5 Dangerous Complications of Untreated Graves’ Disease

In people with Graves’ disease, the most common cause of hyperthyroidism (overactive thyroid) in the United States, the immune system attacks the thyroid, causing the gland to overproduce thyroid hormone, according to the National Institute of Diabetes and Digestive and Kidney Diseases. This can lead to heat intolerance, unintended weight loss, and sleep problems, among other health issues.

If you’ve been diagnosed with Graves’ disease, it’s important to follow your doctor’s treatment regimen. When Graves’ isn’t managed correctly, it can lead to complications affecting many parts of the body, from the eyes and skin to the heart and bones.

Here are a few potentially dangerous complications, plus how you can reduce your risk.

1. Thyroid eye disease

According to the American Thyroid Association (ATA), about one-third of people with Graves’ disease develop Graves’ eye disease, also called Graves’ ophthalmopathy or thyroid eye disease, which is when the immune system attacks the tissues and muscles around the eyes. “Thyroid stimulating hormone receptors are also present on the cells behind the eyes,” explains Alexandra Mikhael, MD, an endocrinologist at Cleveland Clinic Florida’s Weston Hospital.

Thyroid eye disease is linked to the same autoimmune process that causes Graves’ disease itself, not to an overproduction of thyroid hormone. In other words, treating Graves’ disease won’t resolve thyroid eye disease. That said, thyroid eye disease most often develops in people with hyperthyroidism.

Eyes that appear to bulge out are a common symptom of thyroid eye disease, as are dry, irritated eyes, light sensitivity, pain or pressure in the eyes, and double vision. Left untreated, swelling can sometimes compress the optic nerve and potentially lead to vision loss.

Doctors usually first treat thyroid eye disease with antithyroid drugs or surgery to remove the thyroid gland, but these treatments don’t always improve symptoms, says Dr. Mikhael. “Symptoms may initially worsen with treatment of Graves’ disease for the first three to six months, then stay stable and eventually improve,” she says.

Another common treatment for Graves’ disease, radioactive iodine therapy, can make thyroid eye disease worse in some people, so it’s usually not a first-line treatment, she adds. It is sometimes recommended alongside steroids, though, in people with a mild form of the condition.

To relieve symptoms of mild thyroid eye disease, your endocrinologist and/or ophthalmologist may recommend:

• Using lubricating eye drops
• Wearing sunglasses if your eyes are sensitive to light
• Wearing special glasses to correct double vision
• Raising your head when you sleep at night to relieve swelling
• Using cold compresses on your eyes

More serious cases may require medication. Severe cases, which can lead to vision loss, may require surgery on the eyelids (to help reduce the startled appearance that sometimes develops), eye muscles, or bone structure between the eye socket and sinuses. Mikhael estimates that about 5 percent of people with thyroid eye disease have moderate-to-severe ophthalmopathy that causes serious vision problems.

2. Skin problems

Some people with Graves’ disease develop Graves’ dermopathy (also known as pretibial myxedema), a condition where the skin on the shins and sometimes the tops of the feet becomes discolored, thick, and swollen. Most people with the condition also develop thyroid eye disease.

Similar to thyroid eye disease, Graves’ dermopathy stems from an autoimmune process that results in inflammation, causing an accumulation of proteins in the skin, explains Mikhael. This means Graves’ dermopathy may not occur at the same time as Graves’ disease itself.

When Graves’ dermopathy does occur, it’s usually mild and goes away on its own within a year or two, but it can sometimes be painful and require treatment. Your doctor may recommend wearing compression socks.

For more severe cases, topical steroids often improve the skin lesions within a few weeks. Physical therapy can help improve lymphedema, which is swelling due to a buildup of lymphatic fluid, says Mikhael.

3. Thyroid storm

Thyroid storm is a rare but life-threatening condition that can occur when Graves’ disease symptoms suddenly flare up. “It develops in patients with long-standing hyperthyroidism,” says Mikhael, and is usually caused by serious stress on the body, such as a heart attack or infection, but can also occur following radioactive iodine therapy or by taking antithyroid medications irregularly.

Symptoms include a pounding heart, shaking, sweating, agitation, and confusion. Immediate emergency treatment is critical, because a thyroid storm can lead to heart failure and death.

Because thyroid storms are linked to poorly controlled hyperthyroidism, it’s essential to follow your prescribed treatments for Graves’ disease to reduce your risk of this dangerous complication.

4. Heart problems

Thyroid hormones control how your heart beats, and an overproduction in people with Graves’ disease causes the heart to beat faster and harder than normal. Over time, severe, untreated hyperthyroidism can lead to an irregular heartbeat, which in turn can cause blood clots, heart failure, and stroke.

Treatment for hyperthyroidism is essential for preventing heart problems in people with Graves’ disease, says Mikhael.

5. Osteoporosis

In people with hyperthyroidism caused by Graves’ disease, the excess thyroid hormone speeds up the rate at which bone is lost, to where bone can’t be replaced quickly enough. This can lead to decreased bone mineral density, increased bone fracture risk, and, eventually, osteoporosis. The longer hyperthyroidism goes untreated, the greater the risk of osteoporosis, especially in postmenopausal women.

In most cases, early treatment of hyperthyroidism is enough to help prevent osteoporosis. “However, in some cases, osteoporosis may persist despite treatment,” says Mikhael. In addition to treating hyperthyroidism, your doctor may recommend increasing your calcium and vitamin D intake and doing more strength training, she explains.

Reducing Your Risk: Treatments for Graves’ Disease

Treating Graves’ disease is the number one way to help prevent potentially dangerous complications. It usually starts with managing your hyperthyroidism using one or more of the following treatments:

• Beta-blockers These drugs rapidly treat the symptoms of hyperthyroidism, but they don’t treat the overproduction of thyroid hormone itself. Along with other hyperthyroidism treatments, beta-blockers can help prevent heart problems, says Mikhael.
• Antithyroid medication Taking this effective and simple medication can lead to hyperthyroidism remission within a year or two, but it doesn’t cure the condition. The drug is sometimes used as a bridge to radioactive iodine therapy or surgery, explains Mikhael. Rarely, it can be used as a long-term hyperthyroidism treatment. “Antithyroid medications are preferred in patients with a high likelihood of remission, including … people with mild hyperthyroidism,” says Mikhael.
• Radioactive iodine therapy An oral iodine pill destroys overactive thyroid cells with this treatment. “It may temporarily worsen Graves’ eye disease and hyperthyroidism,” says Mikhael. It’s not recommended for people with moderate-to-severe thyroid eye disease or for women who are pregnant, planning to become pregnant, or breastfeeding.
• Surgery You may need to have your entire thyroid gland removed, which will require you to take thyroid replacement medication for the rest of your life. “Surgery may be the best option for patients with large goiters or patients with suspicious thyroid nodules or an overactive parathyroid gland,” says Mikhael, as well as for pregnant women. It’s not a good option for people for whom surgery is risky, including older patients, she adds.
• Smoking cessation While there’s no way to prevent thyroid eye disease, Graves’ dermopathy, or hyperthyroidism, smoking makes them worse, says Mikhael. (People who smoke cigarettes, for example, tend to experience more severe symptoms of thyroid eye disease than nonsmokers, according to the ATA, though the reason for this isn’t clear.) If you smoke, ask your doctor for resources that can help you quit.

In addition, Mikhael adds, “Eating well, exercising daily, caring for your mental health, easing stress through meditation or listening to music, and taking time for self-care” are especially important lifestyle habits for people with Graves’ disease. Stress may trigger or worsen Graves’ disease, according to Mayo Clinic. Eating well and doing physical activity can help keep your bones healthy, which is important because untreated hyperthyroidism can lead to osteoporosis.