Graves' disease is the most common cause of an overactive thyroid (hyperthyroidism). It is an autoimmune condition: the immune system makes antibodies that switch the thyroid gland on, so it produces too much thyroid hormone and often swells into a goiter. It is much more common in women and usually starts between the ages of 20 and 50. This guide covers the symptoms, eye changes, tests, and the three main treatment options.
Quick answer: Common signs of Graves' disease are weight loss despite a good appetite, a fast or irregular heartbeat, tremor, sweating, heat intolerance, anxiety, loose stools, a swelling in the neck (goiter) and, in some people, bulging or gritty, red eyes. Blood tests show a low TSH with high free T4 and/or free T3, and TSH-receptor antibodies (TRAb) confirm Graves'. Treatment is with anti-thyroid tablets (carbimazole or methimazole), radioactive iodine, or surgery, usually with a beta-blocker to control symptoms at first.
Key takeaways
- ✅ Graves' disease is very treatable, but it needs regular blood tests and follow-up.
- ✅ Stopping smoking is one of the most important steps to protect the eyes.
- ✅ Sore throat and fever while on anti-thyroid tablets need an urgent blood count.
- ✅ Not every goiter is Graves' disease; iodine deficiency and nodules are other causes.
Common signs and symptoms
| Area | What you may notice |
|---|
| Heart | Racing or pounding heartbeat, palpitations, irregular rhythm (atrial fibrillation), especially in older adults |
| Weight and appetite | Weight loss even while eating more |
| Nerves and mood | Nervousness, anxiety, irritability, poor sleep, shaky hands |
| Temperature | Feeling hot, sweating, warm moist skin |
| Gut | Frequent or loose stools |
| Muscles | Weakness in the thighs and upper arms, tiredness |
| Neck | A smooth, painless swelling (diffuse goiter) |
| Periods and fertility | Lighter or less frequent periods; difficulty conceiving |
| Hair, nails and skin | Thin hair, brittle nails; rarely, thickened reddish skin on the shins (pretibial myxoedema) |
Older adults may have few classic symptoms and instead feel tired, lose weight, or develop an irregular heartbeat.
Graves' eye disease (thyroid eye disease)
Up to about a third of people with Graves' disease develop eye involvement, often mild. Signs include gritty, dry or watery eyes, redness, puffy eyelids, a staring look, bulging eyes (proptosis) and double vision. See an eye specialist urgently for blurred vision, reduced colour vision or eye pain on movement. Smoking makes thyroid eye disease much more likely and more severe.
What is a goiter?
A goiter is any enlargement of the thyroid gland. It can occur with normal, high or low thyroid function.
- Diffuse goiter with overactivity: Graves' disease
- Iodine deficiency goiter: once very common in parts of India, especially hilly regions; it has fallen greatly since iodised salt became universal under the National Iodine Deficiency Disorders Control Programme
- Hashimoto's thyroiditis: autoimmune, usually leads to an underactive thyroid
- Multinodular goiter and single nodules: most are benign, but nodules are checked with ultrasound and sometimes a needle biopsy (FNAC)
See a doctor if a neck swelling grows quickly, feels hard, or causes difficulty breathing, swallowing or a hoarse voice.
Tests for hyperthyroidism and Graves' disease
| Test | Typical result in Graves' disease |
|---|
| TSH | Low or undetectable (the first and most sensitive test) |
| Free T4 and free T3 | High |
| TSH-receptor antibodies (TRAb/TSI) | Positive; confirms Graves' disease |
| Thyroid scan / radioactive iodine uptake | Diffusely increased uptake; helps tell Graves' from thyroiditis or toxic nodules |
| Thyroid ultrasound | Enlarged gland with increased blood flow; checks for nodules |
Treatment options
| Option | How it works | Points to know |
|---|
| Anti-thyroid tablets (carbimazole, methimazole; propylthiouracil in early pregnancy) | Reduce hormone production | Usually taken for 12 to 18 months; about half of people relapse after stopping. Rare but serious side effects: very low white cell count (agranulocytosis) and liver injury. |
| Radioactive iodine | A capsule or drink destroys overactive thyroid tissue | Effective and simple; most people later need lifelong thyroxine. Not used in pregnancy or breastfeeding, and may worsen active eye disease. |
| Thyroid surgery (thyroidectomy) | Removes the gland | Quick, permanent cure; useful for large goiters or severe eye disease. Lifelong thyroxine afterwards. |
Beta-blockers such as propranolol are often used at first to ease palpitations, tremor and anxiety while the main treatment takes effect.
Urgent warning: if you take carbimazole, methimazole or propylthiouracil and develop a sore throat, mouth ulcers or fever, stop the tablet and get a blood count the same day. Very high fever, confusion, a very fast heartbeat or vomiting in someone with hyperthyroidism can signal a thyroid storm, a medical emergency.
Frequently asked questions
Can Graves' disease be cured?
Many people go into long-term remission with tablets. Radioactive iodine and surgery cure the overactivity permanently but usually leave the thyroid underactive, which is easily treated with a daily thyroxine tablet.
Can I get pregnant with Graves' disease?
Yes, with planning. Thyroid levels should be well controlled first, and medicines may need changing before and during pregnancy. Discuss plans with your doctor early.
Should I avoid iodised salt?
Normal iodised salt is fine for most people. Avoid high-dose iodine supplements, kelp and seaweed products unless your doctor advises them.
Related reading: CBC blood test and white cell count, important to monitor on anti-thyroid medicines.
Last updated: September 2026. General health information only, not a diagnosis or a treatment plan. Please discuss thyroid test results and medicines with a qualified doctor.
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