The thyroid gland may be small, but when it’s working in overdrive, such as what happens with Graves’ disease, it can cause a cascade of physical and emotional effects, including conditions such as heart problems and anxiety.
“People are surprised just how powerful the thyroid is,” says Caroline Messer, MD, an endocrinologist and assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra University–Northwell, in New York City.
Thyroid problems can also be hard to treat over the long term. For example, research has shown that Graves’ disease has a high rate of disease recurrence, even in people who go into remission. According to one long-term study, only about one-third of people with Graves’ disease stayed in remission after 20 years.
Because the symptoms of Graves’ disease and its related conditions can flare up repeatedly, you may find yourself dealing with a variety of physical and emotional challenges. Here are six common problems related to Graves’ disease, and what you can do to fix them.
1. Sleep Problems
One of the most common issues stemming from Graves’ disease is difficulty sleeping, including both falling and staying asleep, says Dr. Messer. In fact, research shows that more than two-thirds of people with Graves’ disease have trouble falling sleep. Blame the high levels of thyroid hormone, which can cause a heartbeat, fast metabolism, sweating, and a feeling of restlessness.
What You Can Do Talk with your endocrinologist about finding the right fix for your hyperthyroidism — whether that’s medication, radioactive iodine, or surgery. Research shows that normalizing thyroid hormone levels may help lower heart rate and reduce the risk of sleep disorders in people with Graves’ disease.
Good sleep-hygiene habits such as avoiding screens for at least an hour before bedtime, keeping your bedroom around 65 degrees F, and limiting both caffeine and alcohol in the hours leading to bedtime may all help you find relief as well.
2. Persistent Fatigue
In addition to insomnia, there’s another reason that Graves’ disease can lead to constant exhaustion: The disorder speeds up the metabolism and uses up a lot of energy, notes Messer. “It’s like you’re revved up all the time,” she says. “Chronic anxiety can make you tired, and it’s the same thing with hyperthyroidism.”
What You Can Do Schedule time to rest and don’t overexert yourself. Shoring up your diet can also help: For instance, including plenty of fruits, vegetables, proteins, and healthy fats in your diet can help keep your blood sugar levels steady throughout the day, whereas eating high-sugar foods will give you a temporary energy boost, followed by a crash.
3. Mood Issues
Graves’ disease can increase irritability and mood swings, as well as increase the risk of depression and anxiety. Studies suggest that excessive levels of thyroid hormones may decrease the levels of the hormone serotonin in the brain; that, in turn, can increase the risk of anxiety and depression.
Patients often have trouble with concentration as well, says Messer, who notes that sometimes her initial visit with a patient is difficult because they’re experiencing brain fog and often can’t focus and fully internalize the information she’s sharing with them.
What You Can Do Getting your thyroid hormone levels under control should help improve some of the emotional and cognitive issues you may be facing, says Messer: “It’s like the brain is on fire from the hyperthyroidism; but when we get the thyroid under control, they’ll often say, ‘Okay I’m back to feeling like myself, I can focus again,’” she says.
In the meantime, if your symptoms flare back up, ask your endocrinologist whether using an antidepressant may also be helpful, at least in the short-term, advises Messer. Talking with a therapist or joining a support group may also help, along with practicing relaxation or mindfulness techniques like yoga and meditation.
4. Eye Complications
About 1 in 3 people with Graves’ disease develop Graves’ eye disease, also known as thyroid eye disease (TED), which can cause symptoms such as pain, bulging eyes, and blurred or double vision.
What You Can Do If you’ve been diagnosed with TED, your doctor will likely go over your treatment options, which may include prescription medications (including an infusion medication), over-the-counter eye drops, and lifestyle remedies such as not smoking, wearing sunglasses, and keeping your head elevated at night.
Before addressing eye symptoms, though, your doctor will likely try to bring your thyroid hormone levels toward normal, which will help improve many of the TED symptoms, says Messer. “The best thing to do is wait until the eyes stabilize before you make a decision about whether they need to be treated,” she says.
5. Heart Problems
Cardiovascular conditions such as atrial fibrillation and irregular heartbeats are increased with Graves’ disease, notes Messer. “That’s because everything — especially your heart rate — is sped up with hyperthyroidism,” she says. In more serious cases, the disease can also contribute to abnormal heart rhythms and conditions like stroke and heart disease.
What You Can Do In addition to following heart-healthy habits such as eating a Mediterranean diet, staying physically active, and reducing stress, you can reduce your risk of heart problems by following your Graves’ disease treatment plan.
Research shows that antithyroid medications as well as beta-blockers (which work by blocking the effects of hormones like adrenaline, thus slowing down heart rate) may help reduce your risk of heart issues including coronary heart disease and heart failure. “After we make the [Graves’ disease] diagnosis, as we’re waiting for thyroid levels to normalize, we put all patients on beta-blockers to help lower the heart rate,” says Messer.
6. Osteoporosis and Bone Fractures
Excess thyroid hormone can lead to bone loss, increasing the risk of osteoporosis and fractures, says Messer. Research shows that people with Graves’ disease have lower bone mineral density throughout the body — including their spine, hips, and forearms — than people without the disorder.
What You Can Do Treating hyperthyroidism can significantly reduce the risk of osteoporosis, according to some research. In addition, your doctor may suggest taking osteoporosis medications such as bisphosphonates, as well as doing weight-bearing exercises and taking vitamin D and calcium supplements, to further improve bone mineral density.
How your doctor addresses your bone loss depends in large part on your age, says Messer. “People under 30 are still building bone density, so if we find the problem and fix it, then usually the bones will just heal themselves,” she says. If you’re older and have experienced significant bone loss, and it doesn’t improve after treating the hyperthyroidism, your endocrinologist will likely recommend osteoporosis medications.
The Takeaway
Graves’ disease causes excessive production of the thyroid hormone, which can lead to a range of physical and emotional symptoms and challenges.
Some of these challenges can include sleep problems and cardiovascular issues, as well as depression and other mental and emotional health effects.
Many of these challenges can be overcome by treating hyperthyroidism, but lifestyle changes such as eating a healthy diet, can also help.
