6 Complications of Graves’ Disease

Thyroid eye disease (TED) is an inflammatory eye disease that occurs when your immune cells mistakenly attack the fat and tissues around the eyes. Graves’ disease is the number one cause of TED, which is sometimes called Graves’ ophthalmopathy.

This complication of Graves’ disease can cause the following symptoms:

• bulging eyes
• swelling
• irritation around the eyes
• retracted eyelids
• vision problems, like double vision or blurry vision
• sensitivity to light
• misalignment of the eyes
• permanent loss of vision (rare)

Treatment includes medications like steroids to reduce inflammation, an IV medication called teprotumumab (Tepezza), and radiation treatment.

If you smoke, quitting can help you manage your TED symptoms. In some cases, you might need surgery to treat any permanent structural changes around the eyes.

The disease usually enters an inactive phase after 6 months to 2 years of treatment.

Thyroid hormones are essential for skeletal development and bone metabolism. But too much thyroid hormone, which can occur when you have Graves’ disease, speeds the rate at which bone mass is lost and mineral density decreases.

This can lead to a condition called osteoporosis. Osteoporosis weakens bones and makes them more likely to break.

You may not have any symptoms of osteoporosis at first. As the condition progresses, it can increase your risk of bone fractures.

While there’s no cure for osteoporosis, medications, vitamins, and lifestyle changes can help strengthen the bones. Treatment options include:

• bisphosphonates, like alendronate (Fosamax) and ibandronate (Boniva)
• hormone therapy
• denosumab (Prolia)
• teriparatide (Forteo)
• increasing intake of calcium and vitamin D
• weight-bearing or high impact exercises like weightlifting, running, and climbing stairs

Graves’ disease can cause reddened, thickened, and rough skin on the shins and feet. This is called Graves’ dermopathy or pretibial myxedema. This complication is usually mild but can cause some pain and discomfort. It often resolves without treatment, but can also be treated locally with topical steroids or steroid injections.

Too much thyroid hormone can affect your body’s cardiovascular system, leading to an increase in your heart rate and the amount of blood your heart pumps.

By making the heart work harder and faster, Graves’ disease can overload the heart and lead to heart failure and other serious complications.

Some of these heart problems include:

• rhythm disorders (arrhythmias)
• rapid heartbeat (tachycardia)
• difficulties pumping blood
• heart failure
• high blood pressure
• heart disease
• increased risk of heart complications during surgery
• blood clots
• stroke

Depending on the specific condition, heart issues from Graves’ disease can be treated with medication, such as beta-blockers, along with an anti-thyroid agent to control the amount of thyroid hormones in your body.

Thyroid storm, also known as thyrotoxic crisis, is a rare complication of Graves’ disease. It’s caused by a sudden, large increase in thyroid hormones.

Thyroid storm is considered a medical emergency. Symptoms of thyroid storm include:

• high fever
• sweating
• fast heartbeat (tachycardia)
• vomiting
• diarrhea
• jaundice
• abdominal pain
• low blood pressure
• weakness
• delirium
• irregular heartbeat (arrhythmia)
• coma

Thyroid storm requires urgent treatment in an intensive care unit (ICU). If you have Graves’ disease and experience symptoms of thyroid storm, call 911 and seek medical attention immediately.

Excessive production of hormones in Graves’ disease causes the thyroid gland to enlarge, resulting in noticeable swelling in your neck. This is called a goiter.

Goiters are usually painless, but in some cases, they can grow large enough that they cause issues such as:

• difficulty swallowing or breathing
• coughing
• hoarseness in your voice

Anti-thyroid drugs used to treat Graves’ disease can also help shrink a goiter.

Untreated Graves’ disease can lead to complications with pregnancy, including:

• miscarriage or stillbirth
• premature birth
• pre-eclampsia (high blood pressure)
• low birth weight
• intrauterine growth restriction (IUGR)
• placental abruption (when the placenta separates from the inner wall of the uterus)
• premature rupture of membrane (when the water breaks early)
• birth defects

Research suggests that the key to managing pregnancy complications when you have Graves’ disease is to maintain normal thyroid hormone levels throughout your pregnancy.

If you’re planning to get pregnant and you have Graves’ disease, talk with your doctor about how to prevent pregnancy complications.

Prompt treatment for Graves’ disease can improve your symptoms and help lower your chances of experiencing complications.

You may be able to prevent complications of Graves’ disease by:

• partnering with your doctor to manage your condition
• following your prescribed treatment plan
• getting appropriate health screenings, like bone density and blood pressure screenings
• taking any prescribed medications or supplements
• avoiding smoking
• managing stress where possible
• exercising regularly, including weight-bearing exercise
• eating foods rich in calcium, magnesium, and vitamin D
• attending preconception counseling if you’re planning to get pregnant

Graves’ disease causes hyperthyroidism. Serious complications can occur if thyroid hormone levels aren’t brought back to normal levels.

Graves’ disease is usually treated with medications, radiation, or surgery. Talk with your doctor to help you choose the best treatment option to help prevent further complications.