DIABETES AND ENDOCRINE SYSTEM Endocrine System • Graves' disease • Hypoglycemia • Goiter • Male hypogonadism • Gestational diabetes • Type 1 diabetes • Hyperthyroidism • Hypothyroidism • Addison's disease • Hyperparathyroidism • Diabetic retinopathy • Cushing's syndrome • Acromegaly • Hypopituitarism • Thyroid nodules • Metabolic syndrome • Prolactinoma • Pituitary tumors • Dehydration • Primary aldosteronism • Hashimoto's disease • Pheochromocytoma • Type 2 diabetes • Prediabetes • Diabetic coma • Diabetic hyperosmolar syndrome • Diabetic ketoacidosis • Diabetes insipidus

Note: All links within content go to MayoClinic.com

Graves' disease is the most common form of hyperthyroidism. It occurs when your immune system mistakenly attacks your thyroid gland and causes it to overproduce the hormone called thyroxine. This abnormal immune response can also affect the tissue behind your eyes as well as your skin, usually on your lower legs and feet.

When you have too much thyroid hormone in your system, your body's metabolism rate can increase by 60 percent to 100 percent because thyroxine regulates your cells' metabolism. A higher metabolism can lead to a number of health problems, such as an irregular heartbeat or anxiety.

Graves' disease is rarely life-threatening. Although it may develop at any age and in either men or women, Graves' disease is more common in women and usually begins after age 20. The disorder is uncommon, affecting about five in every 10,000 people in the United States.

There's no way to stop your immune system from attacking the thyroid gland, but treatments can decrease the production of thyroxine.

Signs and symptoms of Graves' disease and hyperthyroidism may include:

• Anxiety
• Irritability
• Difficulty sleeping
• Fatigue
• A rapid or irregular heartbeat
• A fine tremor of your hands or fingers
• An increase in perspiration
• Sensitivity to heat
• Weight loss, despite normal food intake
• Brittle hair
• Enlargement of your thyroid gland (goiter)
• Light menstrual periods
• Frequent bowel movements

Graves' ophthalmopathy
It's also fairly common for your eyes to exhibit mild signs of a condition known as Graves' ophthalmopathy. In Graves' ophthalmopathy, your eyeball bulges out past its protective orbit. This occurs as tissues and muscles behind your eye swell and cause your eyeball to move forward. Because your eye is so far forward, the front surface of your eye can become dry. Cigarette smokers with Graves' disease are more likely to have eye problems.

Graves' ophthalmopathy may cause these mild signs and symptoms:

• Excess tearing and sensation of grit or sand in either or both eyes
• Reddened or inflamed eyes
• Widening of the space between your eyelids
• Swelling of the lids and tissues around the eyes
• Light sensitivity

Less often, Graves' ophthalmopathy can produce these signs and symptoms:

• Ulcers on the cornea
• Double vision
• Limited eye movements
• Blurred or reduced vision

Graves' dermopathy
Another uncommon sign of Graves' disease is reddening and swelling of the skin, often on your shins and on the top of your feet, called Graves' dermopathy.

Normally, your immune system uses naturally occurring proteins (antibodies) and white blood cells (lymphocytes) to help protect against viruses, bacteria and foreign substances (antigens) that invade your body. In Graves' disease, your immune system mistakenly attacks your thyroid gland, but instead of destroying the gland, an antibody called thyrotropin receptor antibody (TRAb) stimulates the thyroid to make excessive amounts of thyroid hormone.

Your thyroid is part of the endocrine system, which is made up of several glands and tissues that produce hormones. These chemical messengers coordinate many of your body's activities, from digestion to metabolism to reproduction. Thyroxine — a hormone produced by the thyroid — controls your metabolic rate.

Doctors don't know what causes your immune system to attack your thyroid gland. However, they believe a combination of factors, including heredity, sex, age and stress, may determine your likelihood of developing Graves' disease.

See your doctor if you have some of the signs and symptoms of Graves' disease, which may include an enlarged thyroid, protruding eyes, anxiety, intolerance to heat, tremor and weight loss. Go to an emergency room if you are experiencing heart-related signs and symptoms, such as a rapid or irregular heartbeat.

To diagnose Graves' disease, your doctor typically uses these procedures:

• Physical exam. Your doctor examines your eyes to see if they're irritated or protruding and looks to see if your thyroid gland is enlarged. Because Graves' disease increases your metabolism, your doctor will check your pulse and blood pressure and look for signs of trembling. Your doctor will also ask you about your symptoms and your personal and family medical histories.
• Blood sample. Your doctor will likely order blood tests to determine your levels of thyroid-stimulating hormone (TSH) and thyroxine. TSH, produced by your pituitary gland, is the hormone that normally stimulates the thyroid gland. In Graves' disease, an abnormal antibody called TRAb mimics TSH, causing elevated thyroxine even while TSH levels remain low. If you have very low levels of TSH and high levels of thyroxine, your doctor may diagnose Graves' disease.
• Radioactive iodine uptake. Your body needs iodine to make thyroxine. By giving you a small amount of radioactive iodine and later measuring the amount of radioiodine in your thyroid gland, your doctor can determine the rate at which your thyroid gland takes up iodine. A high uptake of radioactive iodine indicates your thyroid gland is producing too much thyroxine, as is the case in Graves' disease. Low uptake occurs in some of the other causes of hyperthyroidism.

There's no treatment to stop your immune system from producing the antibodies that cause Graves' disease. Treatments to control the signs and symptoms of Graves' disease are designed to decrease the production of thyroxine or to block its action. They include:

• Beta blockers. These medications, which include propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor) and nadolol (Corgard), often relieve hyperthyroid signs and symptoms, such as a rapid heart rate, nervousness and tremors. These medications aren't a cure for Graves' because your body will still produce too much thyroxine, but beta blockers block some of the action of the thyroid hormone. Beta blockers are often used in conjunction with other forms of treatment.
• Anti-thyroid medications. These prescription medications, including propylthiouracil and methimazole (Tapazole), prevent your thyroid from producing excessive amounts of hormones. Typically, treatment with anti-thyroid medications continues for at least a year. For 20 percent to 30 percent of people with Graves' disease, treatment with anti-thyroid medications for one to two years causes a long-term remission of the disease. However, relapse is fairly common. These drugs are often used in combination with radioactive iodine treatment or surgery to help control signs and symptoms.
• Radioactive iodine treatment. To make thyroid hormone, your body needs iodine and will use whatever form of iodine is available in your blood. If you take radioactive iodine, the iodine collects in your thyroid gland, and over time the radioactivity destroys the overactive thyroid cells. This causes the thyroid gland to shrink, and problems lessen gradually, usually over several weeks to several months. Because this treatment causes thyroid activity to decline, you likely will later need thyroxine treatment to supply your body with normal amounts of thyroid hormones. Treatment doesn't require a hospital stay. Radioactive iodine treatment may increase your risk of new or worsened symptoms of Graves' ophthalmopathy. This side effect is usually mild and temporary, but radioactive iodine therapy may not be recommended if you already have moderate to severe eye problems. After radioactive iodine treatment, any iodine not taken up into the thyroid gland is excreted in your urine and saliva. This is the most common therapy used for adults with hyperthyroidism in the United States.
• Surgery. If you can't tolerate an anti-thyroid drug and don't want to have radioactive iodine therapy, surgery to remove your thyroid gland (thyroidectomy) is an option. After the surgery, you'll likely need thyroxine treatment to supply your body with normal amounts of thyroid hormones. Risks of this surgery include potential damage to your vocal cords and your parathyroid glands, tiny glands located adjacent to your thyroid gland. Your parathyroid glands produce a hormone that controls the level of calcium in your blood. Complications are rare under the care of a surgeon experienced in thyroid surgery.

Treating Graves' ophthalmopathy
If Graves' disease affects your eyes (Graves' ophthalmopathy), you can manage mild symptoms by using artificial tears liberally during the day and lubricating gels at night. If your symptoms are more severe, your doctor may recommend:

• Medications. Treatment with prescription corticosteroids such as prednisone may diminish swelling behind your eyeball.
• Orbital decompression surgery. In this surgery, your doctor removes the bone between your eye socket (orbit) and your sinuses — the air spaces next to the orbit. This gives the eyes room to move back to their original position. Possible complications include double vision and lip numbness.
• Eye muscle surgery. The inflammation caused by Graves' disease can affect your eye muscles, making them too short to allow the eyes to align properly. In eye muscle surgery, your doctor cuts the muscle where it attaches to your eyeball and then reattaches it farther back. Sometimes, more than one operation is necessary.
• Prisms. You may have double vision either because of Graves' disease or as a side effect of surgery for Graves' disease. Though they don't work for everyone, prisms in your glasses may correct your double vision.

Orbital radiotherapy was once a common treatment for Graves' ophthalmopathy. Orbital radiotherapy uses targeted X-rays over the course of several days to destroy some of the tissue behind your eyes. However, some studies have suggested that this treatment provides no benefit for people who have mild to moderately severe Graves' ophthalmopathy. Your doctor may recommend orbital radiotherapy if your eye problems are worsening and prescription corticosteroids alone aren't effective or well tolerated.

These steps may make your eyes feel better if you have Graves' ophthalmopathy:

• Apply cool compresses to your eyes. The added moisture may soothe your eyes.
• Wear sunglasses. When your eyes protrude, they're more vulnerable to ultraviolet rays and more sensitive to bright light. Wearing sunglasses that wrap around the sides of your head will lessen the irritation of your eyes from the wind.
• Use lubricating eyedrops. Eyedrops may relieve the dry, scratchy sensation on the surface of your eyes. At night, a paraffin-based gel such as Lacri-Lube can be applied.
• Elevate the head of your bed. Keeping your head higher than the rest of your body lessens fluid accumulation in the head and may relieve the pressure on your eyes.

To relieve swelling and reddening of the skin on your shins and on the top of your feet, use over-the-counter creams or ointments containing hydrocortisone. In addition, using compression wraps on the legs may help.