLA-4 and PTPN-22 genes are associated with increased risk of Graves’ disease. HLA-DR3 (HLA-DRB1*03), HLA-DQA1*0501 and HLA-B8 gives a risk ratio of three fold to fourfold in white population. [intechopen.com]

• HLA-B8

  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]

  […] 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]

  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 Sites Global involvement of thyroid gland Pathophysiology Exact [pathologyoutlines.com]

  Polymorphism in HLA-DR, CTLA-4 and PTPN-22 genes are associated with increased risk of Graves’ disease. HLA-DR3 (HLA-DRB1*03), HLA-DQA1*0501 and HLA-B8 gives a risk ratio of three fold to fourfold in white population. [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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11. De Bellis A, Sansone D, Coronella C, et al. Serum antibodies to collagen XIII: a further good marker of active Graves' ophthalmopathy. Clinical endocrinology. Jan 2005;62(1):24-29.