Graves’ disease is the most common cause of an overactive thyroid. It is an autoimmune condition: the immune system makes an antibody (TSH-receptor antibody, also called TRAb or TSI) that switches the thyroid on and keeps it producing too much hormone. It is very treatable, and there are three established treatments. The right one depends on your age, the size of your thyroid, whether your eyes are involved, plans for pregnancy, and your own preferences.
Symptoms
Excess thyroid hormone speeds up the body: a racing or irregular heartbeat, tremor, heat intolerance, sweating, anxiety or irritability, poor sleep, weight loss despite a good appetite, frequent bowel movements, and muscle weakness. Some patients develop an enlarged thyroid (goiter). About one in three develop eye symptoms, such as grittiness, redness, puffiness, staring, or eyes that appear to bulge (thyroid eye disease).
How Graves’ disease is diagnosed
Blood tests show a low TSH with elevated free T4 and/or T3. A positive TSH-receptor antibody confirms Graves’ disease in most patients. When the cause is unclear, a radioactive iodine uptake scan or a thyroid ultrasound with Doppler helps distinguish Graves’ disease from other causes of an overactive thyroid, such as a toxic nodule or thyroiditis, which are treated differently.
The three treatment options
| Treatment | How it works | Main advantages | Main drawbacks |
|---|---|---|---|
| Antithyroid medication (methimazole) | Blocks thyroid hormone production | No radiation or surgery; chance of lasting remission; thyroid preserved | Relapse is common after stopping; rare but serious side effects require monitoring |
| Radioactive iodine | Destroys overactive thyroid tissue | Single oral dose; definitive | Usually causes permanent hypothyroidism; can worsen eye disease; not in pregnancy or breastfeeding |
| Surgery (total thyroidectomy) | Removes the thyroid | Immediate, definitive cure; preferred with large goiter, significant eye disease, or planned pregnancy soon | General anesthesia; lifelong thyroid hormone; small risks to voice nerves and parathyroid glands |
Methimazole
Most patients in the U.S. start with methimazole, typically for 12 to 18 months. Beta-blockers control the racing heart and tremor in the meantime. After a course of treatment, a sizable minority of patients stay in remission; relapse is more likely with a large goiter, high antibody levels at the end of treatment, and smoking. For patients who relapse or prefer to avoid radioiodine and surgery, continuing low-dose methimazole long term is an accepted, well-studied option.
Safety: methimazole can rarely cause a sharp drop in white blood cells (agranulocytosis) or liver injury. If you develop a fever with sore throat or mouth ulcers, or yellowing of the skin, stop the medication and contact us the same day for a blood count. Mild rash and itching are more common and often manageable.
Pregnancy: propylthiouracil (PTU) is generally preferred in the first trimester, because methimazole carries a small risk of birth defects in early pregnancy. If you are planning a pregnancy, discuss the timing and choice of treatment with us beforehand.
Radioactive iodine
Radioactive iodine is taken as a capsule. Thyroid hormone levels fall over the following weeks to months, and most patients become hypothyroid and take a daily thyroid hormone pill afterward, which is simple and safe. Radioiodine can worsen thyroid eye disease, especially in smokers; patients with active eye disease are usually steered toward medication or surgery, or given a short course of steroids to protect the eyes.
Surgery
Total thyroidectomy by an experienced high-volume thyroid surgeon cures the hyperthyroidism immediately and permanently. It is often the best choice for a large goiter, a suspicious nodule, moderate-to-severe eye disease, or a woman who wishes to become pregnant soon. Thyroid levels are normalized with medication before the operation.
Thyroid eye disease
Eye involvement can develop before, during, or after the thyroid is treated. Stopping smoking is the single most important protective step. Mild symptoms are treated with lubricating drops and, in some patients, selenium supplements. Moderate-to-severe or sight-threatening disease is managed together with an ophthalmologist experienced in thyroid eye disease; treatment options include intravenous steroids and teprotumumab, a targeted antibody therapy.
Common questions
Is Graves’ disease the same as Hashimoto’s?
Both are autoimmune thyroid diseases, but they work in opposite directions: Graves’ disease overstimulates the thyroid, while Hashimoto’s thyroiditis gradually damages it and causes an underactive thyroid. Our physicians maintain HashiExperts, a detailed guide to Hashimoto’s thyroiditis.
Can Graves’ disease go away on its own?
Spontaneous remission happens but is unpredictable, and untreated hyperthyroidism strains the heart and bones. Treatment is recommended.
Will I gain weight after treatment?
Some weight regain is common because the high metabolism is corrected. Careful dosing of thyroid hormone after radioiodine or surgery, and attention to diet early on, help limit it.
Graves’ disease care at Diabetes & Endocrine Specialists
Our endocrinologists diagnose and manage Graves’ disease and thyroid eye disease at our La Jolla, La Mesa and Poway offices, including in-office thyroid ultrasound, antibody testing, long-term methimazole management, and coordination with experienced thyroid surgeons and eye specialists when needed. Request an appointment or call (858) 622-7200.
Sources: Ross DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26:1343–1421. Kahaly GJ, et al. 2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism. Eur Thyroid J. 2018;7:167–186. Written by Darius A. Schneider, MD, PhD. Reviewed October 2026.
