Left untreated, Graves’ disease can result in eye and skin conditions. Learn how to spot and treat them
The most common cause of hyperthyroidism (overactive thyroid) in the United States, Graves’ disease is a condition where the immune system attacks the thyroid, causing the gland to overproduce thyroid hormone, according to the National Institute of Diabetes and Digestive and Kidney Diseases. This can lead to heat intolerance, unintended weight loss, and sleep problems, among other symptoms.
After you’ve been diagnosed with Graves’ disease, it’s important to follow your doctor’s treatment regimen. If it isn’t managed correctly, Graves’ can lead to complications affecting many parts of the body, from the eyes and skin to the heart and bones.
Here are a few potentially dangerous complications, plus how you can reduce your risk.
1. Graves’ eye disease
According to the American Thyroid Association (ATA), about one third of people with Graves’ disease experience Graves’ eye disease, also called Graves’ opthalmopathy or thyroid eye disease, which is 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,” explains Alexandra Mikhael, MD, an endocrinologist at Cleveland Clinic.
Graves’ eye disease is linked to the same autoimmune process that causes Graves’ disease itself , not by an overproduction of thyroid hormone. (Treating Graves’ disease, for example, won’t resolve Graves’ eye disease.) That said, Graves’ eye disease most often develops in people with hyperthyroidism.
Symptoms include eyes that appear to bulge out and are dry, irritated, and sensitive to light. People may also experience pain or pressure in the eyes and double vision. Left untreated, swelling can sometimes compress the optic nerve and potentially lead to vision loss.
Doctors usually first treat Graves’ eye disease with antithyroid drugs or surgery to remove the thyroid gland, but these treatments don’t always improve symptoms, says Dr. Mikhael. “Symptoms may initially worsen with treatment of Graves’ disease for the first three to six months, then stay stable and eventually improve,” she says.
Another common treatment for Graves’ disease, radioactive iodine therapy, can make Graves’ eye disease worse in some people, so it’s usually not a first-line therapy, she adds. It is recommended sometimes alongside steroids, though, in people with a mild form of the condition.
To relieve symptoms of mild Graves’ eye disease, your endocrinologist and/or ophthalmologist may recommend:
- Using lubricating eye drops
- Wearing sunglasses if your eyes are sensitive to light
- Wearing special glasses to correct double vision
- Raising your head when you sleep at night to relieve swelling
- Using cold compresses on your eyes
More serious cases may require medication. Severe cases, which can lead to vision loss, may require surgery to the eyelids (to help reduce the startled appearance that sometimes develops), eye muscles, or bone structure between the eye socket and sinuses. Mikhael estimates that about 5 percent [of people with Graves’ eye disease] have moderate to severe ophthalmopathy that causes serious vision problems.
2. Skin problems
Some people with Graves’ disease develop Graves’ dermopathy, a condition where the skin on the shins and sometimes the tops of the feet becomes red, thick, and swollen. Also known as pretibial myxedema, most people with the condition also develop Graves’ eye disease.
Similar to Graves’ eye disease, Graves’ dermopathy is caused by an autoimmune process that results in inflammation, causing 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 sometimes be painful and require treatment. Your doctor may recommend wearing compression socks.
For more severe cases, topical steroids often improve the skin lesions within a few weeks. Physical therapy can help improve lymphedema, or swelling due to a buildup of lymphatic fluid, says Mikhael.
3. Thyroid storm
Thyroid storm is a rare but life-threatening condition that can occur when Graves’ disease symptoms suddenly flare up. “It develops in patients with long-standing hyperthyroidism,” says Mikhael. It’s usually due to serious stress on the body, such as a heart attack or infection, but it can also occur following radioactive iodine therapy for hyperthyroidism or due to irregular use of antithyroid medications, she explains.
Symptoms include a pounding heart, shaking, sweating, agitation, and confusion. Immediate emergency treatment is critical, since a thyroid storm can lead to heart failure and death.
Because thyroid storms are linked to poorly controlled hyperthyroidism, 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, and overproduction in people with Graves’ disease and hyperthyroidism causes the heart to beat faster and harder than normal. Over time, severe, untreated hyperthyroidism can lead to an irregular heartbeat, which in turn can cause problems such as blood clots, heart failure, and stroke.
Once again, treatment for hyperthyroidism is essential to preventing heart problems in people with Graves’ disease, says Mikhael.
In people with hyperthyroidism caused by Graves’ disease, an excess of thyroid hormone speeds up the rate that bone is lost so that it 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. In addition to treating hyperthyroidism, your doctor may recommend increasing your calcium and vitamin D intake and doing more weight-bearing exercises, such as resistance training, she explains.
Treatments for Graves’ disease
Treating Graves’ disease is the number one way to help prevent potentially dangerous complications. It usually starts with managing hyperthyroidism using one or more of the following treatments:
- Beta-blockers These medications rapidly treat the symptoms of hyperthyroidism, but they don’t treat an overproduction of thyroid hormone itself. Along with other hyperthyroidism treatments, beta-blockers are key to preventing heart problems, says Mikhael.
- Antithyroid medication This effective and simple medication can lead to hyperthyroidism remission within one or two years, but it doesn’t cure the condition. It’s sometimes used as a bridge to radioactive iodine therapy or surgery, explains Mikhael. Rarely, it can be used as a long-term hyperthyroidism treatment. “Antithyroid medications are preferred in patients with a high likelihood of remission, including … people with mild hyperthyroidism,” says Mikhael.
- Radioactive iodine therapy This oral iodine pill destroys overactive thyroid cells. “It may temporarily worsen Graves’ eye disease and hyperthyroidism,” says Mikhael. It’s not recommended for people with moderate to severe Graves’ opthalmopathy or those who are pregnant, planning to become pregnant, or breastfeeding.
- Surgery It may be necessary to remove the entire thyroid gland, which requires you to take thyroid replacement medication for the rest of your life. “Surgery may be the best option for patients with large goiters or patients with suspicious thyroid nodules or an overactive parathyroid gland [a gland on the thyroid],” says Mikhael, in addition to those who are pregnant. It’s not a good option for people for whom surgery is risky, including older patients, she adds.
- Quit smoking While there’s no way to prevent Graves’ ophthalmopathy, Graves’ dermopathy, or hyperthyroidism, smoking makes it worse, says Mikhael. (People who smoke cigarettes, for example, tend to experience more severe symptoms of Graves’ eye disease than those who don’t smoke, according to the ATA, but the reason for this isn’t clear.) If you smoke, ask your doctor for resources that can help you quit.
Otherwise, “Eating well, exercising daily, caring for your mental health, easing stress through meditation or listening to music, and taking time for self-care” are all especially important lifestyle habits for people with Graves’ disease, she adds. Stress may trigger or worsen Graves’ disease, according to Mayo Clinic, and eating well and doing physical activity can help keep your bones healthy, which is important because untreated hyperthyroidism can lead to osteoporosis.