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Grave's disease is a tissue-specific autoimmune disorder where the immune system attacks the thyroid gland. From the attack the patient develops hyperthyroidism and many of their bodily processes speed up (National Institute of Diabetes and Digestive and Kidney Diseases, 2021). Grave's disease is classified as a type II hypersensitivity reaction. The onset of this disease usually occurs between the ages of twenty and forty years old. With proper medical treatment, a patient can live a long normal life with Grave's Disease.

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What Is Graves’ Disease? | UCLA Endocrine Center

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You are more likely to have Grave's disease if you identify with one or more of the risk factors below.

You are female.

You are inbetween twenty and forty years old.

You have a family history of Grave's or Hashimoto's.

You have other diseases that Grave's clusters with: Type 1 diabetes, vitiligo, and rheumatoid arthritis.

You are exposed to the following: nicotine use, smoking, chemical exposure, stress

(National Institute of Diabetes and Digestive and Kidney Diseases, 2021).

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Grave's disease is caused by thyroid stimulatiing antibody (TSAb) also known as TSI. TSI binds with TSH receptors on the thyroid and stimulates the hormal response (Pokhrel & Bhusal, 2023). This is what causes the Hyperthyroidism. Hyperthyroidism can cause excess inflammation and growth which feeds into the severe immune response. Grave's disease is considered a type II (cytotoxic) hypersensitivity reaction but it also can sometimes be categorized into type V. This is because the antibodies do not just destroy cells but stimulate them as well.

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Image A is ophthalmopathy caused by infiltrative changes involving the orbital contents with enlargement of the ocular muscles (Rogers, 2024). This is ne clinical manifestation of Graves' Disease. Photograph B is Pretibial Myxedema. This lumpy swollen rash is another clinical manifestation of Graves' Disease (Rogers, 2024).

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Clinical Manifestations of Grave's Disease

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Clinical Manifestations of Grave's Disease

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https://www.youtube.com/watch?v=dMsY3DQe24M

this video identifies some common clinical manifestations of graves' disease.

Graces’ disease is an immune system condition that affects the thyroid gland. With this disorder the body creates too much thyroid hormone, which means that Graves’ disease is also know as hyperthyroidism (Mayo Clinic, 2024). There are many different symptoms associated with graves disease. Some common symptoms include:

Feeling nervous and irritable.

Having a slight tremor of the hands or fingers.

Being sensitive to heat with an increase in sweating or warm, moist skin.

Losing weight, despite wanting to eat more.

Having an enlarged thyroid gland, also called goiter.

Having changes in menstrual cycles.

Not being able to get or keep an erection, called erectile dysfunction, or having less desire for sex.

Having bowel movements often.

Having bulging eyes — a condition called thyroid eye disease or Graves' ophthalmopathy.

Being tired.

Having thick, discolored skin mostly on the shins or tops of the feet, called Graves' dermopathy.

Having fast or irregular heartbeat, called palpitations.

Not sleeping well (Mayo Clinic, 2024).

Graves’ disease presents with various physical symptoms, most notably ophthalmopathy and dermopathy.

Ophthalmopathy has two main forms:

1. Functional changes from sympathetic hyperactivity, causing abnormal eye and eyelid movements(Rogers, 2024).

2. Infiltrative changes where immune-related tissue buildup enlarges eye muscles, affecting over half of patients(Rogers, 2024).

Dermopathy (pretibial myxedema) occurs in a small number of patients with very high thyroid-stimulating immunoglobulin (TSI) levels. It causes swelling, thickened reddish skin—mainly on the shins—and sometimes finger clubbing (thyroid acropachy)(Rogers, 2024).

Thyrotoxic crisis (thyroid storm) is a rare, life-threatening escalation of hyperthyroidism marked by a sudden, extreme rise in thyroid hormone levels. It often occurs in untreated or partially treated Graves’ disease patients exposed to severe stressors such as infection, trauma, or surgery(Rogers, 2024).

Mayo Clinic Staff. (2024, June 14). Graves’ disease: Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240

Rogers, J. (2024). McCance & Huether’s pathophysiology: the biologic basis for disease in adults and children. (9th ed). Elsevier.

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Expected Therapeutic Management of Graves' Disease

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Expected Therapeutic Management of Graves' Disease

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https://www.youtube.com/watch?v=XDc7J6nYwag

this video reviews some treatment options for Grave's disease.

Once a patient is confirmed to have Graves’ disease there are a wide range of treatment options that vary in many different ways. The overarching goal of therapy or treatment is to stop the thyroid from making hormones. One treatment option iis radioactive iodine therapy. With radioactive iodine treatment you consume radioiodine, by mouth. The radioiodine infiltrates the thyroid cells, and over time, destroys the cells that make thyroid hormone. This treatment is not with out its own risks (Mayo Clinic. 2024). Radioiodine therapy may raise the risk of thyroid eye disease or make its symptoms worse, thankfully this side effect is typically mild and doesn't last. Some other side effects of radioactive iodine treatment can include a tender neck and a brief rise in thyroid hormones (Mayo Clinic, 2024). Radioiodine therapy isn't used for treating pregnant people or those who are breastfeeding. This treatment destroys cells that make thyroid hormone. After the treatment, you'll likely need to take daily hormone medicine to get the thyroid hormones your body needs Mayo Clinic, 2024).

Another treatment option is anti-thyroid medicines. These medications block the thyroid from utilizing iodine to make hormones. The two most common medications used are propylthiouracil and methimazole (Mayo Clinici, 2024). These medications are more effective if used in tandem with other forms of therapy as well. When either of these medicines are used without other treatments, hyperthyroidism may come back (Mayo Clinic, 2024). These medicines may work better when they are taken for longer than a year. Anti-thyroid medicines may be used before or after radioiodine therapy as an added treatment. Side effects of both medicines include rash, joint pain, liver failure or a decrease in disease-fighting white blood cells (Mayo Clinic, 2024).

A third treatment option is beta blockers. These types of medications don't stop the body from making thyroid hormones like other therapies. They do however block the effect of hormones on the body (Mayo Clinic, 2024). They may work quickly to ease irregular heartbeats, tremors, anxiety, irritability, heat intolerance, sweating, diarrhea and muscle weakness (Mayo Clinic, 2024).

A final treatment option for treating Graves’ disease is surgical removal of the thyroid. This type of surgery is known as a thyroidectomy (Mayo Clinic, 2024) It should be highlighted that the patient would need to take thyroid medicine for the rest of their life after this surgery. There are some serious risks associated with this surgery including: damage to the nerve that controls the vocal cords and damage to the tiny glands that sit next to the thyroid gland, called the parathyroid glands. The parathyroid glands make a hormone that controls the level of calcium in the blood (Mayo Clinic, 2024).

Mayo Clinic Staff. (2024, June 14). Graves’ disease: Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240

https://www.pacehospital.com/overactive-thyroid-hyperthyroidism-disease

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National Institute of Diabetes and Digestive and Kidney Diseases. (2021, November). Graves’ disease. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease

Pokhrel, B., & Bhusal, K. (2023, June 20). Graves disease. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448195/

UCLA Health. (2023, May 8). What Is Graves’ Disease? | UCLA Endocrine Center. YouTube. https://www.youtube.com/watch?v=QBeq0Kf03lI

(2025). Youtube.com. https://www.youtube.com/results?search_query=type+v+hypersensitivity

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This image shows how the pathophysiologic mechanisms in Graves' Disease work. In the image, T4 is levothyroxine and T3 is triiodothyronine (Jim Yeung, et al, 2023). The immune system starts by producing TSH receptor antibodies, also known as TSIs. These antibodies then bind to the thyroid follicular cells, leading the thyroid to overproduce T3 and T4, resulting in a goiter. Eventually, the TSH decreases from negative feedback, and systemic hyperthyroidism symptoms begin to appear in the patient.

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A simple article for a patient who may be newly diagnosed with Grave's Disease. 

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A simple article for a patient who may be newly diagnosed with Grave's Disease. 

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Being diagnosed with an autoimmune disorder may be scary or confusing. Autoimmune disorders are sometimes less talked about and can be difficult to understand. This would be a good resource for a patient to start with no matter their level of medical knowledge. It includes most of the aspects of the disease with helpful images and descriptive wording. Articles like this one can be an important place to start learning about one's disease.

Cleveland Clinic. (2022). Graves’ Disease: Symptoms, Causes, Treatments & Tests. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15244-graves-disease

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Overview

What is Graves' disease?

Graves' disease is a type of autoimmune disease that damages the thyroid gland. This butterfly-shaped gland in the neck produces hormones that regulate how your body uses energy (metabolism).

Graves' disease is the most common cause of hyperthyroidism (overactive thyroid gland). People with Graves' disease make too much thyroid hormone, which can damage the heart and other organs. The condition gets its name from Robert Graves, an Irish doctor who first described the condition in the 1800s.

Where is your thyroid?

This thumb-sized gland sits at the base of your neck. It's below your Adam's apple and in front of your windpipe. A bridge made of tissue connects the right and front lobes, or sides, of the gland, giving the thyroid a butterfly shape.

How common is Graves' disease?

Graves' disease affects one out of every 200 Americans, making it the top cause of hyperthyroidism.

Who might get Graves' disease?

Graves' disease affects more women than men. It typically occurs in people between the ages of 30 and 50. The condition tends to run in families.

Your risk of developing Graves' disease increases if you have:

Symptoms and Causes

What causes Graves' disease?

Experts don't know what causes autoimmune diseases like Graves' disease. Something triggers the immune system to overproduce an antibody called thyroid-stimulating immunoglobulin (TSI). The trigger may be a combination of genes and exposure to a virus. TSI attaches to healthy thyroid cells, causing the gland to overproduce thyroid hormones.

What are the symptoms of Graves' disease?

Hyperthyroidism speeds up certain body functions. Symptoms of Graves' disease include:

Difficulty sleeping.

Enlarged thyroid (goiter).

Eye inflammation that causes eyeballs to protrude from sockets.

Fast, irregular heartbeat (arrhythmia).

Hand tremors.

Heat intolerance.

Irritability.

Muscle weakness.

Unexplained weight loss.

Diagnosis and Tests

How is Graves' disease diagnosed?

Your healthcare provider may make a diagnosis based on your symptoms, such as an enlarged thyroid, and family history of thyroid or autoimmune disease. You may also have these tests to confirm a Graves' disease diagnosis:

Blood test: Thyroid blood tests measure TSI, an antibody that stimulates thyroid hormone production. Blood tests also check amounts of thyroid-stimulating hormones (TSH). A low TSH level indicates that the thyroid gland is producing too much hormone. The overproduction causes the pituitary gland to make less TSH.

Radioactive iodine uptake (RAIU) test: The thyroid collects iodine from blood to make thyroid hormone. With the RAIU test, you swallow a small amount of radioactive iodine. Ingesting a radioactive material might sound scary, but this treatment safely targets thyroid cells only - the rest of your body isn't affected. A device measures the amount of iodine the thyroid gland absorbs. High levels of iodine absorption can be a sign of Graves' disease.

Thyroid scan: A thyroid scan is an imaging test that utilizes radioactive material to look at how the thyroid is working. It is typically done by injecting a material called technetium before the test, waiting a short period of time and then creating images of the thyroid. During the scan, your provider will see a picture of the gland, as well as being able to see the gland's uptake pattern. This pattern helps tell your provider how well the gland is working. It can also be a part of the diagnosis process in that if you have diffuse (spread out) high uptake, it's likely Graves' disease. If there are focal (specific) areas of uptake, this is more likely to be a different type of hyperthyroidism.

There are also two types of antibodies linked with Graves' disease that may be detected during your tests. These antibodies include TSI (thyroid stimulating antibodies), as well as TBII (thyrotropin binding inhibitory immunoglobulins).

In some patients, there will be negative antibodies and the diagnosis will depend on their lab results (mainly TSH, but also FT4 and FT3), radioiodine uptake and thyroid scan.

Management and Treatment

How is Graves' disease managed or treated?

Graves' disease is a lifelong condition. However, treatments can keep the thyroid gland in check. Medical care may even make the disease temporarily go away (remission):

Beta-blockers: Beta-blockers, such as propranolol and metoprolol, are often the first line of treatment. These medications regulate your heart rate and protect your heart until other hyperthyroidism treatments take effect.

Antithyroid medications: Antithyroid medications, such as methimazole (Tapazole®) and propylthiouracil, block the gland's production of thyroid hormone. In a small percentage of people, these medications cause skin rashes and low white blood cell count, which may increase your risk of infection. Rarely, liver disease develops.

Radiation therapy: Radioiodine therapy involves taking one dose of radioactive iodine in pill or liquid form. Over two to three months, radiation slowly destroys thyroid gland cells. (The rest of your body isn't exposed to radiation.) As the thyroid gland shrinks, hormone levels return to normal. Women who are pregnant or breastfeeding shouldn't get this treatment.

Surgery: A thyroidectomy involves surgically removing all or part of the thyroid gland. After surgery, some people produce too little thyroid hormone (a condition called hypothyroidism). If you develop this problem, you may need to take thyroid replacement hormone medications, such as levothyroxine (Synthroid®) or natural desiccated thyroid (Armour® or Nature-Throid®), for life.

What are the complications of Graves' disease?

Untreated or poorly managed Graves' disease increases your risk for these complications:

Eye disease: Thyroid eye disease, or Graves' ophthalmopathy, occurs when the immune system attacks muscle and tissue around the eyes. Inflammation causes the eyes to protrude or bulge. These changes can cause double vision (seeing two of the same image) and light sensitivity. Severe swelling can damage the optic nerve and lead to vision loss.

Heart problems: Uncontrolled Graves' disease can cause arrhythmia (irregular heartbeat). Arrhythmia increases your risk of stroke, heart failure and other heart problems.

Skin problems: A small number of people with Graves' disease develop red, thickened skin on their shins and feet. This condition is called Graves' dermopathy or pretibial myxedema. The condition isn't painful, but it can be uncomfortable. Over-the-counter hydrocortisone creams, such as Cortizone®, can provide relief.

Thyroid storm: Dangerously high thyroid activity speeds up body functions. It causes arrhythmia, fast pulse and shock. This life-threatening condition is known as a thyroid storm. It requires fast treatment with antithyroid medications.

How does Graves' disease affect pregnancy?

Thyroid hormones play a key role in the development of a baby's brain and nervous system. Untreated hyperthyroidism during pregnancy can be harmful to you and your unborn child. Your healthcare provider may test your hormone levels monthly to ensure they stay within a safe range. Too much thyroid hormone during pregnancy can increase the risk of:

Low birth weight (newborns who weigh less than 5 pounds, 8 ounces).

Miscarriage (loss of pregnancy before the baby is fully developed).

Preeclampsia (high blood pressure during pregnancy).

Premature labor (birth that occurs before the 37th week of pregnancy).

Infant hyperthyroidism (high thyroid hormone levels in a newborn).

Congestive heart failure in mother.

Prevention

How can I prevent Graves' disease?

Experts still aren't certain what causes autoimmune diseases like Graves' disease. Currently, there's no known way to prevent the illness.

Outlook / Prognosis

What is the prognosis (outlook) for people with Graves' disease?

Keeping thyroid hormones in a healthy range can be tricky when you have Graves' disease. Treatments are often effective but can have side effects. After treatment, some people start to produce too little thyroid hormone. They then need thyroid hormone replacement therapy for life.

Living With

When should I call the doctor?

You should call your healthcare provider if you have Graves' disease and you experience:

Double vision.

Extreme muscle weakness.

Fast, irregular heartbeat.

Light sensitivity.

Pressure or pain in the eyes.

Skin rash or itching, which may be a sign of a medication allergy.

Sore throat that doesn't go away.

What questions should I ask my doctor?

If you have Graves' disease, you may want to ask your healthcare provider:

What is the best treatment for me?

What are the treatment side effects?

Should I avoid certain medications?

Could surgery to remove the thyroid help me?

Does Graves' disease cause other health problems?

Should I look out for signs of complications?

A note from Cleveland Clinic

Thyroid hormone levels that are too high due to Graves' disease can cause serious health problems. Your healthcare provider will regularly check your thyroid hormone levels to ensure numbers stay in a healthy range. Sometimes, treatments to reduce excess thyroid hormone result in your body making too little hormone. If that occurs, thyroid hormone replacement therapy can fill the gap.

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Graves' disease is a type of autoimmune disease that damages the thyroid gland. This butterfly-shaped gland in the neck produces hormones that regulate how your body uses energy (metabolism). Graves' disease is the most common cause of hyperthyroidism (overactive thyroid gland). People with Graves' disease make too much thyroid hormone, which can damage the heart and other organs.

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Resources for Those Impacted by Graves' Disease

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Resources for Those Impacted by Graves' Disease

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This link is to the Graves’ Disease and Thyroid Foundation, an organization that supports patients who have graves’ disease as well as other thyroid disorders. This is a great resource to connect patients with because it offers educational materials that are written specifically for patients. It is also useful because it can connects patients to a larger community where they can find support. This organization also seems to have a toll-free hotline that patients can access for a variety of needs. Lastly this site would be a great resource because it not only provides supports for patients, but also for families and support people, so really the whole unit impacted by the diagnosis.

https://www.thyroid.org/graves-disease/

This would also be a great resource to share with patients who have recently received a diagnosis of graves’ disease. This resource is beneficial in that it has medically accurate and up to date information regarding Graves’ disease and it is published by the American Thyroid Association. This resource provides detailed overviews of different treatment options, including what patients can expect both during the treatment and what to expect afterwards. Because this resource is written for patients the content balances technical accuracy and is readable for non-medical individuals. This resource can help patients better understand their diagnosis, support informed treatment planning and setting realistic expectations.

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Discover the Graves' Disease and Thyroid Foundation for trusted resources, education, and support on thyroid health and autoimmune disorders.

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Graves’ disease is an autoimmune condition that causes hyperthyroidism and is caused by thyroid-stimulating immunoglobulin (TSI). The TSI can be synthesized within B lymphocytes, lymph nodes, and bone marrow (Pokhrel & Bhusal, 2023). The thyroid-stimulating immunoglobulin binds with the thyroid-stimulating hormone (TSH) receptor and stimulates TSH. The overproduction of T3 and T4 leads to goiter, which causes systemic effects of thyrotoxicosis. Effects of thyrotoxicosis include, but are not limited to, increased metabolic rate, heat intolerance, and tachycardia (Pokhrel & Bhusal, 2023). The same autoantibodies can activate fibroblasts and other cells in the tissues behind the eyes, causing inflammation and an overgrowth of the tissues. The increased pressure from swollen muscles and fatty tissue causes the eyeballs to protrude, which leads to lid retraction and potentially results in vision problems. Fibroblasts can also be stimulated in the skin, leading to GAGs deposition, and can cause the skin to become thickened, red, and swollen (Shahid et al., 2025). Even though Graves' Disease is a thyroid disease, it can affect the whole body.

Pokhrel B, Bhusal K. Graves Disease. [Updated 2023 Jun 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448195/

Shahid MA, Ashraf MA, Sharma S. Physiology, Thyroid Hormone. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500006/

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Graves' Disease is considered a type II hypersensitivity reaction because the antibodies target the thyroid gland. In a type II hypersensitivity, autoantibodies are directed at cell-surface molecules, and they alter cell function (Saavedra Torres & Mohammed, 2025). Usually, the autoantibodies cause cell damage, but in Graves' Disease, they actually stimulate the cells instead. The TSIs act as agonists at the TSH receptor, causing continuous hormone production (Huang et al., 2015). Therefore, Graves' Disease does not conform to the traditional definition of type II hypersensitivity.

Huang, Y. M., Shih, L. J., Hsieh, T. W., Tsai, K. W., Lu, K. C., Liao, M. T., & Hu, W. C. (2024). Type 2 hypersensitivity disorders, including systemic lupus erythematosus, Sjögren's syndrome, Graves' disease, myasthenia gravis, immune thrombocytopenia, autoimmune hemolytic anemia, dermatomyositis, and graft-versus-host disease, are THαβ-dominant autoimmune diseases. Virulence, 15(1), 2404225. https://doi.org/10.1080/21505594.2024.2404225

Saavedra Torres JS, Mohammed RH. Type II Hypersensitivity Reaction. [Updated 2025 Sep 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563264/?utm_source=chatgpt.com