Signs and Symptoms of Graves' Disease (Hyperthyroid state):

The onset of symptoms of Graves' disease (GD) is usually gradual and may include:

• Fatigue
• Weight loss despite a good appetite
• Restlessness, nervousness, irritability, erratic behavior
• Impaired sleep
• Irritation of the skin over the shins (lower legs)
• Tachycardia (rapid heart rate)
• Atrial fibrillation (irregular heart beat)
• Changes in libido (sex drive)
• Muscle weakness
• Heat intolerance
• Tremor of the hands
• Enlarged thyroid gland - often accompanied by feeling of fullness in the neck
• Increased sweating
• Shortness of breath upon exertion
• Blurred or double vision
• Eye swelling or redness
• Changes in hair texture
• Changes in the menstrual cycle
• Increased frequency of stools

Irritability and heat intolerance are seen more often in younger patients with Graves' disease while decreased appetite and weight loss are more common to older patients. Atrial fibrillation occurs in approximately 20% of Graves' disease patients over the age of 50 and rarely in younger patients. Diffuse goiter appears in approximately 90% of patients under the age of 50 and in approximately 75% of those over 50. The gland may be 2-10 times its normal size.

The symptoms of Graves' ophthalmopathy and associated problems include:

• Eyelid retraction

1. Eyelids do not completely close, resulting in dryness, grittiness, corneal ulceration or abrasion, which can lead to varying degrees of loss of visual acuity. When the patient sleeps, the eyes do not close completely which exacerbates these symptoms. Incomplete closure leads to:
2. Fixed stare
3. Lid lag - if the person is asked to slowly look down, it appears as if one eyelid is 'left behind' since there is a delay in initiation of movement of the upper lid downwards

• Soft tissue damage resulting in swelling and redness of eyelids and light sensitivity (photophobia)
• Exophthalmos (also called proptosis) resulting in bulging of the eyeballs due to excess tissue, fat, and muscle behind the orbits of the eyes
• Strabismus (misalignment of the eyes due to extraocular muscle imbalance) resulting in limited eye movement or diplopia (double vision)
• Corneal ulceration from exposure to air and insufficient tear production
• Optic nerve compression resulting decreased vision or reduced color vision