Graves’ Disease Testing
- Also Known As:
- Diffuse Thyrotoxic Goiter
- Toxic Diffuse Goiter
- Autoimmune Hyperthyroidism
- Basedow Disease
- Exophthalmic Goiter
What Is Graves’ Disease?
Graves’ disease is an autoimmune disease which most commonly causes hyperthyroidism, or an overactive thyroid. When you have Graves’ disease, your immune system makes thyroid antibodies which cause your thyroid gland to produce more thyroid hormones than needed by the body.
Hyperthyroidism increases a person’s metabolism and causes symptoms such as anxiety, weight loss, intolerance to heat, and sleep problems.
Left untreated, Graves’ disease can cause serious health problems, including an irregular heartbeat and osteoporosis. Approximately one out of three people with Graves’ disease also experience eye problems, such as bulging eyes, eye swelling, and red or inflamed eyes. Occasionally, Graves’ disease causes eye problems without causing hyperthyroidism.
Although Graves’ disease can affect anyone, it most commonly occurs between 30 and 50 years of age. You are more likely to develop Graves’ disease if you:
- Have a family history of Graves’ disease
- Have a personal or family history of other autoimmune disorders, such as rheumatoid arthritis or lupus
- Are a smoker
- Are female, although it’s unclear whether the increased risk is related to hormonal or genetic differences
- Have been pregnant within the last 12 months
- Recently experienced a stressful life event
Graves’ disease is the most common cause of hyperthyroidism in the U.S. It affects about 1 in every 200 people.
The Role of Graves’ Disease Testing
If you have signs or symptoms that suggest Graves’ disease, your doctor may begin by ordering thyroid function testing such as TSH and free T4, to determine whether the thyroid is producing excess thyroid hormones.
If hyperthyroidism is confirmed by thyroid function testing, additional tests are conducted to determine the cause of your overactive thyroid gland and to select the appropriate treatment. In some cases, additional testing will not be needed because a patient’s medical history and physical examination provide strong enough evidence of Graves’ disease.
Although most cases of hyperthyroidism are due to Graves’ disease, an overactive thyroid gland can also be caused by other medical problems, such as certain medications, too much iodine in the diet, and thyroid tumors.
During and after treatment for Graves’ disease, patients have periodic testing to monitor the effectiveness of their treatment.
Who should get testing?
To diagnose Graves’ disease, tests may be ordered if you have certain abnormalities on a physical exam or if you report symptoms that may be related to an overactive thyroid gland.
Many symptoms of Graves’ disease are nonspecific, meaning that they can be caused by a number of different medical conditions. Some patients have severe symptoms, while other patients have only mild ones. Symptoms of Graves’ disease include:
- Insomnia or trouble sleeping
- Irritability or moodiness
- Hair loss
- Difficulty concentrating
- Frequent bowel movements
- Increased sweating and feeling overheated
- Weight loss, despite increased appetite
- Irregular menstrual periods
- Rapid or irregular heartbeat
- A swollen neck, caused by enlargement of the thyroid gland
Your doctor may also order Graves’ disease testing if you have symptoms suggestive of eye problems caused by Graves’ disease, known as Graves’ ophthalmopathy or Graves’ orbitopathy. Symptoms of eye problems caused by Graves’ disease include:
- Sensation of itching or irritation of the eyes
- Increased tearing
- Eye pain
- Eye swelling
- Bulging eyes
- Blurred vision
- Double vision
Getting test results
It can take several business days to receive the results of tests for Graves’ disease. Your results may be communicated during a follow-up appointment and, in some cases, you may receive a test report that shows your test results.
Interpreting the results of Graves’ disease testing can be complex as Graves’ disease can affect patients differently. For example:
- Not all patients have the same patterns of elevated thyroid hormones typical of hyperthyroidism.
- Patients with mild Graves’ disease may test negative for thyroid antibodies.
- A small minority of patients with Graves’ disease have eye problems without an overactive thyroid.
Because of these factors, doctors may consider a number of test results in making a diagnosis of Graves’ disease, and some patients will require more tests than others.
Types of Graves’ Disease Tests
Patients being evaluated for Graves’ disease may have tests that measure thyroid hormone levels, tests that detect the presence of thyroid antibodies, and imaging tests. Some patients will require more tests than others before a diagnosis can be established.
The table below lists tests that may be used to diagnose or rule out Graves’ disease.
|Blood Tests Used to Diagnose Graves’ Disease|
|Test||What It Measures||Typical Result in Graves’ Disease|
|Thyroid-Stimulating Hormone (TSH)||Hormone that prompts the thyroid gland to make thyroid hormones||Below normal|
|T3 (Free or Total)||Thyroid hormone||Usually high|
|T4 Free||Thyroid hormone||Usually high|
|Thyroid Antibodies||Thyroid antibodies which cause the thyroid to make too much thyroid hormone||Usually present|
Imaging tests can often reveal the cause of hyperthyroidism, including Graves’ disease. The following imaging tests may be ordered:
- Radioactive Iodine Uptake
- Thyroid Scan
Getting Tested for Graves’ Disease
Blood tests will usually be ordered by your doctor. A blood sample may be drawn at your doctor’s office, clinic, a laboratory, or other medical setting. Imaging tests are conducted at hospitals, imaging centers, and medical clinics.
Thyroid function tests that detect if your thyroid is overactive may be performed using commercially available at-home tests. However, the antibody and imaging tests that establish Graves’ disease as the cause of hyperthyroidism cannot be done at home.
If an at-home thyroid test indicates an overactive thyroid gland, it is important to discuss your concerns and test results with a doctor. A doctor can help you determine what is causing the problem and plan appropriate treatment.
A.D.A.M. Medical Encyclopedia. Graves disease. Updated January 26, 2020. Accessed August 18, 2021. https://medlineplus.gov/ency/article/000358.htm
A.D.A.M. Medical Encyclopedia. Radioactive iodine uptake. Updated January 26, 2020. Accessed August 20, 2021. https://medlineplus.gov/ency/article/003689.htm
A.D.A.M. Medical Encyclopedia. Thyroid ultrasound. Updated January 26, 2020. Accessed August 20, 2021. https://medlineplus.gov/ency/article/003776.htm
A.D.A.M. Medical Encyclopedia. Heat intolerance. Updated August 5, 2021. Accessed August 25, 2021. https://medlineplus.gov/ency/article/003094.htm
American College of Radiology. Thyroid scan and uptake. Updated February 8, 2018. Accessed August 20, 2021. https://www.radiologyinfo.org/en/info/thyroiduptake
American Thyroid Association. Graves disease. Date unknown. Accessed August 10, 2021. https://www.thyroid.org/graves-disease/
American Thyroid Association. Hyperthyroidism. Date unknown. Accessed August 24, 2021. https://www.thyroid.org/hyperthyroidism/
Columbia Surgery. At-home thyroid testing kits: What we know…and what we don’t: An interview with Dr. Hyesoo Lowe. Columbia Surgery website. Date unknown. Accessed June 18, 2021. https://columbiasurgery.org/news/home-thyroid-testing-kits-what-we-knowand-what-we-dont
Davies TF. Pathogenesis of Graves disease. Ross DS, ed. UpToDate. Updated March 15, 2021. Accessed August 19, 2021. https://www.uptodate.com/contents/pathogenesis-of-graves-disease
Davies TF. Clinical features and diagnosis of Graves orbitopathy (ophthalmopathy). In: Ross DS, ed. UpToDate. Updated March 19, 2021. Accessed August 20, 2021. https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-graves-orbitopathy-ophthalmopathy
Donkol RH, Nada AM, Boughattas S. Role of color Doppler in differentiation of Graves disease and thyroiditis in thyrotoxicosis. World J Radiol. 2013;5(4):178-183. doi:10.4329/wjr.v5.i4.178
Elhomsy G, Griffing GT. Antithyroid antibody. Staros EB, ed. Updated December 24, 2014. Accessed August 1, 2021. https://emedicine.medscape.com/article/2086819-overview
Fröhlich E, Wahl R. Thyroid autoimmunity: Role of anti-thyroid antibodies in thyroid and extra-thyroidal diseases. Front Immunol. 2017;8:521. Published 2017 May 9. doi:10.3389/fimmu.2017.00521
Hershman JM. Hyperthyroidism. Reviewed September 2020. Accessed August 10, 2021. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/thyroid-disorders/hyperthyroidism
LaFranchi S. Clinical manifestations and diagnosis of Graves disease in children and adolescents. In Geffner ME, ed. UpToDate. Updated June 2, 2020. Accessed August 20, 2021. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-graves-disease-in-children-and-adolescents
MedlinePlus: National Library of Medicine. Graves disease. Updated August 18, 2020. Accessed August 16, 2021. https://medlineplus.gov/genetics/condition/graves-disease
National Institute of Diabetes and Digestive and Kidney Diseases. Hyperthyroidism (overactive thyroid). Updated August 2016. Accessed August 3, 2021. https://www.niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism
National Institute of Diabetes and Digestive and Kidney Diseases. Graves disease. Updated September 2017. Accessed August 18, 2021. https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease
Ross DS. Laboratory assessment of thyroid function. In: Cooper DS, ed. UpToDate. Updated December 11, 2019. Accessed August 3, 2021. https://www.uptodate.com/contents/laboratory-assessment-of-thyroid-function
Ross DS. Graves hyperthyroidism in nonpregnant adults. In: Cooper DS, ed. UpToDate. Updated July 28, 2020. Accessed August 15, 2021. https://www.uptodate.com/contents/graves-hyperthyroidism-in-nonpregnant-adults-overview-of-treatment
Ross DS. Diagnosis of hyperthyroidism. In: Cooper DS, ed. UpToDate. Updated April 19, 2021. Accessed August 3, 2021. https://www.uptodate.com/contents/diagnosis-of-hyperthyroidism
Ross DS. Disorders that cause hyperthyroidism. In: Cooper DS, ed. UpToDate. Updated July 16, 2021. Accessed August 15, 2021. https://www.uptodate.com/contents/disorders-that-cause-hyperthyroidism
Schraga ED. Hyperthyroidism, thyroid storm, and Graves disease clinical presentation. In Khardori R, ed. Medscape. Updated April 23, 2020. Accessed August 18, 2021. https://emedicine.medscape.com/article/767130-clinical
Yeung, SJ. Graves disease clinical presentation. In Khadori R, ed. Medscape Updated April 17, 2020. Accessed August 16, 2021. https://emedicine.medscape.com/article/120619-clinical