From the Guidelines
Graves' disease does not typically cause fever as one of its primary symptoms, but it can lead to fever in rare cases of thyroid storm or as a side effect of treatment with thioamides, such as agranulocytosis, which usually presents with sore throat and fever 1. Fever is not a characteristic feature of this autoimmune thyroid disorder, which instead commonly presents with symptoms like rapid heartbeat, weight loss, anxiety, tremors, heat intolerance, and bulging eyes (exophthalmos). However, in rare cases, patients with severe untreated hyperthyroidism may develop thyroid storm, a life-threatening condition that can include high fever, often exceeding 103°F (39.4°C), along with extreme tachycardia, agitation, and delirium. Some key points to consider include:
- Thyroid storm requires immediate emergency treatment with medications like beta-blockers (such as propranolol), anti-thyroid drugs (methimazole or propylthiouracil), and supportive care.
- If a person with known Graves' disease develops a fever, it's more likely due to an unrelated infection or another condition rather than the Graves' disease itself.
- The underlying mechanism of Graves' disease involves antibodies that stimulate the thyroid to overproduce hormones, which accelerates metabolism but doesn't directly trigger the immune response that causes fever.
- Beta-blockers, such as propranolol, can be used to treat the increased heart rate and tremor associated with thyrotoxicosis, hyperthyroidism, and Graves' disease, and may also reverse some of the reduced systemic vascular resistance associated with these conditions 1.
From the Research
Graves' Disease and Fever
- Graves' disease is an autoimmune disorder that causes hyperthyroidism, and its symptoms can be varied and widespread 2, 3, 4.
- While the primary symptoms of Graves' disease are related to hyperthyroidism, such as weight loss, heat intolerance, and exophthalmos, some patients may also experience systemic complications, including cardiac and skeletal disease 2.
- In some cases, Graves' disease can be associated with extrathyroidal manifestations, such as Graves' orbitopathy, which can cause inflammation and other symptoms in the eyes and surrounding tissues 3, 4.
- Fever is not typically listed as a primary symptom of Graves' disease, but it can occur in some cases, particularly if the patient has a coexisting condition, such as acute rheumatic fever 5.
- A case study published in the Journal of Pediatric Endocrinology & Metabolism reported a patient with Graves' disease who also had acute rheumatic fever, which presented with symptoms including fever, tachycardia, and exophthalmos 5.
Treatment and Management
- The treatment of Graves' disease typically involves antithyroid medications, radioactive iodine, or surgery, with the goal of reducing thyroid hormone production and alleviating symptoms 2, 3, 6.
- In some cases, patients with Graves' disease may require high doses of radioactive iodine to achieve remission, particularly if they have a large thyroid volume or high iodine uptake 6.
- Emerging treatments for Graves' disease, including monoclonal antibodies and small molecules, are being tested in clinical trials and may offer new options for patients in the future 3, 4.