Graves' Disease: Symptoms, Diagnosis, and Treatment

Graves' disease is an autoimmune disorder that primarily affects thyroid function and related tissues. Its symptoms are diverse and develop gradually, ranging from mild discomfort to severe health threats. Common symptoms in patients include accelerated metabolism, eye abnormalities, and skin changes, which may vary significantly depending on individual immune responses.

The symptoms of this disease typically appear in stages; early on, there may be only mild fatigue or weight loss that goes unnoticed. As the condition worsens, more obvious signs such as bulging eyes, irregular heartbeat, or skin redness may appear. Early recognition of these symptom characteristics aids in early diagnosis and treatment, preventing complications.

Early Symptoms and Signs

The early symptoms of Graves' disease are often mistaken for general fatigue or stress responses. Patients may gradually exhibit the following signs over weeks to months:

• Unexplained weight loss, even with normal or increased appetite
• Persistent fatigue that does not improve with rest
• Tremors in the hands or limbs, especially noticeable at rest

Some patients may show signs of accelerated metabolism, such as:

• Palpitations or rapid heartbeat, with noticeable venous pulsations
• Excessive sweating, even in moderate temperatures
• Sleep disturbances, such as insomnia or easy awakening

These symptoms may be misdiagnosed as stress or menopausal symptoms and should be confirmed through blood tests for autoimmune markers.

Common Symptoms

Symptoms Related to Hyperthyroidism

Hyperthyroidism is a core manifestation of Graves' disease, with common symptoms including:

• Palpitations or tachycardia (heart rate exceeding 100 beats per minute at rest)
• Abnormally elevated body temperature, especially in the morning
• Increased gastrointestinal activity, leading to diarrhea or frequent bowel movements

Accelerated metabolism may also lead to muscle weakness, particularly in the upper limbs and pelvic girdle muscles. Some patients may experience muscle atrophy accompanied by uncoordinated movements. Additionally, nails may become brittle and break easily, and hair may fall out more readily.

Ocular Symptoms (Graves' Ophthalmopathy)

About 30-50% of patients will exhibit eye-related symptoms known as "Graves' Ophthalmopathy." Common manifestations include:

• Protrusion of the eyeballs (exophthalmos), which may prevent the eyelids from closing completely
• Dry eyes or a foreign body sensation, with abnormal tear secretion
• Blurred vision or double vision, with severe cases potentially leading to corneal ulcers

Ocular symptoms may occur independently of thyroid symptoms or worsen concurrently. Patients may feel discomfort in bright light, experience increased blinking, and in severe cases, limited eye movement leading to displacement of the eyeball.

Skin and Systemic Symptoms

A minority of patients may develop red, warm skin lesions on the lower limbs, referred to as "pretibial myxedema." This skin condition is most commonly seen on the front of the shins and feels rubbery to the touch. Other systemic symptoms include:

• Irritability, anxiety, or difficulty concentrating
• Women may experience menstrual cycle irregularities
• Decreased bone density, increasing the risk of osteoporosis

Disease Progression and Symptom Changes

The symptoms of Graves' disease may exhibit fluctuating changes. In the early stages, excess thyroid hormones may lead to high metabolic symptoms, such as elevated body temperature and increased appetite. As the disease progresses, thyroid follicles may atrophy due to prolonged stimulation, leading to symptom relief, but this may transition into a phase of hypothyroidism.

The development of ocular symptoms may occur independently of changes in thyroid function. Some patients may continue to experience worsening eye disease even after thyroid symptoms are controlled, requiring specialized treatment. Long-term uncontrolled cases may lead to corneal ulcers and optic nerve compression, resulting in permanent vision loss.

When to Seek Medical Attention

Immediate medical attention should be sought if the following occurs:

• Unexplained rapid weight loss (more than 5 kg per month)
• Persistent palpitations accompanied by chest pain or difficulty breathing
• Protrusion of the eyeballs accompanied by blurred vision or double vision

If the following emergency symptoms occur, immediate medical attention is required:

• Severe ocular pressure pain, unable to close the eyes normally
• Difficulty swallowing or breathing (due to throat swelling)
• Confusion or hypertensive crisis

Regular monitoring of thyroid function indices (such as TSH, T3/T4) is crucial for assessing symptom changes. If the current treatment plan cannot control symptom deterioration, it is essential to discuss adjusting the treatment strategy with a physician.

 

Frequently Asked Questions

Do patients with Graves' disease need long-term medication?

The vast majority of patients require long-term treatment, but this depends on the severity of the condition and treatment response. Antithyroid medications (such as thionamides) typically need to be taken for several months to years, and some individuals may require lifelong medication management. After radioactive iodine treatment or surgery, some individuals still need regular follow-up to avoid rebound thyroid dysfunction.

How can I determine if symptoms are worsening due to Graves' disease?

If symptoms such as increased heart rate, worsening tremors, sudden weight loss, or worsening eye protrusion occur, this may indicate disease progression. It is advisable to immediately document relevant symptom changes and discuss treatment plan adjustments with a physician. Regular blood tests to monitor thyroid function indices are also key for assessment.

Is it safe to become pregnant during treatment?

Hormonal changes during pregnancy may trigger or exacerbate the condition, but with physician monitoring and adjustments to medication dosage (switching to safer medications like propranolol), most patients can still safely become pregnant. It is necessary to confirm the control status of the condition with a physician before planning pregnancy and to monitor thyroid function every 4-6 weeks during pregnancy.

Can protruding eyes be improved through surgery?

Severe eye protrusion (thyroid eye disease) may require orbital radiotherapy or orbital surgery. Surgery can remove some surrounding eye tissue or adjust the eye muscles to relieve pressure on vision or cosmetic issues. However, surgery is only suitable after the condition stabilizes (usually after 6-12 months).

What dietary components should be avoided to manage the condition?

Excessive iodine intake may exacerbate hyperthyroidism, so it is advisable to avoid seaweeds, iodized salt, and iodine-containing supplements. A balanced intake of high-fiber foods, B vitamins, and limiting caffeine and alcohol is recommended to reduce the risk of palpitations and nervous excitability. Individual dietary plans should be developed in consultation with a physician or nutritionist.