Symptoms of Graves' Disease

Graves' disease is an autoimmune disorder primarily affecting the function of the thyroid gland 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 can 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, often overlooked. As the condition worsens, obvious signs such as exophthalmos, abnormal heart rhythms, or skin redness and swelling may occur. Recognizing these early features helps in prompt diagnosis and treatment, preventing complications.

Early Symptoms and Signs

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

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

Some patients exhibit signs of accelerated metabolism, such as:

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

This may be misdiagnosed as stress or menopausal symptoms, requiring blood tests to confirm autoimmune markers.

Common Symptoms

Symptoms Related to Hyperthyroidism

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

• Palpitations or tachycardia (resting heart rate over 100 bpm)
• Abnormally increased body temperature, especially in the morning
• Accelerated gastrointestinal activity, leading to diarrhea or frequent bowel movements

Metabolic acceleration can also cause muscle weakness, particularly in the upper limbs and pelvic girdle muscles. Some patients may experience muscle atrophy with coordination issues. Nails may become brittle and prone to breakage, and hair loss may occur more easily.

Ocular Symptoms (Graves’ Ophthalmopathy)

About 30-50% of patients develop eye-related symptoms known as "Graves’ Ophthalmopathy." Common features include:

• Exophthalmos (bulging eyes), which may cause eyelids to be unable to fully close
• Dry eyes or foreign body sensation, abnormal tear secretion
• Blurred vision or diplopia, 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, blink more frequently, and in severe cases, eye movement restriction can cause eye displacement.

Skin and Systemic Symptoms

A small number of patients develop redness, warmth, and swelling of the skin on the lower limbs, called "pretibial myxedema." This skin lesion is most common on the front of the lower leg, with a rubbery hardness upon touch. Other systemic symptoms include:

• Irritability, anxiety, or difficulty concentrating
• Menstrual irregularities in women
• Reduced bone density, increasing the risk of osteoporosis

Disease Progression and Symptom Changes

Symptoms of Graves' disease can fluctuate. In the early stages, excess thyroid hormones may cause hypermetabolic symptoms such as increased body temperature and appetite. As the disease progresses, the thyroid follicular cells may atrophy due to prolonged stimulation, leading to symptom remission, but potentially transitioning into hypothyroidism.

Development of ocular symptoms may be independent of thyroid function changes. Some patients continue to experience worsening eye disease even after thyroid symptoms are controlled. Long-term uncontrolled cases may develop corneal ulcers or optic nerve compression, resulting in permanent vision loss.

When to Seek Medical Attention

Immediate medical attention is necessary if you experience:

• Unexplained rapid weight loss (more than 5 kg per month)
• Persistent palpitations with chest pain or difficulty breathing
• Exophthalmos with blurred vision or diplopia

Emergency symptoms requiring urgent care include:

• Severe ocular pressure pain and inability to close the eyes normally
• Difficulty swallowing or breathing (due to laryngeal swelling)
• Altered consciousness or hypertensive crisis

Regular monitoring of thyroid function indices (such as TSH, T3/T4) is crucial for assessing symptom changes. If current treatments fail to control symptom worsening, discuss with your physician to adjust the treatment plan.

 

Frequently Asked Questions

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

Most patients require long-term treatment, but this depends on the severity of the disease and response to therapy. Antithyroid drugs (such as thionamides) are usually taken for several months to years, with some requiring lifelong medication control. After radioactive iodine therapy or surgery, periodic follow-up is necessary to prevent rebound thyroid dysfunction.

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

If you experience increased heart rate, tremors, sudden weight loss, or worsening exophthalmos, it may indicate disease progression. Keep a record of symptom changes and discuss with your doctor about treatment adjustments. Regular blood tests for thyroid function are also key for assessment.

Is it safe to conceive during treatment?

Hormonal changes during pregnancy can trigger or worsen the condition, but with medical supervision and dose adjustments (using safer medications like propranolol), most patients can conceive safely. Confirm disease control with your doctor before planning pregnancy, and monitor thyroid function every 4-6 weeks during pregnancy.

Can surgical correction improve exophthalmos?

Severe exophthalmos (thyroid eye disease) may require orbital radiation therapy or orbital decompression surgery. Surgery can remove part of the orbital tissue or adjust eye muscles to relieve pressure and improve appearance. Surgery should be performed after the disease stabilizes (usually after 6-12 months).

Which dietary components should be avoided to control the disease?

Excessive iodine intake may worsen hyperthyroidism. Avoid seaweed, iodized salt, and iodine-containing supplements. A balanced diet rich in fiber and vitamin B complex, while limiting caffeine and alcohol, can help reduce palpitations and nervous excitement. Personal dietary plans should be made in consultation with your doctor or a nutritionist.