Graves’ disease is a disorder in which the immune system attacks the thyroid, causing the gland to overproduce thyroid hormones. It’s a common cause of hyperthyroidism, or an overactive thyroid. This can lead to symptoms such as heat intolerance, sleep problems, and unintended weight loss, among other health issues.
If you’ve been diagnosed with Graves’ disease, it’s important to stick to your treatment regimen. When Graves’ isn’t properly managed, it can lead to complications affecting many parts of the body, from the eyes and heart to the skin and bones.
Here are five potentially dangerous complications to know about, plus steps you can take to reduce your risk.
1. Thyroid Eye Disease
According to the American Thyroid Association, about one-third of people with Graves’ disease develop Graves’ eye disease, also called Graves’ ophthalmopathy or thyroid eye disease. It occurs when the immune system attacks the tissues and muscles around the eyes.
“Thyroid stimulating hormone receptors are also present on the cells behind the eyes,” says Alexandra Mikhael, MD, an endocrinologist at Cleveland Clinic’s Weston Hospital in Florida.
Thyroid eye disease is linked to the same autoimmune process that causes Graves’ disease itself, not to an overproduction of thyroid hormones. In other words, treating Graves’ disease won’t resolve thyroid eye disease.
Eyes that appear to bulge out are a common symptom of thyroid eye disease, as are dry, irritated eyes, double vision, light sensitivity, and pain or pressure in the eyes. Left untreated, swelling can sometimes compress the optic nerve and potentially lead to vision loss.
If you have Graves’ disease, the first step is treating the overactive thyroid. But these treatments don’t always improve thyroid eye disease.
“Symptoms may initially worsen with treatment of Graves’ disease, for the first three to six months, and then stay stable and eventually improve,” says Dr. Mikhael.
Another common treatment for Graves’ disease, radioactive iodine therapy, can make thyroid eye disease worse in some people, so it’s usually not a first-line treatment, she adds. It is sometimes recommended alongside steroids, though, in people with a mild form of the condition.
- Using lubricating eye drops
- Propping your head up when you sleep to relieve swelling
- Using cold compresses on your eyes
- Wearing special glasses to correct double vision
- Wearing sunglasses if your eyes are sensitive to light
More serious cases may require prescription medication. Severe cases, which can lead to vision loss, may require surgery on the eyelids, eye muscles, or bone structure between the eye socket and sinuses.
Only a small percentage of people with thyroid eye disease need surgery though.
2. Skin Problems
Some people who have Graves’ disease develop a condition where the skin on the shins and sometimes the tops of the feet becomes discolored, lumpy, and thick. This is known as Graves’ dermopathy, or pretibial myxedema.
Similar to thyroid eye disease, Graves’ dermopathy stems from an autoimmune process that results in inflammation, causing an accumulation of proteins in the skin, explains Mikhael. This means Graves’ dermopathy may not occur at the same time as Graves’ disease itself.
When Graves’ dermopathy does occur, it’s usually mild and goes away on its own within a year or two. But it can be painful sometimes and require treatment. Your doctor may recommend wearing compression socks or using topical ointments to help with swelling.
For more severe cases, your doctor can prescribe medication to help reduce swelling, improve blood flow, reduce the size of lumps, or improve the way your immune system works.
3. Thyroid Storm
A thyroid storm is a rare but life-threatening condition that can occur when Graves’ disease symptoms suddenly accelerate. “It develops in patients with long-standing hyperthyroidism,” says Mikhael. It’s usually caused by serious stress on the body, such as a heart attack, infection, or injury. But it can also occur after radioactive iodine therapy or from taking antithyroid medications irregularly.
Symptoms include agitation, confusion, a pounding heart, shaking, and sweating. Immediate emergency treatment is critical, because a thyroid storm can lead to heart failure and death.
A thyroid storm is the result of poorly controlled hyperthyroidism. So it’s essential to follow your prescribed treatments for Graves’ disease to reduce your risk of this dangerous complication.
4. Heart Problems
Thyroid hormones control how your heart beats, so an overproduction causes the heart to beat faster and harder than normal.
Over time, untreated hyperthyroidism can lead to an irregular heartbeat, which can cause blood clots, heart failure, and stroke.
Treatment for hyperthyroidism is essential for preventing heart problems in people with Graves’ disease, says Mikhael.
5. Osteoporosis
In people with hyperthyroidism caused by Graves’ disease, the excess thyroid hormone speeds up the rate of bone loss, to where bone can’t be replaced quickly enough. This can lead to decreased bone mineral density, increased bone fracture risk, and, eventually, osteoporosis. The longer hyperthyroidism goes untreated, the greater the risk of osteoporosis, especially in postmenopausal women.
In most cases, early treatment of hyperthyroidism is enough to help prevent osteoporosis. “However, in some cases, osteoporosis may persist despite treatment,” says Mikhael.
Reduce Your Risk by Treating and Managing Graves’ Disease
Treating Graves’ disease is the number one way to help prevent potentially dangerous health complications. It usually starts with managing hyperthyroidism using one or more of the following treatments:
- Beta-blockers: These drugs rapidly treat the symptoms of hyperthyroidism, but they don’t treat the hormone overproduction itself.
- Antithyroid medication: Taking this medication can help your body make less thyroid hormone and improve symptoms, but it doesn’t cure Graves’ disease. The drug is sometimes used as a bridge to radioactive iodine therapy or surgery, explains Mikhael. In some people, it may be used as a long-term treatment.
- Radioactive iodine therapy: Oral iodine (in liquid or pill form) destroys overactive thyroid cells. “It may temporarily worsen Graves’ eye disease and hyperthyroidism,” says Mikhael. It’s not recommended for women who are pregnant, planning to become pregnant, or breastfeeding. This type of therapy destroys cells that make thyroid hormones, so you’ll most likely need to take daily hormone replacement medication after treatment.
- Surgery: You may need to have part or all of your thyroid gland removed. “Surgery may be the best option for those who have large goiters, suspicious thyroid nodules, or an overactive parathyroid gland,” says Mikhael, as well as pregnant women who can’t take other treatments. It’s not a good option for people for whom surgery is risky, including older people, she adds.
Making certain lifestyle changes can also help prevent complications related to Graves’ disease and promote overall health. For starters, smoking can increase your risk of developing thyroid eye disease or worsen it. So if you smoke, quit. Ask your doctor for resources that can help.
In addition, Mikhael says, “Eating well, exercising daily, caring for your mental health, easing stress through meditation or listening to music, and taking time for self-care” are especially important lifestyle habits for stress relief. Stress may trigger or worsen Graves’ disease, according to Mayo Clinic.
Eating well and staying active can also help keep your bones healthy, which is important, because untreated hyperthyroidism can lead to osteoporosis.
The Takeaway
Left unmanaged, Graves’ disease can lead to health complications that can affect different parts of the body. But taking steps to treat Graves’ disease and adopting healthy lifestyle habits can help protect your health. Work with your doctor to stay on top of your Graves’ disease treatment and management plan.
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