Graves’ disease causes the thyroid gland to increase in size and produce more thyroid hormones, resulting in increased free T4 and/or T3 giving rise to hyperthyroidism. Certain symptoms arise as a result and if left untreated, complications develop, which can be fatal.
Graves’ is the most common cause and accounts for 70% of hyperthyroidism cases.
High levels of thyroid hormones put the body in a hypermetabolic state. It means that there is an increased rate of metabolic activity and an abnormal increase in the body’s basal metabolic rate.
This puts the body’s metabolism in top gear raising a variety of symptoms and signs. If left untreated, certain complications develop some of which can be life-threatening.
Consequently, you will see symptoms, which are due to the direct and indirect effect of hyperthyroidism in people with Graves’ disease. They include:
- Enlargement of the thyroid gland
- Anxiety and irritability
- Fine tremors in hands and fingers
- Warm and moist skin
- Loss of weight in spite of good food intake
- Reduced libido
- Frequent bowel movements
- Rapid or irregular heartbeats
- Excessive sweating
- Behavioral and personality changes, which can include anxiety, psychosis, and depression
On examination, you may see
- an enlarged non-tender thyroid gland
- Lid lag if eyes are involved
In addition, the following eye and skin symptoms are seen:
Graves’ ophthalmopathy or Graves’ eye disease
Graves’ ophthalmopathy is a characteristic symptom of Graves’ disease and is characterized by retracted eyelids, which cause the eyeball to protrude. This is called exophthalmus or proptosis. It is seen to occur in 30% of the patients with Graves’.
Signs and symptoms Graves’ eye disease include:
- Blurring of vision
- Double vision
- In advanced cases, there will be a loss of vision or blindness.
- Pressure or pain in the eyes
- Reddened eyes due to inflammation
- Sensitivity to light
These bulging eye symptoms occur due to the action of the disturbed immune system on the tissues and muscles around the eyes causing inflammation and swelling.
In severe cases of exophthalmus, you may not be able to close your eyes completely.
In Graves’ eye disease, the cornea of the eye can get damaged due to dryness. Too much of dryness can cause infection and ulcers to develop on the cornea leading vision impairment and even blindness. Infection can lead to conjunctivitis
Graves’ dermopathy or Graves’ skin disease
Due to the autoimmune system of the body, painless, thickened, reddish, patchy, raised skin rashes are seen usually on the lower limbs more particularly on the shins and on the top of your feet. It gives the affected skin an orange peel appearance.
The skin sign and the eye manifestations are due the buildup carbohydrates and inflammation beneath the skin and around the eyes.
This incidence is not so common and most of those who develop Graves’ dermopathy also develop Graves’ ophthalmopathy.
Symptoms in women
Graves’ disease is more commonly seen in women – about seven times more commonly as compared to men and mostly seen between the ages of 20 to 40 years
In women, Graves’ disease can cause changes in the menstrual cycles. The periods become irregular and lighter.
The hormonal changes that occur during pregnancy can cause the thyroid gland to enlarge. This can be normal and usually does not affect the pregnancy.
However, if hyperthyroidism develops, it can be dangerous for the pregnancy and the baby.
Symptoms in children
The warning signs of Graves’ disease may be difficult to spot in children. They are not typical as described above of adults.
Children exhibit hyperactivity, which the parents may mistake as natural. Some children may show psychiatric behavioral changes.
In children, you will see the following symptoms and signs:
- An enlarged thyroid gland in the neck
- Difficulty in swallowing
- Bulging eyes (exophthalmus)
- Changes in weight (gain or loss)
- Rapid heartbeat as seen by the fast pulse
- Hair loss
- Weakness or fatigue
- Cannot tolerate hot weather
- Irritability and mood swings
- Cannot concentrate
- Emotional outbursts, like crying or yelling
- An initial rapid growth rate that slows down and which eventually leads to short build
Complications of untreated Graves’ disease
Graves’ disease should be treated because if not treated or treated inadequately, it can lead to complications, some of which develop suddenly and are serious.
Thyroid storm also referred to as thyrotoxic crisis, is a condition you will see in untreated or improperly treated hyperthyroidism.
It is a complication that can develop suddenly in patients with Graves’ disease. The onset may be triggered by a stressful situation. This can be life-threatening and can cause heart failure, liver failure, and kidney failure. Treatment, therefore, has to be prompt.
You will see the following symptoms of thyroid storm:
- The patient becomes very irritable
- Develops a rapid heart rate and high blood pressure
- Has fever
- Delirium is present
- The patient may go into a coma if not controlled
- Heart problems
Untreated Graves’ disease can affect the heart and alter its structure and functioning. It can lead to arrhythmias (irregular heart rhythm) and congestive heart failure.
Too much of thyroid hormones in the blood interfere with the absorption of calcium by the bones. Hyperthyroidism, therefore, makes the bones brittle and weak (osteoporosis).
Complications during pregnancy
Pregnancy is a time when there are so many stressful things going in the mother’s mind and body. This makes the woman very prone to developing complications if she is suffering from Graves’ disease.
Possible dangers include miscarriage, preterm birth, fetal thyroid dysfunction, poor fetal growth, maternal heart failure, and preeclampsia.