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Graves' disease (GD), a form of hyperthryroidism (overactive thyroid gland) was named for Robert Graves who first described the symptoms in 1835. It is an autoimmune disease meaning that the body produces antibodies against itself that infiltrate and attack the thyroid gland. The antibodies attack the follicles where the thyroid hormones are stored and also stimulate the production of more hormones leading to increased levels of thyroid hormones in the blood. As a result, the production of T3 and T4 is no longer under the control of the normal TSH feedback system, but rather as a response to the stimulation by the autoantibodies. Accordingly, TSH levels are usually very low or even undetectable in patients with Graves' disease, while the T4 and T3 levels are elevated.

The incidence of hyperthyroidism (overactive thyroid gland) in the general population is estimated at 1 per 1000 people, with women being up to 10 times more likely to develop the syndrome than men. Hyperthyroidism can be caused by several different disorders.

Graves' disease is the most common form of hyperthyroidism (approximately 60-80% of cases) in individuals who are not taking thyroid hormones. The symptoms of Graves' disease result from body tissue being exposed to excessive levels of thyroid hormones. The presence of diffuse toxic goiter is a common occurrence and refers to an enlarged thyroid gland which overproduces thyroid hormone.

Graves' disease may also be associated with:

• Graves' ophthalmopathy - an autoimmune disease that affects the extraocular muscles (the muscles that rotate the eyes up/down and to the sides). Inflammation causes the tissue behind the eyeball to swell, forcing the eyeball to bulge.

• Dermopathy (disease of the skin) - Pretibial myxedema is characterized by thickened, raised areas of skin that often resemble an orange peel. It is found on the shins below the knees. The lesions are usually asymmetric and often accompanied by non-pitting edema (when you press a finger against a swollen area for 5 seconds and then quickly remove it, no indentation is left in the skin). This is usually found in patients with severe Graves' Ophthalmopathy.

• Acropachy - soft tissue swelling of hands and feet causing "clubbing" or a bulbous-like appearance. This is rare.

The onset of Graves' disease is usually gradual and develops between the ages of 20 and 40. It can occur in children but this is very unusual. It is considered a rare disorder with occurrence estimated at approximately 5 cases per 10,000 people.

Graves' disease is not a life-threatening condition if treated but when left untreated, it can lead to numerous health problems. Long-term exposure to excessive thyroid hormone levels can lead to:

• Osteoporosis
• Neonatal hyperthyroidism (if a pregnant woman with Graves' disease is not treated)
• Progression of Graves' ophthalmopathy
• Progressively severe cardiac problems (e.g., atrial fibrillation) especially in the elderly
• Severe acropachy
• Weight loss
• Anxiety
• Thyroid storm