Symptoms of Graves' Disease from Most to Least Common
The most common symptoms of Graves' disease include tachycardia, nervousness, tremors, heat intolerance, and excessive sweating, followed by weight loss, fatigue, and goiter. 1, 2
Most Common Symptoms (>50% of patients)
- Tachycardia (rapid heart rate)
- Nervousness/anxiety
- Tremors (especially of the hands)
- Heat intolerance
- Excessive sweating
- Weight loss (unintentional)
- Fatigue
- Goiter (diffuse thyroid enlargement)
- Palpitations
- Insomnia
Common Symptoms (25-50% of patients)
- Emotional lability/mood changes
- Hyperkinesis (increased motor activity)
- Diarrhea or increased bowel movements
- Muscle weakness
- Menstrual irregularities in women
- Warm, moist skin
- Hypertension
Less Common Symptoms (10-25% of patients)
- Distinctive ophthalmic signs:
- Eyelid lag or retraction
- Exophthalmos (bulging eyes)
- Stare
- Dyspnea (shortness of breath)
- Hair thinning
- Increased appetite despite weight loss
Rare Symptoms (<10% of patients)
- Pretibial myxedema (localized skin changes)
- Thyroid storm (severe acute exacerbation of hyperthyroidism)
- Flash pulmonary edema
- Atypical presentations:
- "Apathetic thyrotoxicosis" (especially in elderly)
- Cardiovascular complications (heart failure, arrhythmias)
Important Clinical Considerations
- Graves' disease is responsible for approximately 95% of hyperthyroidism cases in pregnancy 1
- Laboratory findings typically show low TSH with elevated free T4 and/or T3 levels 2, 3
- Diagnosis is confirmed by the presence of TSH receptor antibodies (TRAb) 2, 4
- Untreated hyperthyroidism can lead to serious complications including:
Common Diagnostic Pitfalls
- Relying solely on TSH without measuring free T4 and T3 levels
- Missing "T3 toxicosis" where only T3 is elevated but T4 is normal
- Overlooking atypical presentations, especially in elderly patients ("apathetic thyrotoxicosis")
- Failing to distinguish between Graves' disease and other causes of hyperthyroidism
Understanding this symptom hierarchy helps clinicians recognize Graves' disease earlier, particularly when classic symptoms like ophthalmopathy may not be present initially.