What Are Your Risks for Hyperthyroidism and Graves' Disease?

Risk Factors, Triggers, Causes, Signs and Symptoms

Sad Hispanic woman sitting at edge of bed
JGI/Tom Grill/Blend Images/Getty Images

Hyperthyroidism—sometimes referred to as thyrotoxicosis—is a condition where your thyroid is overactive, and overproducing thyroid hormone. Graves' disease is an autoimmune disease that usually causes you to become hyperthyroid.

There are a number of risk factors for both hyperthyroidism and Graves' disease, and we explore them in this article.

Gender

Gender is an important risk factor. Both Graves' disease and hyperthyroidism affect women as much as 8 times more often than men.

Personal and Family History

Having any past history of thyroid problems, autoimmune disease, or endocrine disease yourself or in your family puts you at greater risk for developing Graves' disease and hyperthyroidism.

Age

While Graves' disease and hyperthyroidism can develop at any age, the highest risk is between the ages of 20 and 40.

Pregnancy

Pregnancy and the year after childbirth are both times of greater risk for Graves' disease and hyperthyroidism

Smoking

There is an increased risk of Graves' disease in cigarette smokers. Smokers with Graves' ophthalmopathy, also known as thyroid eye disease, also tend to have more severe symptoms that are more resistant to treatment.

Excessive Intake of Thyroid Hormone

Taking too much prescription thyroid hormone—whether by accident, or by deliberate self-medication—can cause medication-induced hyperthyroidism. Some over-the-counter energy, diet and glandular supplements also contain some active thyroid hormone, which can cause hyperthyroidism.

 

Exposure to or Excessive Intake of Iodine/Iodine Drugs

Being exposed to or ingesting an excess of iodine, whether through medical tests, topical exposure, or ingesting of iodine or supplements containing iodine (i.e., kelp, bladderwrack) can trigger hyperthyroidism.

Certain Medical Treatments and Drugs

Some treatments and medications can trigger Graves' disease and/or hyperthyroidism in some people.

A partial list includes:

  • Interferon Beta-1b
  • Interleukin-4
  • Immunosuppressant therapy
  • Antiretroviral treatment for AIDS
  • Lithium

There are also two particular situations that are known triggers:

  • A third of patients receiving monoclonal antibody (Campath-1H) therapy for multiple sclerosis (MS) develop Graves' disease within six months.
  • Receiving a donated organ or bone marrow transplant from someone with Graves' disease can cause the Graves' disease in the recipient.

Trauma to the Thyroid

Trauma to your thyroid can sometimes trigger hyperthyroidism. The types of trauma include:

  • vigorous manipulation or palpation of the thyroid
  • surgery to the thyroid, parathyroids, or the area surrounding the thyroid
  • injection to the thyroid
  • biopsy of the thyroid
  • neck injury, i.e., whiplash, or from an automobile seat belt after a crash

Major Stress

Stress is a factor that appears to trigger the onset of Graves' disease in some patients. Researchers have documented a definite connection between major life stress and the onset of Graves' disease.

The type of stressful situations most associated with with the onset of Graves' disease include:

  • death of a spouse
  • divorce or separation
  • loss of a job
  • death of close family member
  • a major accident or personal injury

Other Factors

Holistic and nutritional practitioners have also suggested that there may be other trigger factors, including:

  • Consumption of the artificial sweetener aspartame
  • Nutritional or dietary deficiencies
  • Gluten sensitivity or other food and environmental allergies and sensitivities
  • Chronic bacterial or viral infections

Symptoms of Graves' Disease/Hyperthyroidism

Based on your risk factors, you will also want to consider your own potential symptoms of an overactive thyroid.

Goiter

The most common symptom of Graves' disease is goiter, an enlargement of the thyroid, with symptoms that can include a visibly larger neck, a feeling of fullness in the neck or throat, discomfort with ties or scarves, a feeling like the thyroid is vibrating or buzzing, a choking sensation, pain or tenderness in the neck or hoarseness.

Weight Changes

Usually patients lose weight without change in diet or exercise, or they experience dramatically increased appetite (especially for carbohydrates) without any weight gain. Some people lose so much weight and stop eating, or eat so little, that they may be misdiagnosed as anorexic. Some people actually stop eating, or eat very little—and are considered anorexic. In some cases, women—especially teenagers—have actually been misdiagnosed as anorexic, because of rapid, dramatic weight loss, when the actual problem was the onset of Graves' disease. A small percentage of patients actually gain weight with hyperthyroidism because they increase their intake to such an extent that the increased metabolism does not compensate.

Pregnancy Problems

Difficulty in pregnancy, in particular, weight loss during pregnancy, or excessive nausea and/or vomiting can be a symptom of thyroid problems. Rapid weight loss after pregnancy can also be a symptom of hyperthyroidism.

Temperature Problems

Some people with hyperthyroidism feel warm or hot when others are cold, or feel warm all the time. They may run a low grade fever, sweat more, or feel thirsty.

Heart and Blood Pressure Changes

Symptoms include racing, fast heartbeat, sensation of a "loud" or pounding heartbeat, skipped beats, palpitations, or abnormal heart rhythms.

Gastrointestinal Problems

Symptoms include frequent bowel movements, loose bowel movements, diarrhea, more frequent urination, or nausea.

Energy / Muscles / Joints

Hyperthyroid symptoms include extreme fatigue, muscle and joint fatigue, especially in leg and arm muscles, difficulty climbing stairs, exercise intolerance. A percentage of hyperthyroid patients actually have more energy, and feel like they need little sleep, and feel a need to exercise.

Skin Changes 

Some of the symptoms include unusually smoother, younger-looking or velvety skin (due to rapid cell turnover.) Some people experience worsening acne, bruising, spider veins on the face and neck, blister-like bumps on the forehead and face (called "milaria bumps"), flushing in the face, hives, itching, vitiligo.

Graves' Dermopathy/Pretibial Myxedema

This is an unusual symptom seen in some Graves' disease patients that features waxy, reddish-brown lesions on the shins and lower legs skin (and less often the extremities, face or trunk) that are itchy and inflamed. These lesions heal into rough patches.

Changes to Hair / Nails / Hands

Excessive hair loss from the head and body is a common symptom. Other signs include thinner and finer hair, nails that easily break. Thyroid acropachy, where fingertips and toes swell and become wider, even clubbed, and onycholysis/Plummer's nails, where the underlying nail bed separates away from the skin, are also symptoms of Graves' and hyperthyroidism.

Eye Problems

Even in patients who don't have Graves' ophthalmopathy, there can be eye-related symptoms, including bulging of the eyeballs, dry eyes, achiness or pain behind the eyes, redness in the eyes, puffiness, and a wide-eyed look.

Thinking/Cognition Problems

Some Graves' disease and hyperthyroidism patients have difficult concentrating or making decisions, memory problems, and racing thoughts.

Mood Problems

Most patients with Graves' disease, hyperthyroidism experience some changes to mood and feelings, including depression, mood swings, uncontrollable anger, and irrational anger.

Panic and Anxiety

Anxiety is a very common hyperthyroidism symptom, including restlessness, nervousness, and even panic attacks. In rare cases, mania, psychosis, or delirium can be hyperthyroidism symptoms.

Reflex/Movement Issues

Some people with hyperthyroidism have fast reflexes, startle easily, and jumpy, and have tremors. They may be always moving, jiggling, tapping a foot, etc.

Sleep Problems

Insomnia, or difficulty going back to sleep after waking, are common hyperthyroidism symptoms.

Especially in Men

Men can experience a low sex drive, fertility problems, and gynecomastia, an enlargement or tenderness in the breasts.

Especially in Women

In women, hyperthyroidism can cause infertility, miscarriage, changes to sex drive, worsening premenstrual syndrome, erratic or even nonexistent menstrual periods.

Especially in Newborns/Babies

Newborns who are hyperthyroid are more likely to be premature, and have a low birthweight. They may have a yellowish cast to the skin, a visible goiter or enlarged neck, and prominent eyes. These babies may also have an elevated heart rate and body temperature. In terms of temperament, these babies may be irritable, restless, hyperactive, and appear to be anxious or unusually alert. They may eat but suffer from frequent diarrhea and vomiting, and may fail to gain weight.

Especially in Children

Children with hyperthyroidism are likely to have a goiter. They may also have increased appetite and/or weight loss, weakness, school problems, hyperactivity, emotional outbursts, and temper tantrums.

Especially in Teenagers

In teenagers, a dramatic increase in appetite, or unusual weight loss, may be seen. They may have sports performance problems, and delayed puberty.

Especially in the Elderly / Seniors

Older people may have more frequent falls, tremors, atrial fibrillation, or dementia. Some older people have what's known as "apathetic hyperthyroidism"—which has symptoms not typically associated with hyperthyroidism, including appearing depressed, lacking in energy, confused, forgetful, and constipated—without weight loss.

Graves' Ophthalmopathy

Graves' ophthalmopathy is an inflammatory autoimmune eye disorder that, while separate from Graves' disease that affects the thyroid, is often seen in conjunction with it. Graves' ophthalmopathy is also known by a variety of other names, including thyroid eye disease (TED), thyroid associated ophthalmopathy (TAO), thyroid associated orbitopathy, orbital dystrophy (OD), dsythyroid orbitopathy, thyroid ophthalmopathy, exophthalmos, immune exophthalmos, Grave's orbitopathy, and Graves' eye disease.

For Graves' disease patients who also have Graves ophthalmopathy, in addition to bulging of the eyes, one of the more common eye-related symptoms is "lid lag"—where the upper eyelid doesn't smoothly follow along when you look down. Other symptoms can include pain or itchiness, blurred vision, reduced color or brightness in vision, double vision, poor night vision, light sensitivity, and "floaters."

Thyroid Storm

A very small percentage of patients with hyperthyroidism develop a life-threatening condition known as thyroid storm. During a thyroid storm, the heart rate, blood pressure and body temperature can become uncontrollably high. Symptoms can include an extremely high fever (up to 106), a heart rate as high as 200 beats per minute, palpitations, chest pain, shortness of breath, high blood pressure, confusion, delirium, psychosis, stupor, fatigue, and other symptoms. Whenever thyroid storm is suspected, the patient must go immediately on an emergency basis to the hospital, as this is a life-threatening condition that can develop and worsen quickly, and requires treatment within hours to avoid fatal complications such as stroke or heart attack.

Sources:

Bahn, R, Burch, H, Cooper, D et al. "Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and the American Association of Clinical Endocrinologists. Endocrine Practice, 2011;17(No. 3)

Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 9th ed., Philadelphia: Lippincott Williams & Wilkins (LWW), 2005.

De Groot, Leslie, M.D., Thyroid Disease Manager, Online book. Online

Continue Reading