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Diagnosis

The diagnosis of Graves' disease may include:

Physical exam. Your doctor examines your eyes to see if they're irritated or protruding and looks to see if your thyroid gland is enlarged. Because Graves' disease increases your metabolism, your doctor will check your pulse and blood pressure and look for signs of tremor.

Blood sample. Your doctor will order blood tests to determine your levels of thyroid-stimulating hormone (TSH), the pituitary hormone that normally stimulates the thyroid gland, as well as levels of thyroid hormones. People with Graves' disease usually have lower than normal levels of TSH and higher levels of thyroid hormones.

Another laboratory test measures the levels of the antibody known to cause Graves' disease. This test usually isn't necessary to make a diagnosis, but a negative result might indicate another cause for hyperthyroidism.

Radioactive iodine uptake. Your body needs iodine to make thyroid hormones. By giving you a small amount of radioactive iodine and later measuring the amount of it in your thyroid gland with a specialized scanning camera, your doctor can determine the rate at which your thyroid gland takes up iodine. The amount of radioactive iodine taken up by the thyroid gland helps determine if Graves' disease or another condition is the cause of the hyperthyroidism. This test may be combined with a radioactive iodine scan to show a visual image of the uptake pattern.

Ultrasound. Ultrasound uses high-frequency sound waves to produce images of structures inside the body. Ultrasound can show if the thyroid gland is enlarged, and is most useful in people who can't undergo radioactive iodine uptake, such as pregnant women.

Imaging tests. If the diagnosis of Graves' ophthalmopathy isn't clear from a clinical assessment, your doctor may order an imaging test, such as CT scan, a specialized X-ray technology that produces thin cross-sectional images. Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to create either cross-sectional or 3-D images, also may be used.

Treatment

The treatment goals for Graves' disease are to inhibit the production of thyroid hormones and to block the effect of the hormones on the body. Some treatments include:

Radioactive iodine therapy

With this therapy, you take radioactive iodine, or radioiodine, by mouth. Because the thyroid needs iodine to produce hormones, the radioiodine goes into the thyroid cells and the radioactivity destroys the overactive thyroid cells over time. This causes your thyroid gland to shrink, and symptoms lessen gradually, usually over several weeks to several months.

Radioiodine therapy may increase your risk of new or worsened symptoms of Graves' ophthalmopathy. This side effect is usually mild and temporary, but the therapy may not be recommended if you already have moderate to severe eye problems.

Other side effects may include tenderness in the neck and a temporary increase in thyroid hormones. Radioiodine therapy isn't used for treating pregnant women or women who are breast-feeding.

Because this treatment causes thyroid activity to decline, you'll likely need treatment later to supply your body with normal amounts of thyroid hormones.

Anti-thyroid medications

Anti-thyroid medications interfere with the thyroid's use of iodine to produce hormones. These prescription medications include propylthiouracil and methimazole (Tapazole).

Because the risk of liver disease is more common with propylthiouracil, methimazole is considered the first choice when doctors prescribe medication.

When these two drugs are used alone, a relapse of hyperthyroidism may occur at a later time. Taking the drug for longer than a year, however, may result in better long-term results. Anti-thyroid drugs may also be used before or after radioiodine therapy as a supplemental treatment.

Side effects of both drugs include rash, joint pain, liver failure or a decrease in disease-fighting white blood cells. Methimazole isn't used to treat pregnant women in the first trimester because of the slight risk of birth defects. Therefore, propylthiouracil is the preferred anti-thyroid drug during the first trimester for pregnant women. After the first trimester, methimazole use is generally resumed and propylthiouracil is no longer prescribed.

Beta blockers

These medications don't inhibit the production of thyroid hormones, but they do block the effect of hormones on the body. They may provide fairly rapid relief of irregular heartbeats, tremors, anxiety or irritability, heat intolerance, sweating, diarrhea, and muscle weakness.

Beta blockers include:

Propranolol (Inderal)

Atenolol (Tenormin)

Metoprolol (Lopressor, Toprol-XL)

Nadolol (Corgard)

Beta blockers aren't often prescribed for people with asthma, because the drugs may trigger an asthma attack. These drugs may also complicate management of diabetes.

Surgery

Surgery to remove all or part of your thyroid (thyroidectomy or subtotal thyroidectomy) also is an option for the treatment of Graves' disease. After the surgery, you'll likely need treatment to supply your body with normal amounts of thyroid hormones.

Risks of this surgery include potential damage to the nerve that controls your vocal cords and the tiny glands located adjacent to your thyroid gland (parathyroid glands). Your parathyroid glands produce a hormone that controls the level of calcium in your blood. Complications are rare under the care of a surgeon experienced in thyroid surgery.

Treating Graves' ophthalmopathy

Mild symptoms of Graves' ophthalmopathy may be managed by using over-the-counter artificial tears during the day and lubricating gels at night. If your symptoms are more severe, your doctor may recommend:

Corticosteroids. Treatment with prescription corticosteroids, such as prednisone, may diminish swelling behind your eyeballs. 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. Though they don't work for everyone, prisms in your glasses may correct your double vision.

Orbital decompression surgery. In this surgery, your doctor removes the bone between your eye socket (orbit) and your sinuses - the air spaces next to the orbit. This gives your eyes room to move back to their original position.

This treatment is usually used if pressure on the optic nerve threatens the loss of vision. Possible complications include double vision.

Orbital radiotherapy. Orbital radiotherapy was once a common treatment for Graves' ophthalmopathy, but the benefits of the procedure aren't clear. Orbital radiotherapy uses targeted X-rays over the course of several days to destroy some of the tissue behind your eyes. Your doctor may recommend orbital radiotherapy if your eye problems are worsening and prescription corticosteroids alone aren't effective or well-tolerated.

Graves' ophthalmopathy doesn't always improve with treatment for Graves' disease. Symptoms of Graves' ophthalmopathy may even get worse for three to six months. After that, the signs and symptoms of Graves' ophthalmopathy usually stabilize for a year or so and then begin to get better, often on their own.

Lifestyle and home remedies

If you have Graves' disease, make your mental and physical well-being a priority:

Eating well and exercising can enhance the improvement in some symptoms while being treated and help you feel better in general. For example, because your thyroid controls your metabolism, you may have a tendency to gain weight when the hyperthyroidism is corrected. Brittle bones also can occur with Graves' disease, and weight-bearing exercises can help maintain bone density.

Easing stress as much as you can may be helpful, as stress may trigger or worsen Graves' disease. Listening to music, taking a warm bath or walking can help relax you and put you in a better frame of mind. Partner with your doctor to construct a plan that incorporates good nutrition, exercise and relaxation into your daily routine.

For Graves' ophthalmopathy

These steps may make your eyes feel better if you have Graves' ophthalmopathy:

Apply cool compresses to your eyes. The added moisture may soothe your eyes.

Wear sunglasses. When your eyes protrude, they're more vulnerable to ultraviolet rays and more sensitive to bright light. Wearing sunglasses that wrap around the sides of your head will also lessen the irritation of your eyes from the wind.

Use lubricating eyedrops. Eyedrops may relieve the dry, scratchy sensation on the surface of your eyes. A paraffin-based gel, such as Lacri-Lube, can be applied at night.

Elevate the head of your bed. Keeping your head higher than the rest of your body lessens fluid accumulation in the head and may relieve the pressure on your eyes.

Don't smoke. Smoking worsens Graves' ophthalmopathy.

For Graves' dermopathy

If the disease affects your skin (Graves' dermopathy), use over-the-counter creams or ointments containing hydrocortisone to relieve swelling and reddening. In addition, using compression wraps on your legs may help.

Preparing for your appointment

You'll probably see your primary care physician first. You may be referred to a specialist in disorders of hormone function and the endocrine system (endocrinologist). If you have Graves' ophthalmopathy, your doctor may also recommend that you see a doctor who specializes in disorders of the eyes (ophthalmologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including family medical history, and any major stresses or recent life changes.

Make a list of all medications, vitamins or supplements that you're taking. Make note of the dosage of each.

Write down questions to ask your doctor.

Preparing a list of questions can help you make the most of your time with your doctor. For Graves' disease, some basic questions to ask your doctor include:

What's the most likely cause of my symptoms?

What kinds of tests do I need? Do these tests require any special preparation?

Is this condition temporary or long-lasting?

What treatments are available, and which do you recommend?

What types of side effects can I expect from treatment?

I have other health conditions. How can I best manage these conditions together?

Where can I find more information on Graves' disease?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be prepared to answer the following:

When did you first notice your symptoms?

Do you have symptoms all the time or do they come and go?

Have you recently started a new medication?

Have you experienced rapid or unintended weight loss? How much have you lost?

Have you observed any change in your menstrual cycle?

Have you experienced any sexual dysfunction?

Are you having trouble sleeping?

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The diagnosis of Graves' disease may include: Physical exam. Your doctor examines your eyes to see if they're irritated or protruding and looks to see if your thyroid gland is enlarged. Because Graves' disease increases your metabolism, your doctor will check your pulse and blood pressure and look for signs of tremor.

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Cretinism- Hyposecretion

During the first few months of pregnancy, the developing baby depends solely on the mother for its thyroid hormone supply, which is essential for normal growth and brain development. In a normal pregnancy, the child would being to develop it's own T3. When the child has cretinism, it doesn't produce its T3, so when the mother stops, the child is left with a hyposecreting thyroid. This causes cretinism or related hypothyroid diseases.

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The treatment goals for Graves' is to inhibit thyroid production and block the effects of hypersecretion.

This is done in a myriad of ways, including; anti-thyroid medication, iodine therapy, beta-blockers (for symptoms), and even surgery (in severe cases)

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Physical exams (noticing abnormal BMI or thyroid size), blood tests (testing for T4 and T3 levels), ultrasounds, and radioactive iodine uptake (RAIU) tests.

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Can result in Graves' opthalmopathy and Graves' dermopathy. Increased irritability, heat sensitivity, unchecked weight loss, and arrhythmia. Thyrotoxix crisis' are a life-threatening condition possible with severe hyperthyroidism.

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Cretinism: The past, present and future of diagnosis and cure

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The neonatal diagnosis and treatment of congenital hypothyroidism prevents severe intellectual delay, a significant contribution by many in the past century. The present century must address the needs of the millions of infants in nonaffluent parts of the world where congenital hypothyroidism of all etiologies, including iodine deficiency, is still a major health problem.

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National Institute of Diabetes, Digestive, and Kidney Diseases

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National Institute of Diabetes, Digestive, and Kidney Diseases

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National Institute of Diabetes and Digestive and Kidney Diseases

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What is Graves' disease?

Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactive thyroid. With this disease, your immune system attacks the thyroid and causes it to make more thyroid hormone than your body needs. The thyroid is a small, butterfly-shaped gland in the front of your neck. Thyroid hormones control how your body uses energy, so they affect nearly every organ in your body-even the way your heart beats.

The thyroid is a small gland in your neck that makes thyroid hormones.

If left untreated, hyperthyroidism can cause serious problems with the heart, bones, muscles, menstrual cycle, and fertility. During pregnancy, untreated hyperthyroidism can lead to health problems for the mother and baby. Graves' disease also can affect your eyes and skin.

How common is Graves' disease?

Graves' disease is the most common cause of hyperthyroidism in the United States. The disease affects about 1 in 200 people. ¹

Who is more likely to develop Graves' disease?

Graves' disease usually affects people between ages 30 and 50, but can occur at any age. ² The disease is seven to eight times more common in women than men. ³ A person's chance of developing Graves' disease increases if other family members have the disease.

People with other autoimmune disorders are more likely to develop Graves' disease than people without these disorders. Conditions linked with Graves' disease include

What other health problems could I develop because of Graves' disease?

Without treatment, Graves' disease can cause some serious health problems, including

an irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart-related problems

an eye disease called Graves' ophthalmopathy or Graves' orbitopathy (GO), which can cause double vision, light sensitivity, and eye pain-and, rarely, can lead to vision loss

thinning bones and osteoporosis

Is Graves' disease during pregnancy a problem?

Thyroid hormone levels that are just a little high are usually not a problem in pregnancy. However, more severe hyperthyroidism that isn't treated can affect both the mother and the baby. If you have Graves' disease, be sure your hyperthyroidism is under control before becoming pregnant. Learn more about causes, diagnosis, and treatment of hyperthyroidism during pregnancy.

What are the symptoms of Graves' disease?

You may have common symptoms of hyperthyroidism such as

fast and irregular heartbeat

frequent bowel movements or diarrhea

heat intolerance

nervousness or irritability

tiredness or muscle weakness

trembling hands

trouble sleeping

weight loss

Rarely, people with Graves' disease develop a reddish thickening of the skin on the shins, a condition called pretibial myxedema or Graves' dermopathy. This skin problem is usually painless and mild, but it can be painful for some.

GO can cause retracted eyelids, meaning the eyelids are pulled back from the eye. GO can also cause bulging eyes, double vision, and swelling around the eyes.

What causes Graves' disease?

Researchers aren't sure why some people develop autoimmune disorders such as Graves' disease. These disorders probably develop from a combination of genes and an outside trigger, such as a virus.

With Graves' disease, the immune system makes an antibody called thyroid-stimulating immunoglobulin (TSI) that attaches to thyroid cells. TSI acts like thyroid-stimulating hormone (TSH), a hormone made in the pituitary gland that tells the thyroid how much thyroid hormone to make. TSI causes the thyroid to make too much thyroid hormone.

How do health care professionals diagnose Graves' disease?

Your health care provider may suspect Graves' disease based on your symptoms and findings during a physical exam. One or more blood tests can confirm that you have hyperthyroidism and may point to Graves' disease as the cause.

Other clues that hyperthyroidism is caused by Graves' disease are

an enlarged thyroid

signs of Graves' eye disease, present in about one out of three people with Graves' disease⁴

a history of other family members with thyroid or autoimmune problems

If the diagnosis is uncertain, your doctor may order further blood or imaging tests to confirm Graves' disease as the cause.

A blood test can detect TSI. However, in mild cases of Graves' disease, TSI may not show up in your blood. The next step may be one of two imaging tests that use small, safe doses of radioactive iodine. Your thyroid collects iodine from your bloodstream and uses it to make thyroid hormones; it will collect radioactive iodine in the same way.

Radioactive iodine uptake test. This test measures the amount of iodine the thyroid collects from the bloodstream. If your thyroid collects large amounts of iodine, you may have Graves' disease.

Thyroid scan. This scan shows how and where iodine is distributed in the thyroid. With Graves' disease, the entire thyroid is involved, so the iodine shows up throughout the gland. With other causes of hyperthyroidism such as nodules-small lumps in the gland-the iodine shows up in a different pattern.

Learn more about thyroid tests.

What are my treatment options for Graves' disease?

You have three treatment options: medicine, radioiodine therapy, and thyroid surgery. Radioiodine therapy is the most common treatment for Graves' disease in the United States, ⁴ but doctors are beginning to use medicine more often than in the past. 5,6 Based on factors such as your age, whether you are pregnant, or whether you have other medical conditions, your doctor may recommend a specific treatment and can help you decide which one is right for you.

Radioiodine therapy

For radioiodine therapy, you take radioactive iodine-131 (I-131) by mouth as a capsule or liquid. I-131, at a higher dose than the dose used for imaging tests, slowly destroys the cells of the thyroid gland that produce thyroid hormone. The dose of I-131 usually used for radioiodine therapy does not affect other body tissues.

You take radioactive iodine-131 as a capsule or liquid.

Although it's unlikely, you may need more than one radioiodine treatment to bring your thyroid hormone levels into the normal range. In the meantime, treatment with medicines called beta blockers can control your symptoms.

Almost everyone who has radioactive iodine treatment later develops hypothyroidism, or underactive thyroid, because the thyroid hormone-producing cells have been destroyed. However, hypothyroidism is easier to treat and causes fewer long-term health problems than hyperthyroidism. People with hypothyroidism can completely control the condition with daily thyroid hormone medicine.

Doctors don't use radioiodine therapy to treat pregnant women or women who are breastfeeding. Radioactive iodine can harm the fetus' thyroid and can be passed from mother to child in breast milk.

Medicines

Beta blockers. Beta blockers don't stop your thyroid from producing thyroid hormone but can reduce symptoms until other treatments take effect. These medicines act quickly to relieve many of the symptoms of hyperthyroidism, such as trembling, rapid heartbeat, and nervousness. Most people feel better within hours of taking beta blockers.

Antithyroid medicines. Antithyroid therapy is the simplest way to treat hyperthyroidism. Antithyroid medicines cause your thyroid to make less thyroid hormone. These medicines usually don't provide a permanent cure, but in some people, the effects last a long time after they stop taking the medicine. Doctors most often use the antithyroid medicine methimazole.

Doctors usually treat pregnant and breastfeeding women with antithyroid medicine, since this treatment may be safer for the baby than other treatments. Doctors use propylthiouracil more often than methimazole during the first 3 months of pregnancy because methimazole may harm the fetus, although this happens rarely. Also rarely, propylthiouracil may affect the fetus, but any effects are less harmful than having uncontrolled hyperthyroidism during pregnancy.

Once treatment with antithyroid medicine begins, your thyroid hormone levels may not move into the normal range for several weeks or months. The total average treatment time is about 12 to 18 months, ⁷ but treatment can continue for many years in people who don't want radioiodine or surgery to treat their Graves' disease.

Antithyroid medicines can cause side effects in some people, including

allergic reactions such as rashes and itching

a decrease in the number of white blood cells in your body, which can lower resistance to infection

liver failure, in rare cases

Call your doctor right away if you have any of the following symptoms:

fever

sore throat

tiredness

weakness

dull pain in your abdomen

loss of appetite

skin rash or itching

easy 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. Sometimes doctors use surgery to treat people with large goiters, or pregnant women who are allergic to or have side effects from antithyroid medicines.

Before surgery, your doctor will prescribe antithyroid medicines to bring your thyroid hormone levels into the normal range. This treatment prevents a condition called thyroid storm-a sudden, severe worsening of symptoms-that can occur when people with hyperthyroidism have general anesthesia.

After surgery to remove your thyroid, you will develop hypothyroidism and need to take thyroid hormone medicine every day for life. After surgery, your doctor will continue to check your thyroid hormone levels and adjust your dose as needed.

What is Graves' ophthalmopathy (GO)?

GO is a condition that occurs when the immune system attacks the muscles and other tissues around the eyes.

The result is inflammation and a buildup of tissue and fat behind the eye socket, causing the eyeballs to bulge out. Rarely, inflammation is severe enough to compress, or push on, the optic nerve that leads from the eye to the brain, causing vision loss.

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 mild GO, and about 5 percent develop severe GO. ⁷ This eye condition usually lasts 1 to 2 years and often improves on its own.

GO can occur before, at the same time as, or after other symptoms of hyperthyroidism develop. Eye problems sometimes develop long after Graves' disease has been treated, but this happens rarely. GO may even occur in people whose thyroid function is normal. Smoking makes GO worse. If you smoke and need help quitting, go to SmokeFree.gov.

Treatment

The eye problems of Graves' disease may not improve after thyroid treatment, so doctors often treat the two problems separately.

Eye drops can relieve dry, gritty, irritated eyes-the most common of the milder symptoms. If pain and swelling occur, your doctor may prescribe a steroid such as prednisone. Other medicines that reduce your body's immune response, such as rituximab, may also provide relief.

Eye drops can relieve dry, gritty, irritated eyes.

Sunglasses can help with light sensitivity. Special eyeglass lenses may help reduce double vision. If you have puffy eyelids, your doctor may advise you to sleep with your head raised to reduce swelling. If your eyelids do not fully close, taping them shut at night can help prevent dry eyes.

Your doctor may recommend surgery to improve bulging of your eyes and correct the vision changes caused by pressure on the optic nerve. A procedure called orbital decompression makes the eye socket bigger and gives the eye room to sink back to a more normal position. Eyelid surgery can return retracted eyelids to their normal position.

Rarely, doctors treat Graves' eye disease with radiation therapy to the muscles and tissues around the eyes.

What should I avoid eating if I have Graves' disease?

People with Graves' disease may be sensitive to harmful side effects from iodine. Eating foods that have large amounts of iodine-such as kelp, dulse, or other kinds of seaweed-may cause or worsen hyperthyroidism. Taking iodine supplements can have the same effect.

Talk with your health care professional about what foods you should limit or avoid, and let him or her know if you take iodine supplements. Also, share information about any cough syrups or multivitamins that you take because they may contain iodine.

References

[1] Genetics Home Reference. National Library of Medicine. National Institutes of Health. Published August 2017; last reviewed July 2013. https://ghr.nlm.nih.gov/condition/graves-disease#statistics. Accessed August 17, 2017.

[2] Smith TJ, Hededüs L. Graves' disease. The New England Journal of Medicine. 2016;375(16):1552-1565.

[3] Yeung SJ, Habra MA, Chiu AC. Graves' disease. Medscape emedicine website. http://emedicine.medscape.com/article/120619-overview#a6. Updated March 2017. Accessed August 17, 2017.

[4] Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-1421.

[5] Burch HB, Burman KD, Cooper DS. A 2011 survey of clinical practice patterns in the management of Graves' disease. Journal of Clinical Endocrinology and Metabolism. 2012 Dec;97(12):4549-4558.

[6] Brito JP, Schilz S, Singh Ospina N, Rodriguez-Gutierrez R, Maraka S, Sangaralingham LR, Montori VM. Antithyroid drugs-the most common treatment for Graves' Disease in the United States: a nationwide population-based study. Thyroid. 2016 Aug;26(8):1144-1145.

[7] Burch HB, Cooper DS. Management of Graves disease: a review. JAMA. 2015;314(243):2544-2554.

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Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactive thyroid. With this disease, your immune system attacks the thyroid and causes it to make more thyroid hormone than your body needs. The thyroid is a small, butterfly-shaped gland in the front of your neck.

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The hypothalamus releases TRH- thyrotropin releasing hormone, which in turn tells the anterior pituitary gland to release TSH- thyroid stimulating hormone. TSH tells the thyroid to produce T4 and T3.

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A combination of genes and outside triggers (like a virus)

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Yellow and Blue Enrollment Process Flowchart

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Conversion of T4 at target tissues. T3 regulates body temperature, metabolism, and heart rate.

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T4 is secreted by thyroid follicles. It plays a central role in digestion, heart and muscle function, brain development, and maintenance of bones.

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The thyroid gland is found at the base of the throat, and consists of two lobes and a connecting isthmus. It's also called the "butterfly" gland, and houses the parathyroid glands on its posterior.

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The thyroid gland produces Thyroxine (T4) and Triiodothyronine (T3), and is the major metabolic hormone. It controls the rate of oxidation of glucose to supply body heat and chemical energy, and is needed for tissue growth and development.

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Early diagnosis is important- cretinism can be prevent if T4 is pushed within the first month. The preferred treatment is replacement therapy to raise T4 and T3 levels.

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Routine prenatal and postnatal testing using the Guthrie Test, and blood TSH tests

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- Hypersecretion

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- Hyposecretion

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Cretinism can result in severe mental and physical retardation if not treated before three to fourweeks (the severity is due to the importance of the first six months of growth).

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Graves' disease is an autoimmune disorder that results in hyperthyroidism

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Iron deficiency
Prenatal trauma
Underactive pituitary gland
Genetic predisposition

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Cretinism is untreated congenital hypothyroidism

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Grave's Disease

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Cretinism

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Graves' Disease- Hypersecretion

Graves' disease is caused by a malfunction in the immune system, although the exact reason why this happens is still unknown. The body produces an antibody to one part of the cells in the thyroid gland. The immune system makes an antibody called thyroid-stimulating immunoglobulin (TSI) that attaches to thyroid cells. TSI acts like thyroid-stimulating hormone (TSH), a hormone made in the pituitary gland that tells the thyroid how much thyroid hormone to make. This causes the thyroid gland to be stimulated by both the pituitary gland hormone and antibodies which makes the thyroid overproduce thyroid hormone.