Thyroid disease is a common contributor to hormone imbalance in women and one that I see almost daily in my practice. Hypothyroidism, and specifically, Hashimoto’s thyroiditis, gets the most attention, simply because it is most prevalent. But today I want to shine a light on the other end of the spectrum: hyperthyroidism, and specifically, Graves’ disease.  

Keep reading to learn more about:

• Hyperthyroidism vs. hypothyroidism
• Hyperthyroidism vs. Graves’ disease
• Hyperthyroid and Graves’ symptoms
• The immune system connection
• Graves’ disease diagnosis and other causes of hyperthyroidism

Let’s get started! 

What Is Graves’ Disease?

Let’s start with the basics. Your thyroid is an endocrine gland that sits in the front of your neck and produces thyroid hormone. Thyroid hormone is required to set the metabolic rate of each cell in the body.

When the thyroid gland is working properly, we don’t give it much thought. However, when the thyroid produces too little thyroid hormone, called hypothyroidism, everything slows down creating fatigue, constipation, depression and hair loss. When the thyroid produces too much thyroid hormone, called hyperthyroidism, a whole set of other symptoms are experienced. 

What is Graves’ Disease? Graves’ disease is in the category of immune system disorders called autoimmune disease. While Hashimoto’s thyroiditis (add link to Hashimoto’s article) is the autoimmune version of hypothyroidism, Graves’ disease is the autoimmune hyperthyroid disease. 

Graves’ disease is the most common form of hyperthyroidism where thyroid hormone production is overactive producing a high metabolic rate, an increased need for nutrition and a host of hyperthyroidism symptoms. 

Graves’ disease symptoms and signs include:

• Increased hunger
• Weight loss (unintentional)
• Hot flashes
• Sweating
• Frequent or loose stools
• Insomnia
• Anxiety
• Rapid heart rate/heart palpitations
• Hyperactivity
• Muscle weakness
• Warm and moist skin
• Agitation
• Fatigue 
• Heat intolerance
• Tremor
• Changes in the menstrual cycle 
• Graves’ ophthalmopathy – bulging eyes
• Graves’ dermopathy – thick red skin on shins or top of feet
• Goiter
• Osteopenia/osteoporosis

If not managed, Graves’ disease may cause damage to the body, including heart complications. Thyroid storm, or thyrotoxic crisis, is a rare and life-threatening complication of Graves’ disease where levels of thyroid hormone become extremely elevated. 

Those with Graves’ are also at higher risk of developing other autoimmune disease because of the similar root causes. And interestingly 10 to 20 percent of people with Graves’ disease go on to develop hypothyroidism or Hashimoto’s.

Graves’ And Thyroid Disease

What causes Graves’ disease? It’s helpful to think of Graves’ as an immune disease affecting the thyroid instead of an independent thyroid disease. I’ll dive more into this in Part 2 of this series where I discuss a functional medicine approach to Graves’ disease treatment.

With this perspective, we begin to uncover the specific aspects that lead to development of autoimmunity for each individual, including a genetic predisposition, intestinal permeability (leak gut) and environmental triggers. 

Read more about this in Graves’ Disease Part 2 here.

Graves’ Disease Diagnosis

When Graves’ symptoms are present, blood testing is helpful for diagnosing Graves’ and distinguishing it from other forms of hyperthyroidism. As with Hashimoto’s, antibody testing is important. 

Antibody thyrotropin receptor antibodies (TRAb) is most often elevated in Graves’, although not always. This antibody mimics the pituitary hormone called thyroid stimulating hormone (TSH) that signals the thyroid to produce more thyroid hormone. 

It’s also possible to have elevated thyroid peroxidase antibodies (TPO) and thyroglobulin antibodies in Graves’ even though these are most commonly associated with Hashimoto’s. 

In my practice, I run a full thyroid panel along with these three antibodies.

While Graves’ disease is the most common reason for hyperthyroidism, other reasons for hyperthyroidism include:

• Toxic multinodular goiter (enlarged thyroid with nodules)
• Toxic adenoma (benign tumor that produces thyroid hormone)
• Thyroiditis (an acute event of hyperthyroidism, often followed by hypothyroidism, such as postpartum thyroiditis)

Other testing that is sometimes used to get the proper diagnosis includes radioactive iodine uptake. High iodine uptake is associated with Graves’. Thyroid ultrasounds are used to look for thyroid nodules, or lumps in the thyroid gland. 

Now that we’ve covered the basics of Graves’ disease, including symptoms and testing, stay tuned for Part 2 of this article where I cover a functional medicine approach to Graves’ disease and how to restore thyroid function by addressing the root causes. 

References

1. Subekti, I., & Pramono, L. A. (2018). Current Diagnosis and Management of Graves' Disease. Acta medica Indonesiana, 50(2), 177–182. Full text: http://www.actamedindones.org/index.php/ijim/article/view/817/pdf 
2. Umar, H., Muallima, N., Adam, J. M., & Sanusi, H. (2010). Hashimoto's thyroiditis following Graves' disease. Acta medica Indonesiana, 42(1), 31–35. Full text: http://www.inaactamedica.org/archives/2010/20305330.pdf