Graves’ disease

Graves’ disease is an autoimmune disorder in which the body’s immune system mistakenly attacks healthy tissue in the thyroid gland. As a result, the thyroid produces too many hormones, which is a condition known as hyperthyroidism or overactive thyroid. Graves’ disease is the leading cause of hyperthyroidism.
The thyroid has many important functions that help your body work normally, including controlling metabolism, body temperature, and heart rate. When the thyroid is overactive, the imbalance of hormones interferes with these processes. Thyroid hormones also have a big impact on reproductive health.  

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Impact of Graves’ disease on fertility

About 50% of women with Graves’ disease have difficulties getting pregnant. Having an excess of thyroid hormone can cause irregular periods – and women with irregular periods may not ovulate monthly. 
During pregnancy, untreated Graves’ disease can lead to low birth weight, miscarriage, stillbirth, birth defects, preeclampsia, premature labor, heart failure, and passing hyperthyroidism onto the baby. 

Potential causes of Graves’ disease

Doctors aren’t sure what causes the immune system to attack the thyroid, but there are certain factors that can increase the risk of developing Graves’ disease, such as:

• Smoking cigarettes
• Family history of thyroid disease
• Other autoimmune disorders (rheumatoid arthritis, lupus, type 1 diabetes, celiac disease, vitiligo)

Stress, pregnancy, and infections may also trigger the immune system to produce antibodies that harm the thyroid.

Symptoms of Graves’ disease

Having an excess of thyroid hormones can cause the following symptoms:

• Light, irregular and missed periods (amenorrhea)
• Fast heartbeat
• Trembling hands
• Sleeping problems
• Weight loss
• Muscle weakness
• Heat sensitivity
• Sweating
• Thin hair and skin
• Nervousness and irritability
• Enlarged thyroid gland

⅓ of people with Graves’ disease also experience eye problems including inflammation, swelling, and bulging of the eyes. If you are having any eye symptoms, be sure to consult with an ophthalmologist in addition to an endocrinologist.

Rarely, people with Graves’ disease get a skin condition which causes lumpy, red, and thicker skin at the front of the shins (called pretibial myxedema or Graves’ dermopathy).

Diagnosis of Graves’ disease

Doctors diagnose Graves’ disease by checking your symptoms and performing certain blood tests: 

• Thyroid blood tests measure the levels of thyroid hormones and thyroid-stimulating hormone (TSH) in your bloodstream. 
• Thyroid antibody blood tests measure your levels of thyroid antibodies. People with Graves’ disease have higher levels of thyroid-stimulating antibodies (TSI), thyrotropin receptor antibodies (TRAb), and thyrotropin-binding inhibitory immunoglobulins (TBII). 
• Your doctor may also have you take a small amount of radioactive iodine to test how much of it gets absorbed by your thyroid gland. High absorption can signal Graves’ disease.
• In some cases, doctors will do an ultrasound to measure the blood flow to the thyroid.

Treatment to improve fertility

Treatment for Graves’ disease is very successful and the prognosis is quite good for people with this condition. Once your hormone levels are back to normal, your menstrual cycle will become regular again, fertility will improve, and you shouldn’t experience problems during pregnancy.

Autoimmune thyroid disease is treated with medications that stop your thyroid hormones from getting too high. For Graves’ disease, doctors usually prescribe beta-blocker drugs to control the heart rate, and antithyroid medications, which prevent the overproduction of thyroid hormones. 

If, after 6 months of taking medications, your thyroid levels are still too elevated, your doctor may recommend treatment with radioactive iodine or surgery to remove all or most of the thyroid. These can eventually lead to hypothyroidism (underactive thyroid), which will need to be treated with daily medication.

You’ll work closely together with your endocrinologist to monitor your thyroid hormone levels and make any necessary adjustments to your treatment plan during pregnancy. For instance, methimazole, an antithyroid medicine, and radioiodine therapy can’t be used during pregnancy as they can harm the baby. Propylthiouracil is an antithyroid medication that is safe to take throughout pregnancy. Your body goes through many hormonal changes during pregnancy, which can also make your thyroid hormone levels go up.
To boost thyroid health, you can also take vitamin D, iron, and zinc supplements. Ask your doctor for advice on the right supplement and dose. Finally, a diet low in iodine (seafood has the highest iodine content) and high in cruciferous vegetables (broccoli, Brussels sprouts, cauliflower, and kale) can help with hyperthyroidism.

This article has been verified by a medical professional

• Graves’ Disease. Cleveland Clinic. Accessed 08 November 2022.
• Graves’ Disease. American Thyroid Association. Accessed 08 November 2022.
• Graves’ disease. Office on Women’s Health – U.S. Department of Health & Human Services. Accessed 08 November 2022.
• Quintino-Moro A et al.: High Prevalence of Infertility among Women with Graves’ Disease and Hashimoto’s Thyroiditis. International Journal of Endocrinology. 2014(982705).