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Graves’ Disease

An autoimmune disease that makes the thyroid overactive — the most common cause of hyperthyroidism in the U.S. It can also affect the eyes. Medicine, radioactive iodine or surgery control it well.

Call 911 for possible thyroid storm — a rare, life-threatening flare of an overactive thyroid. Warning signs include a high fever, a very fast or irregular heartbeat, confusion or severe agitation, vomiting or diarrhea, and fainting or passing out (Cleveland Clinic, NHS, Merck Manual).

Get urgent care — call your doctor right away or go to the emergency room — for:

What is Graves’ disease?

Graves’ disease is an autoimmune disorder. The immune system makes an antibody, thyroid-stimulating immunoglobulin (TSI), that pushes the thyroid — the butterfly-shaped gland in the front of the neck — to make more hormone than the body needs. Because thyroid hormones control how the body uses energy, many functions speed up, even the heartbeat (NIDDK). It affects nearly 1 in 100 Americans and causes about 4 in 5 cases of hyperthyroidism in the U.S. (NIDDK) — the most common cause of an overactive thyroid (American Thyroid Association). An MBHA guide to thyroid problems in general is on the way.

Symptoms of an overactive thyroid

Symptoms vary and can come and go. They may include weight loss despite a bigger appetite; a rapid or irregular heartbeat; nervousness, irritability, trouble sleeping and tiredness; shaky hands and muscle weakness; sweating or trouble with heat; more frequent bowel movements; and an enlarged thyroid, called a goiter (NIDDK). Mood swings are common, and a goiter can sometimes make breathing or swallowing harder (MedlinePlus). In older adults it may look like loss of appetite or withdrawal and be mistaken for depression or dementia (NIDDK).

Nervousness and a racing heart overlap with anxiety, so new symptoms like these are worth a thyroid check; our Anxiety guide covers anxiety itself. An MBHA guide to rapid heartbeat is on the way.

Untreated, Graves’ disease can lead to heart rhythm problems, thinning bones (osteoporosis), muscle problems, eye problems, and problems with periods, fertility and pregnancy (NIDDK). For changes in your periods, see also our Female Problems guide. MBHA guides to osteoporosis and pregnancy are on the way.

Graves’ eye disease and skin changes

About 1 in 3 people with Graves’ disease develop thyroid eye disease (Graves’ ophthalmopathy), when the immune system attacks the muscles and tissues around the eyes (NIDDK, American Thyroid Association). It can cause gritty, dry or watery eyes, light sensitivity, redness, puffy lids, pain behind the eyes, bulging eyes and double vision (American Thyroid Association). Most cases are mild (NIDDK); only about 5% of people with Graves’ disease have inflammation severe enough to cause serious or permanent vision trouble (American Thyroid Association). See Thyroid eye disease below and our Eyes guide.

Rarely, the skin on the shins (sometimes the tops of the feet) becomes reddish, thick and rough: Graves’ dermopathy. Most cases are mild and painless (NIDDK).

Who is more likely to get it?

How it is diagnosed

Tip: the supplement biotin can make thyroid tests look abnormal when they aren’t. Stop it for 2 to 3 days before thyroid blood tests (American Thyroid Association, American Thyroid Association).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Beta-blockers for symptoms, then antithyroid medicine (usually methimazole; PTU in early pregnancy), radioactive iodine or surgery, with lifelong thyroid hormone after the last two. Eye disease: eye care, quitting smoking, selenium in some cases, steroids, teprotumumab, rarely orbital radiation, and eye surgery. Cost estimate being researched. Strong evidence. Treatment almost always controls the overactive thyroid; antithyroid medicine is not a permanent cure. Most eye disease is mild.
Chiropractic No role in treating Graves’ disease. About $50–$200 a visit without insurance; not a treatment for Graves’ disease. We found no evidence that it treats Graves’ disease. MBHA advises no neck work with a large goiter, after recent thyroid surgery or with a racing heart.
Acupuncture Fine needles, used alongside medical treatment. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Little research, mostly small and low-certainty. One small blinded trial found no benefit for Graves’ eye disease.
Herbal medicine Bugleweed and lemon balm are promoted for an overactive thyroid. Avoid iodine and kelp supplements, and pause biotin before blood tests. Cost estimate being researched. Weak evidence: lab studies and small open studies only. No herb replaces treatment, and herbs can interact with medicines.
Massage therapy Gentle relaxation massage, avoiding pressure on the front of the neck. Private therapists about $60–$120 for 45–60 minutes. May help you relax. It does not change thyroid hormone levels.
MBHA Wellness Coach An MBHA Wellness Coach helps with stress, sleep, quitting smoking, bone health, caffeine, regular labs, eye comfort and pregnancy planning. MBHA coaching cost estimate being researched. Supports your medical treatment; quitting smoking matters most for the eyes.

Approach 1 of 6

Conventional medicine (AMA)

An endocrinologist usually leads care, with an ophthalmologist (medical eye doctor) for eye disease. The best treatment depends on your age, symptoms, other conditions such as heart disease or pregnancy, and your preferences (American Thyroid Association). The American Thyroid Association’s 2016 guideline makes 124 evidence-based recommendations on these choices (ATA guideline, Thyroid 2016). We don’t list doses — ask your doctor or pharmacist.

1. Beta-blockers for symptoms

Medicines such as propranolol, atenolol or metoprolol ease a racing heart, shakiness and nervousness while other treatment takes effect. They don’t lower thyroid hormone levels (American Thyroid Association, NIDDK).

2. Antithyroid medicines

Methimazole is used most often; propylthiouracil (PTU) is kept for special situations such as the first trimester of pregnancy (American Thyroid Association, NIDDK). They make the thyroid produce less hormone. Levels take weeks to months to normalize, and treatment averages 1 to 2 years but can last many more (NIDDK). If thyroid and antibody tests are normal after a course, the medicine may be stopped (American Thyroid Association). Side effects include rash, itching, a drop in white blood cells and, rarely, liver damage; call your doctor right away for yellow skin or eyes, belly pain, loss of appetite, easy bruising, fever, chills or a constant sore throat (NIDDK, MedlinePlus).

3. Radioactive iodine

Radioactive iodine-131, swallowed as a capsule or liquid, slowly destroys overactive thyroid cells (NIDDK). Most people need one dose; about 10% need a second (American Thyroid Association). It is never used in pregnancy or breastfeeding, and you will be given steps to limit others’ radiation exposure for a time (American Thyroid Association). It can worsen thyroid eye disease, especially in smokers, so your doctor may add steroids or suggest another option (American Thyroid Association).

4. Surgery (thyroidectomy)

Removing all or nearly all of the thyroid gives a quick, radiation-free cure of the overactive thyroid. It may be advised in pregnancy, with severe eye disease, a large goiter, side effects from antithyroid medicine or suspected cancer. Choose an experienced thyroid surgeon; risks include a hoarse voice and low calcium, usually temporary (American Thyroid Association). Hormone levels must be well controlled first, because surgery can trigger thyroid storm (NIDDK).

5. Lifelong thyroid hormone

Almost everyone treated with radioactive iodine, and everyone whose thyroid is removed, needs a daily thyroid hormone tablet for life. An underactive thyroid is easier to treat than an overactive one (NIDDK, American Thyroid Association).

6. Thyroid eye disease

7. Quitting smoking

Smoking makes Graves’ eye disease worse. Free help: 1-800-QUIT-NOW (1-800-784-8669) (NIDDK).

What it costs

Cost estimate being researched. Ask your doctor’s office and insurer what you will pay for tests, medicine, radioactive iodine or surgery.

How well it works — what to expect

Graves’ hyperthyroidism is, in general, controllable and safely treated, and treatment is almost always successful (American Thyroid Association). Eye disease often improves with treatment or on its own, but can return or worsen; stressful life events and smoking are triggers (NIDDK).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic has no role in treating Graves’ disease. We found no evidence that it affects the thyroid, the antibodies behind the disease or thyroid eye disease.

MBHA caution about neck work. If you see a chiropractor for another problem, mention your Graves’ disease. MBHA advises avoiding neck manipulation or pressure with a large goiter, after recent thyroid surgery — when the neck is often stiff and sore (American Thyroid Association) — or with a racing heart, which needs a medical check first. Serious side effects of spinal manipulation are very rare, but may be more likely in people with underlying health problems (NCCIH).

What it costs

About $50–$200 a visit without insurance (MedicalCostInfo).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

We found little research on acupuncture for Graves’ disease:

Some people use acupuncture for stress alongside medical care — never instead of it. Complications are relatively few but have come from non-sterile needles and poor technique (NCCIH); MBHA advises no needling over a goiter or a healing scar.

What it costs

About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Avoid iodine, kelp and seaweed supplements. With Graves’ disease you may be sensitive to iodine; large amounts from seaweed or supplements may cause or worsen an overactive thyroid. Some cough syrups and multivitamins contain iodine too — ask your doctor (NIDDK, American Thyroid Association).

Bugleweed and lemon balm

Both are promoted for an overactive thyroid, but the evidence is weak. A 1985 lab study found that extracts blocked Graves’ antibodies in test tubes, and its authors called their traditional use “poorly documented” (lab study, Endocrinology 1985). Two open (unblinded) German studies of bugleweed in mild overactive thyroid reported fewer symptoms (study, Phytomedicine 2008, study, Wien Med Wochenschr 2013); neither was placebo-controlled or limited to Graves’ disease. No herb has been shown to control Graves’ disease. We don’t list doses.

Biotin and blood tests

Biotin can make thyroid tests look abnormal when they are normal; stop it 2 to 3 days before testing and tell your doctor you take it (American Thyroid Association, American Thyroid Association).

Interactions

Herbs can interfere with how medicines work, supplements can act like drugs, and “natural” doesn’t mean safe (American Thyroid Association). Tell your doctor and pharmacist about every supplement you take with methimazole (MedlinePlus). Never stop thyroid medicine to try an herb: stopping antithyroid medicine suddenly can trigger thyroid storm (Cleveland Clinic). Selenium for eye disease is covered under conventional medicine. Supplement costs: cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage won’t change thyroid levels, but gentle massage may help you relax. Its risk appears low; rare serious problems have mostly involved vigorous techniques such as deep tissue massage (NCCIH).

  • No pressure on the front of the neck, especially with a goiter or after thyroid surgery (MBHA advice), and none on the eyes if you have eye disease.
  • Ask for a cool room if heat bothers you (NIDDK), and postpone massage while your heart is racing or your thyroid isn’t yet controlled.

What it costs

Private therapists charge about $60–$120 for 45–60 minutes (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build habits that support your treatment, alongside your endocrinologist and eye doctor.

MBHA coaching cost estimate being researched.

Another approach

Thyroid eye disease

Thyroid eye disease usually appears within the first year after diagnosis and is usually mild, improving on its own over time (American Thyroid Association). It can start before the thyroid problem or, rarely, after treatment, even with normal thyroid levels (NIDDK).

Everyday eye comfort

Keeping it from getting worse

Avoid all cigarette smoke, keep thyroid levels normal, and discuss radioactive iodine carefully if you have eye disease (American Thyroid Association). High thyroid antibody levels and high cholesterol are also risk factors (EUGOGO guideline, 2021). Moderate-to-severe or uncertain cases should see an ophthalmologist (American Thyroid Association).

Another approach

Graves’ disease and pregnancy

With regular thyroid tests and prescribed medicine, you can have a healthy pregnancy (NIDDK). Graves’ disease is the most common cause of an overactive thyroid in women of childbearing age (American Thyroid Association).

Use a prenatal vitamin with iodine as experts advise, but avoid seaweed supplements (NIDDK). An MBHA pregnancy guide is on the way.

Another approach

Thyroid storm

Thyroid storm is a sudden surge of thyroid hormone that sends the body into overdrive. It is rare but a medical emergency, treated in hospital, often in intensive care (Cleveland Clinic). See the warning signs in the box at the top of this page — and call 911.

Triggers include untreated or under-treated hyperthyroidism, infection, injury, surgery, pregnancy or giving birth (Merck Manual, NHS), suddenly stopping antithyroid medicine, and a large iodine load such as scan contrast dye (Cleveland Clinic). With treatment most people improve within 24 hours. To help prevent it, take your medicine as prescribed, see your provider regularly and manage stress (Cleveland Clinic).

Member stories

Living with Graves’ Disease? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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