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Massachusetts Eye and Ear
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Otolaryngology–Head and Neck Surgery

Graves’ Disease/ Hyperthyroidism

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Located in the lower portion of the neck, the thyroid gland produces thyroid hormones and is responsible for regulating the body’s metabolism. In patients with hyperthyroidism or Graves’ disease, the thyroid produces too much thyroid hormone, resulting in a variety of problems.

The most common cause of hyperthyroidism is Graves’ disease, a condition marked by enlargement of the thyroid (also known as goiter), a bulging appearance to the eyes (ophthalmopathy), and sometimes changes to the skin along the legs.

Other causes of hyperthyroidism include Toxic Nodular Goiter, when multiple nodules in the thyroid produce too much thyroid hormone, and a Solitary Toxic Nodule, in which a single thyroid nodule produces excessive thyroid hormones.

In cases of Toxic Nodular Goiter, significant enlargement of the thyroid can occur, causing the enlarged mass to press on surrounding structures, which can cause swallowing and breathing problems.

9Common Symptoms

  • Nervousness
  • Palpitations
  • Increased sweating
  • Irritability
  • Tremor
  • Unintentional weight loss
  • Insomnia
  • Headaches
  • A change in the appearance of the eyes

Diagnosis and Treatment

A diagnosis of hyperthyroidism is made when a blood test shows high levels of thyroid hormones and very low levels of thyroid-stimulating hormones (TSH), which is produced by the pituitary gland. When there are excessive levels of thyroid hormones in the bloodstream, the body’s normal feedback mechanism turns off the pituitary gland’s production of TSH, resulting in very low TSH levels.

Patients diagnosed with hyperthyroidism are first evaluated and treated by endocrinologists, specialists in treating medical thyroid issues. The endocrinologist may order additional testing for hyperthyroidism, which may include a nuclear medicine scan.

Patients with hyperthyroidism are always initially treated with antithyroid drugs (methimazole and/or PTU), which inhibit thyroid hormone production by the thyroid gland. Although very effective, antithyroid medications are often needed for long periods of time to achieve remission and have some risk of mild to severe side effects. Sometimes beta-blockers are also prescribed to initially control the symptoms related to hyperthyroidism.

More definitive treatment options include:

  • Radioactive iodine therapy: Used to destroy thyroid tissue and can be effective in achieving a cure for some patients with hyperthyroidism. Patients with eye findings in Graves’ disease and those with compression symptoms are often not candidates for this treatment.
  • Surgical treatment: May be considered if there are co-existing thyroid enlargement nodules, known eye disease, and/or a preference to avoid radioactive iodine.

In patients with Graves’ disease or Toxic Nodular Goiter, the entire thyroid gland is usually removed. In patients with a Toxic Solitary Nodule, the surgeon usually removes half of the thyroid.

Support Group

Mass Eye and Ear has an eye thyroid/Graves’ disease support group. This open forum gives members the opportunity to exchange information about Graves' disease. Email for more information.

Meet Our Team

The Thyroid and Parathyroid Endocrine Surgery Division is staffed by surgeons, radiologists, and other medical specialists skilled in the evaluation and treatment of problems of the thyroid and parathyroid. Our combination of medical expertise allows us to treat patients of all thyroid and parathyroid conditions.

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