Graves’ Disease: Symptoms, Diagnosis, Treatment and Emerging Therapies
Dr Teng-Teng Chung outlines the key features of Graves’ disease, including its symptoms, diagnosis, treatment options, and emerging therapies that may shape future care. She also discusses the importance of specialist assessment, ongoing monitoring, and recent advances in research that may help improve outcomes for patients with autoimmune thyroid disease.
Graves’ disease is the most common cause of hyperthyroidism (an overactive thyroid), a condition in which the thyroid gland produces excessive amounts of thyroid hormone. As an autoimmune disorder, it develops when the immune system mistakenly stimulates the thyroid gland, leading to increased hormone production and a range of symptoms that can affect daily life.
Early recognition and appropriate management are important, as untreated hyperthyroidism may affect the cardiovascular system, bone health, and overall wellbeing. At the London Lauriston Clinic, patients with Graves’ disease can access expert endocrine care, specialist diagnostic testing, and personalised treatment planning.
What is Graves’ Disease?
Graves’ disease is an autoimmune condition in which the immune system overstimulates the thyroid gland, causing it to make too much thyroid hormone. This can lead to weight loss, palpitations, tremor, heat intolerance, anxiety, poor sleep, and, in some cases, eye symptoms such as gritty eyes or bulging.
Some patients may also develop thyroid eye disease, an inflammatory condition affecting the tissues around the eyes.
The severity and combination of symptoms can vary considerably between individuals. Some patients develop symptoms gradually over several months, while others experience a more rapid onset.
How Graves’ Disease Is Diagnosed
Diagnosis is usually made from blood tests showing a low or undetectable TSH and raised free T4 and/or free T3, with high TSH receptor antibodies (TRAb) helping to confirm the diagnosis.
TRAb testing is especially useful when the picture is not straightforward, and it can also help predict the chance of relapse after treatment. A thyroid scan or ultrasound is sometimes used if the diagnosis is uncertain.
In addition to confirming the diagnosis, blood tests play an important role in assessing disease severity and monitoring response to treatment over time.
Patients looking for more information about thyroid conditions, testing, and thyroid health can also explore our Thyroid Health Guide.
Treatment Options for Graves’ Disease
Treatment aims to control symptoms and reduce thyroid hormone production.
The main options are anti-thyroid tablets such as carbimazole or propylthiouracil, radioactive iodine, or surgery (thyroidectomy).
Anti-thyroid drugs are often used first, especially when trying to avoid definitive treatment, while beta-blockers may be used short term to ease palpitations and tremor. TRAb levels often fall during medical treatment and after surgery but may rise for a period after radioactive iodine.
The most appropriate treatment depends on several factors, including age, symptom severity, thyroid gland size, future pregnancy plans, and individual preferences. Treatment decisions are therefore best made following a comprehensive discussion with an endocrinology specialist.
Pregnancy and Monitoring
TRAb is also important in pregnancy because high levels can affect the baby’s thyroid. For many patients, repeat blood tests are needed to guide dose changes and to decide whether treatment can eventually be stopped.
Regular follow-up is an important part of managing Graves’ disease. Monitoring allows treatment to be adjusted when necessary and helps identify patients who may be at greater risk of relapse after completing a course of anti-thyroid medication.
Newer Therapies
Research is moving beyond simply blocking thyroid hormone production and toward treatments that reduce the autoimmune attack itself.
One promising approach is targeting the neonatal Fc receptor (FcRn), which helps recycle antibodies; early studies have shown that this can lower disease-specific TRAb by more than 60% within weeks.
Other experimental approaches are also being developed to target the TSH receptor pathway more directly, with the aim of treating both thyroid overactivity and eye disease more precisely.
Clinical trials of these therapies are currently underway at University College London Hospital UCLH under the care of Dr Teng-Teng Chung. These newer treatments are not yet routine care, but they suggest a future in which Graves’ disease may be managed not only by controlling hormone levels, but also by lowering the antibodies driving the disease.
When to See a Specialist
Specialist assessment should be considered if symptoms suggest hyperthyroidism (an overactive thyroid), particularly when experiencing unexplained weight loss, persistent palpitations, tremor, heat intolerance, anxiety, or changes affecting the eyes.
Patients who are pregnant, planning a pregnancy, experiencing thyroid eye disease, or having difficulty achieving stable thyroid hormone levels may particularly benefit from specialist endocrinology input.
Early assessment can help establish an accurate diagnosis and ensure that treatment decisions are tailored to individual circumstances.
About Dr Teng-Teng Chung
Dr Teng-Teng Chung PhD, FRCP is a Consultant Endocrinologist at the London Lauriston Clinic with specialist expertise in thyroid disorders, including Graves’ disease, thyroid eye disease, thyroid nodules, thyroid cancer, and thyroid disorders in pregnancy.
She is also the Clinical Lead for the Adult Thyroid Service at University College London Hospital (UCLH), where she provides multidisciplinary, patient-centred care for a wide range of thyroid conditions.
Alongside her clinical practice, Dr Chung is actively involved in endocrine research and clinical trials investigating innovative treatments for autoimmune thyroid disease. Her work includes involvement in studies exploring emerging therapies that target the underlying immune mechanisms responsible for Graves’ disease and thyroid eye disease, with the aim of improving long-term outcomes for patients.
