DEAR MAYO CLINIC: My friend was just diagnosed with Graves' disease, but I don’t know much about it. I want to be supportive and educate myself. What is Graves' disease, and how does it affect the body? How is it treated?

ANSWER: Graves' disease is a condition of the immune system that leads to an overactive thyroid. It is caused by antibodies attacking the thyroid by mistake. The thyroid and the hormones it produces are the gas pedal for the body. When someone produces too much thyroid hormones, the body goes into overdrive. Your pulse increases, you overheat, you lose sleep — these symptoms make people feel so unwell that they seek medical attention. This is what leads to additional testing and the diagnosis of Graves' disease.

In overdrive, muscle strength is lost, and the heart beats faster, adding extra wear and tear. Much like a car running at a high RPM (revolutions per minute) for an extensive period of time, that's not good for the engine. The goal is to treat this overactive phase when treating Graves' disease.

The main complication of Graves' disease is thyroid eye disease. Inflammation and bulging of the eyes occur in a third of people diagnosed with Graves' disease. Managing thyroid eye disease requires an endocrinologist to address the thyroid and ophthalmologists who deal with eye changes. Ear, nose and throat (ENT) specialists are occasionally involved in surgeries related to the eye disease as well.

All these specialists operate together in a Thyroid Eye Disease Clinic at Mayo Clinic. The morning is dedicated to the patient moving between the different specialties and performing a set of specific tests. At noon, the specialists meet to discuss patient impressions, review the test results and create a care plan. The patient is seen again in the early afternoon, and the care plan is discussed. This includes suggestions on medication or surgery and clinical trials suited for that patient, dwelling in detail on the route the patient is interested in and contrasting it with the other choices. The benefit of this system is that a patient can get all this analysis done in one day, resulting in increased patient satisfaction. Also, the number of clinical trials is increasing, with more available choices forecasted for patients in the near future.

Research and innovation surrounding Graves' disease is another area of focus for the future. The ability to create molecules that hit a specific target has increased tremendously over the last few years. This is particularly effective when we know the mechanism of a disease and what the target should be. With thyroid eye disease, the main complication of Graves' disease, we know the receptor we aim to block. There have been a number of clinical trials that we are a part of that aim to block that receptor, improve the eye disease and, for some of these drugs, also treat the Graves' disease at the same time.

Targeting some of these areas has resulted in noticeable improvement in eye disease in the past several years. Furthermore, we are seeing that there are molecules in development that, in the next few years, will likely show ability to prevent the eye disease or reverse some of these changes that have already occurred. They'll do this by lowering, if not eliminating, the antibodies that are causing the problem in the first place. I am quite optimistic looking at some of the early results of our trials that there will be major benefits for patients in the coming years. — Marius Stan, M.D., Endocrinology, Mayo Clinic, Rochester, Minnesota

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Dr. Marius Stan, a Mayo Clinic endocrinologist, has more on this thyroid disorder. 

Editor's note: January is National Thyroid Disease Awareness Month.

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"Thyroid, and mainly thyroid hormones, are the gas pedal, if you will, for the body," says Dr. Stan.

"And as we're pushing that gas pedal, metabolism accelerates, our heart rate beats faster, we feel hot, we can't rest, we can't sleep," he says.

Other symptoms of Graves' disease may include anxiety, weight loss, heat sensitivity and bulging eyes.

"It's a situation of an overactive thyroid that is caused by antibodies that we unfortunately produce that end up really whipping the thyroid into an overactive state," he says.

The thyroid gland is located at the base of the neck, just below the Adam's apple.

Medications are often the first line of treatment. When that doesn't work, surgery or radioactive iodine to destroy the thyroid tissue may be an option. 

Dr. Stan is leading several clinical research trials targeting the disorder.

"I'm quite optimistic, looking at some of the early results of our trials, that there will be major benefits for patients in the coming years," he says.

When to see a doctor

Graves' disease, the most common cause of hyperthyroidism, is more common among women and in people younger than age 40.

If you experience unintentional weight loss, a rapid heartbeat, unusual sweating, swelling at the base of your neck, or other signs of hyperthyroidism, schedule an appointment with your healthcare professional. Make sure to communicate all observed symptoms, including minor ones, during your appointment.

Related posts:

• Sharing Mayo Clinic: An eye on the future
• Mayo Clinic Q and A: Women and thyroid disease
• Mayo Clinic Minute: Treating thyroid nodules without surgery

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There's also a treatment called radiofrequency ablation (RFA), which uses heat to make the nodules smaller. Dr. Marius Stan, a Mayo Clinic endocrinologist, says this nonsurgical treatment for shrinking thyroid nodules offers patients a safe and highly successful procedure. He says Mayo Clinic also is researching how RFA may be used to treat thyroid cancer. 

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:10) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"Radiofrequency ablation, which many people might simply call an RFA, is a way of targeting a specific part of the thyroid, an abnormal part, by delivering high energy into that specific area of the thyroid and destroying it," says Dr. Stan.

He says patients with enlarged, benign thyroid nodules are good candidates for RFA.

"Patients will have an inch and a half to two inches thyroid nodules in diameter that we think are reaching the point where a problem is present or is likely going to be present," Dr. Stan says.

Radiofrequency ablation (RFA) works by works by using heat to shrink or destroy benign thyroid nodules.

Along with retaining thyroid function, there are other advantages.

"The benefit is that we can do it in the outpatient setting, without the scar on the neck," he says.

Treating thyroid nodules is one application for RFA. Mayo Clinic is one of the leading U.S. institutions to research using RFA for thyroid cancer treatment.

"We hope that this will also be able to destroy a thyroid cancer very specifically, as opposed to a surgical approach that would eliminate part of the thyroid," says Dr. Stan.

Related posts:

• Mayo Clinic Q and A: Understanding thyroid nodules
• Thyroid Disease Can Diminish Quality of Life

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Editor's note: This story was written by patient Marge Cabanski.

I am Marge Cabanski, and at 74 years old in November 2020, I began experiencing eye irritation. It was diagnosed as Graves' disease. Though I had had my thyroid irradiated in 2017, an autoimmune reaction within my body led to a further diagnosis of severe thyroid eye disease.

By May 2021, my eyesight had deteriorated to the extent that I couldn't drive, read or identify colors, and the simplest of life's daily tasks had become difficult. I felt that I was going blind.

Treatment with my local ophthalmologist and appointments with several endocrinologists were not helping. My primary care physician suggested that I consider Mayo Clinic in Rochester, Minnesota, for treatment.

My first visit to Mayo was a full day of testing, and meeting one on one with what became my Mayo team: Endocrinologist Dr. Marius Stan, Ophthalmologists Dr. Lilly Wagner, Dr. Erick Bothun and Dr. Ahmed Sheikh, and Otolaryngologist ― Head and Neck Surgeons, Drs. Janalee Stokken and Linda Yin.

Their approach was to test for what they knew would be helpful in diagnosing and treating my thyroid eye disease, meeting with me one on one, answering all my questions and concerns, and coming up with a plan. As I got to know my team, my confidence grew, and the knowledge I gained was empowering.

The initial treatments with high doses of steroids had no effect in calming my thyroid eye disease. My eyes were bulging, and they were swollen and inflamed. My blurred vision, which was already bad, worsened. I had double vision and significant pain, and I was frightened.

During a return visit several weeks after my initial visit, I met with my Mayo team. Ultimately, I chose to have orbital decompression surgery.

Drs. Stokken and Yin performed the delicate three-hour surgery at Mayo Clinic Hospital ― Rochester, Saint Marys Campus. Several hours after the surgery, my eyesight was restored. It was like a miracle, making me able to immediately read an eye chart and identify colors. And although my double vision was not eliminated, I have been able to read, drive and enjoy all that life has to offer.

I will return to see Dr. Wagner for a checkup in the spring. I will schedule a surgery to realign my eyes to eliminate the double vision. I hope to return to hiking on uneven ground and kayaking, and the active lifestyle I so enjoy.

My lasting impression of Mayo Clinic is how coordinated my team worked for me and how caring each doctor was in presenting me with all the information I needed to confidently make decisions. I am so thankful I found Mayo Clinic.

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Myth or Matter-of-Fact: Women are far more likely than men to have thyroid problems.

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Myth or Matter-of-Fact: Women are far more likely than men to have thyroid problems.

Miss the program?  Here's the podcast: MayoClinicRadio 10-10-15 PODCAST

Follow #MayoClinicRadio and tweet your questions.

Mayo Clinic Radio is available on iHeartRadio.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

To find and listen to archived shows, click here.

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ANSWER: Before you move forward with treatment for hypothyroidism, it would be worthwhile to wait and repeat the test in several months to confirm your diagnosis. Even if the results are the same at that time, you should consider several other factors before you decide on treatment.

Your thyroid is a small, butterfly-shaped gland at the base of the front of your neck. Hypothyroidism, sometimes called underactive thyroid, is a condition in which your thyroid gland doesn’t produce enough of certain important hormones. The hormones that the thyroid gland makes — triiodothyronine, or T3, and thyroxine, or T4 — have a large impact on your health, affecting all aspects of your metabolism. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins.

The rate at which your thyroid makes T3 and T4 is regulated by another hormone that your pituitary gland produces, called thyroid-stimulating hormone, or TSH. The term “borderline hypothyroidism” typically is used when blood tests show that your body’s level of TSH is slightly above normal, but your T3 and T4 levels are normal. Another name for this condition is subclinical hypothyroidism.

Not all physicians agree on whether there is benefit to treating hypothyroidism at this stage. That’s because treatment typically involves a daily dose of a synthetic hormone, and if you take that medication in excessive doses it can have a negative effect on a variety of your body’s systems, including your brain, heart and muscle function. It also can interfere with how your body handles fluid and fats.

If left untreated, about 30 percent of people whose condition falls into the category of subclinical hypothyroidism have their TSH levels return to normal within one year. Only 3 percent per year will go on to develop the classical form of hypothyroidism. That condition is characterized by elevated TSH levels and low levels of T3 and T4. It requires treatment in all cases.

If a second blood test confirms your diagnosis of subclinical hypothyroidism, there are several factors to consider before you decide on treatment. In general, treatment is recommended if you have symptoms of hypothyroidism, such as fluid retention, fatigue, increased sensitivity to cold, constipation, muscle weakness or painful joints, among others. Treatment also may be necessary if you have another underlying medical condition, such as congestive heart failure or high cholesterol.

In these cases of subclinical hypothyroidism, many physicians recommend treatment for three to six months to see if it helps relieve symptoms. If after the initial course of treatment the symptoms remain, then treatment needs to be re-evaluated.

If you have subclinical hypothyroidism, but you don’t have symptoms or other health problems, then it would be wise to wait with treatment and be tested again in six to 12 months. If your TSH level is significantly higher; if it increases consistently and you have a family history of thyroid disease; or if another blood test finds you have positive anti-thyroid antibodies, therapy would be appropriate at that time. — Marius N. Stan, M.D., Endocrinology, Mayo Clinic, Rochester, Minn.

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