Hyperthyroidism and Graves’ disease

An overactive thyroid, or hyperthyroidism, makes too much thyroid hormone, most often because of Graves’ disease.

This page is general information, not medical advice. Talk with your clinician before making any changes to your care.

What is hyperthyroidism?

Your thyroid is a small gland at the front of your neck. Its hormones control how fast your body uses energy. When the thyroid makes too much hormone, many body processes speed up. This is hyperthyroidism, also called overactive thyroid.

Graves’ disease is an autoimmune condition. Your immune system makes antibodies that act like a signal telling the thyroid to keep working. The thyroid responds by making more hormone than your body needs. Some people with Graves’ also have eye changes, called Graves’ eye disease or thyroid eye disease.

What are the symptoms?

Symptoms can include:

A fast, pounding, or irregular heartbeat
Shaky hands
Feeling nervous, anxious, or irritable
Trouble sleeping
Sweating more or feeling too warm
Losing weight even though you’re eating the same or more
More frequent bowel movements
Weak muscles, especially in the upper arms and thighs
Lighter or less frequent periods
Swelling at the front of the neck (goiter)

With Graves’ eye disease, eyes may feel gritty, look red or puffy, bulge forward, or see double. Older adults may have milder symptoms, sometimes only a fast heartbeat or tiredness.

What causes it, and who is at risk?

Graves’ disease is the most common cause. Other causes include:

Thyroid nodules that make extra hormone on their own (toxic nodules)
Inflammation of the thyroid (thyroiditis), including after pregnancy, which can let stored hormone leak out
Taking more thyroid hormone medicine than your body needs
Getting too much iodine from medicines or supplements

You’re more likely to have Graves’ disease if you’re a woman, have family members with thyroid disease, or have another autoimmune condition, such as type 1 diabetes or rheumatoid arthritis. It often starts before age 40. Smoking raises the chance of Graves’ eye disease and can make it worse.

How is hyperthyroidism diagnosed?

Your clinician will check your heart rate, neck, and eyes, and order blood tests:

TSH (thyroid-stimulating hormone): a hormone from the pituitary gland that tells the thyroid how much to make. In hyperthyroidism, TSH is usually low because the brain is trying to slow the thyroid down.
Free T4 and T3: the thyroid hormones themselves. These are usually high.
Thyroid antibodies (TSI or TRAb): antibodies that point to Graves’ disease.

To find the cause, you may also have a radioactive iodine uptake scan, which measures how much iodine your thyroid takes in, or a thyroid ultrasound. The uptake scan isn’t done during pregnancy or breastfeeding.

How is hyperthyroidism treated?

The right treatment depends on the cause, your age, whether you’re pregnant or planning to be, and your preferences. The main options are:

Beta blockers: medicines that ease a fast heartbeat, shaking, and nervousness while other treatment starts working. They don’t change hormone levels.
Antithyroid medicines: pills that lower how much hormone the thyroid makes. Methimazole is used most often. Propylthiouracil is used in certain cases, such as early pregnancy. Many people with Graves’ take these for 12 to 18 months.
Radioactive iodine: a pill or liquid that slowly shrinks the thyroid. It isn’t used in pregnancy or breastfeeding.
Surgery: removing all or part of the thyroid (thyroidectomy).

After radioactive iodine or surgery, most people need daily thyroid hormone medicine for life.

Living with hyperthyroidism and when to get care

With treatment, hormone levels can usually be brought into a healthy range. You’ll have regular blood tests, especially in the first months. Talk with your clinician if:

Your symptoms come back after treatment
You’re planning a pregnancy or find out you’re pregnant
You have eye irritation, puffiness, or double vision; you may also need an eye specialist (ophthalmologist)
You’d like help to quit smoking, which helps protect your eyes

When to get emergency care

Call 911 or go to the nearest emergency room if someone with an overactive thyroid has a very fast heartbeat with a high fever, confusion or agitation, chest pain, trouble breathing, or fainting. These can be signs of thyroid storm, a rare emergency.

If you take an antithyroid medicine and get a fever, sore throat, or mouth sores, stop the medicine and call your clinician right away. This can be a sign of a rare drop in infection-fighting white blood cells.

Common questions

Can Graves’ disease go away?

Sometimes. Some people’s Graves’ disease goes into remission after a course of antithyroid medicine, which means hormone levels stay normal without it. It can come back, so regular blood tests continue.

Which treatment is best for Graves’ disease?

There’s no single best choice. Antithyroid medicine, radioactive iodine, and surgery all work, and each has trade-offs. An endocrinologist can help you weigh them based on your health, eye symptoms, pregnancy plans, and preferences.

Will my weight change after treatment?

Many people regain weight they lost while their thyroid was overactive. Your clinician can tell you what to expect.

Is it safe to get pregnant with Graves’ disease?

Many people with Graves’ disease have healthy pregnancies. Treatment choices change before and during pregnancy, so talk with your clinician before you try to conceive or as soon as you find out you’re pregnant.

How do I know if my eye symptoms are from Graves’?

Tell your clinician about any eye changes, such as gritty, red, puffy, or bulging eyes, or double vision. You may also need to see an eye specialist.

Does Madison Medical Care take insurance?

We’re a self-pay practice, so we don’t bill insurance for visits. Labs, imaging, and prescriptions still go through your insurance. We can’t see patients who have Medicare or Medicaid.

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Reviewed by Joe Kimura, MD