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An autoimmune disease that drives the thyroid — often also affecting the eyes, and treatable.
Also known as: Graves’ disease · autoimmune hyperthyroidism
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Graves’ disease is the counterpart to Hashimoto’s: here too the immune system makes antibodies against the thyroid, but they do not block, they push the accelerator. The TSH-receptor antibodies sit in the same lock as TSH and drive the gland continuously — whatever the pituitary actually orders. In the blood you therefore see a very low TSH beside high free hormones: the control has switched off, the gland runs on anyway. The onset is typical: it does not start with tiredness but with being driven. Palpitations, tremor, sleeplessness, warm damp skin, weight loss despite a good appetite, often an unfamiliar irritability that others read as stress or an anxiety disorder. One feature concerns the eyes: in some people the same process attacks the tissue behind the eyeball, which swells; the eyes come forward, water, press, or vision doubles. This eye involvement follows its own course and does not automatically improve with the blood values. Smoking is the most important thing that can be changed here — it makes eye symptoms clearly more likely and more severe. For the gland itself there are several routes, and none of them is an emergency decision. If a high fever, marked confusion or persistent vomiting are added to the racing heart, this is no longer the ordinary overactivity but a situation that is treated at once.
Over- or underactivity should be diagnosed and treated (e.g. hormone replacement) — the key step.
Iodine is the building block of thyroid hormones; both deficiency and excess can harm. Iodised salt and sea fish cover the need.
A low TSH alone can have other reasons. Only the free hormones beside it show whether there really is too much in circulation — and in some only free T3 is raised.
Overactivity can also come from an autonomous nodule or from a passing inflammation. The distinction decides the route, because these forms are treated quite differently.
Smoking is the best-established changeable factor for eye involvement: it occurs more often, runs more severely and responds less well to treatment.
The medicines that slow hormone production can, rarely, make the white cells collapse. Hence the rule: fever and a sore throat under this treatment are not a trivial infection but a reason to have a blood count done at once.
Iodine-containing X-ray contrast media and high-dose iodine preparations can fan overactivity. Anyone with thyroid disease should say so before an examination.
After successful treatment the function tips the other way in many people over time. The monitoring therefore stays, even when you feel well.
Antithyroid drugs slow the making of hormone — with a two to six week delay, because the filled store must empty first. After twelve to eighteen months about half stay settled once stopped. Radioiodine and surgery remove the tissue; the underactivity that follows is the intended state, not a mistake.
About one to two in a hundred people develop it in their lifetime, women considerably more often. On antithyroid drugs it takes two to six weeks to improve; treatment runs twelve to eighteen months. After that about half stay settled, the other half come back, usually in the first year. The eye involvement follows a course of its own: one to three years of active phase, then a quiet state — eye surgery is only planned after that.
Often the first thing noticed — at night in bed, not on exertion. An irregular pulse needs looking at promptly, because an overactive thyroid can set off atrial fibrillation.
A fine, fast tremor that shows with the hands held out. With it the sense of not being able to come down although nothing is happening.
Turnover outruns intake. In older people this sign is sometimes missing altogether — there the overactivity shows more as a rhythm problem or weakness.
In a T-shirt when others are cold. The skin feels warm and damp, not cold and clammy.
A gritty feeling, watering, light sensitivity, a staring look, less often double vision. New double vision or failing sight needs examining quickly.
Not diarrhoea in the strict sense but a sped-up gut. Often noticed only in hindsight.
Stairs and getting out of a chair become hard although the muscles do not hurt. Under constant drive the body breaks down protein.
Large iodine amounts can trigger a flare. Seaweed preparations and iodine contrast media are the relevant sources, not the iodised salt in bread.
Until treatment takes hold the body burns more. Eating sparingly in this time costs muscle — 1.2 g protein per kg a day and regular meals counter it.
For the eye involvement the evidence is strongest: 200 µg a day over 6 months improved the course of mild eye disease in a European trial. On the overactivity itself it has no effect.
Heavy strain often precedes flares. Relaxation methods do not change the autoimmune situation, but they help with palpitations and inner restlessness alongside treatment.
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AWMF 031-003 · S1 · 2023-04 — in force
Radioiodtherapie bei benignen Schilddrüsenerkrankungen
checked 2026-09