Graves' disease is the most common cause of hyperthyroidism in the United States. Other causes of hyperthyroidism include multinodular goiter, toxic solitary nodules of the thyroid, and functioning thyroid cancer. Other rare causes for hyperthyroidism include TSH-secreting pituitary tumors and hCG-secreting trophoblastic tumors of the ovary or testis. Struma ovarii is another rare cause of hyperthyroidism. All of the latter conditions cause increased thyroid radioactive iodine uptake on scanning. Additional causes of hyperthyroidism include subacute thyroiditis and certain phases of Hashimoto's thyroiditis as well as exogenous thyroid hormone intake and iodide-induced hyperthyroidism (due to kelp, amiodarone x-ray contrast).

Symptoms of Graves' disease are those of hyperthyroidism and may include anxiety, restlessness, irritability, emotional instability, fatigue, muscle weakness or cramps, increased appetite, palpitations and heat intolerance. Patients may also have a fast heart beat, atrial fibrillation, tremor, an eye stare and changes in hair. Osteoporosis tends to occur if hyperthyroidism left untreated. There may also be increased sweating and increased numbers of bowel movements, shortness of breath on exertion and weight changes. Usually there is weight loss, but occasional patients gain weight ironically due to an increased appetite. Periodic paralysis with low potassium may occur in men who are of Asian, Filipino, or Native American ethnic backgrounds. Menstrual irregularities and cardiac angina are also common.

Additionally, with Graves' disease there is usually a goiter. There may be exophthalmos (eye protrusion) and skin myxedema. The myxedema seen with Graves' disease is generally seen in the shins, but may affect other areas of skin.

Treatment for hyperthyroidism is directed at the cause of the problem. For Graves' disease, patients and their physicians have the option of treatment with thionamides (eg. methimazole or PTU), surgery or radioactive iodine. Symptomatic relief may be obtained from propranolol or other beta adrenergic blockers.

Graves' eye disease (ophthalmopathy, thyroid associated orbitopathy) came to national attention when First Lady Barbara Bush developed Graves' disease with exophthalmos (eye protrusion). Her husband, President George Bush, also had Graves' disease, but this is considered coincidental and Graves' disease is not contagious. Only a small minority of patients with Graves' disease develop exophthalmos. When it becomes significant and noticeable, aggressive treatment with prednisone is commenced, along with low dose radiation therapy to the orbital muscles.

People with Graves' disease who do develop thyroid eye disease may have involvement of one or both eyes to variable degrees. Occasionally thyroid eye disease occurs without noticeable enlargement of the thyroid gland or any hyperthyroidism. Thyroid eye disease is not particularly helped by removing the thyroid gland surgically or ablating it with radioactive iodine. The autoimmune attack causing enlargement of the retro-orbital muscles of the eye occurs as a problem of the immune system and are not particularly improved by removal of the thyroid. In fact, radioactive iodine has been associated with temporary worsening of Graves' eye disease. It is important for patients to have normal levels of thyroid hormone in order to reduce the appearance of stare and eye protrusion caused by retraction of the eye muscles in hyperthyroidism.

Octreotide has been shown to be another option for treatment of some patients with thyroid eye disease. Patients with Graves' eye disease who have somatostatin receptors in the eye muscle and who have localization of nuclear isotope on Octreoscan-111 scanning have shown improvement in eye findings when treated with octreotide 300 mcg daily over 12 weeks. This was reported by Krassus and associates in Clinical Endocrinology 1995 42:571-580.