6 Things That Can Worsen Graves' Disease Symptoms

Graves' disease is a chronic autoimmune condition in which the immune system mistakenly launches an attack on the thyroid gland. The damage increases the production of thyroid hormones.

This leads to an overactive thyroid, which can cause symptoms and complications such as eye discomfort, fertility problems, thinning bones, and a rapid, irregular heartbeat, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Treatments - medication, radioactive iodine, or surgery to decrease thyroid hormone levels - can help reduce these problems and prevent future health complications. But there's a lot you can do, too, to manage your symptoms.

For example, some lifestyle habits and environmental triggers can make Graves' worse, and knowing what can aggravate your symptoms can help you stay healthy in the future. Here are six possible triggers.

1. Smoking

More than one-third of people with Graves' disease develop Graves' ophthalmopathy, or thyroid eye disease . It happens when your immune system attacks the tissues around your eyes, leading to bulging, a feeling of grittiness, and puffiness, among other eye symptoms, according to the NIDDK.

If you're a current smoker who has Graves', research shows quitting can decrease the risk of developing thyroid eye disease, which is exacerbated by smoking.

"So, if you smoke, quit. Smoking can also delay your eligibility for treatment, because you may have to hold off on radioactive iodine therapy until you've quit," says Jamil Alkhaddo, MD , an endocrinologist with Kaiser Permanente in San Marcos, California.

2. Caffeine

Thyroid hormone is like oil for an engine: It helps keep your body running smoothly, says Dr. Alkhaddo. But having too much thyroid hormone cranks everything up, which is why people with Graves' might feel more anxious, experience heart palpitations, get a case of the shakes, or have frequent bowel movements.

Caffeine , which is present in coffee, tea, chocolate, and many sodas and energy drinks, can worsen symptoms in a body already overstimulated by thyroid hormone, he says. Too much caffeine can cause headaches, an increased heart rate, insomnia , irritability, and jitters, according to Mayo Clinic. So pay attention to how caffeine affects how you feel, and scale back if necessary.

3. Stress

Stress can aggravate some Graves' symptoms, such as anxiety, heart palpitations, and irritation.

That alone is worth finding enjoyable activities that boost your resilience against stress and help you deal with stressors in the moment. Most important, your body's stress response can trigger a thyroid storm, a rare but life-threatening complication where a large amount of thyroid hormone is released into the bloodstream.

If you develop anxiety, a high fever, or a rapid heart rate or are delirious or lose consciousness - all of which are symptoms of a thyroid storm - go to the emergency department right away.

4. Thyroid Supplements

Alkhaddo cautions against taking thyroid support supplements, even though they are widely available and easily accessible. "These supplements [can sometimes] contain a very high dose of iodine," he says. Iodine is needed to produce thyroid hormone,

according to the American Thyroid Association, but taking excess iodine for a hyperactive thyroid over time is like "adding more wood to the fire," says Alkhaddo. Before starting any supplement, talk to your endocrinologist.

5. Pregnancy and Childbirth

Although pregnancy can cause Graves' to flare up during the first trimester, symptoms usually get better later in the pregnancy, says Alkhaddo. Why? Research suggests that estrogen and HCG (human chorionic gonadotropin) hormones rise quickly in early pregnancy, which may stimulate the thyroid during the first trimester, according to the NIDDK.

But, as the immune system begins to quiet down later on in pregnancy, Alkhaddo says, so does the Graves' disease. If you're pregnant or looking to become pregnant, you should expect your Graves' to reemerge after delivery.

"We see a lot of flare-ups around six weeks postpartum because of changing hormones," Alkhaddo says. Your endocrinologist will likely want to see you six weeks after delivery and do lab work. But if you're experiencing symptoms of Graves' before that, make an earlier appointment.

Unfortunately, symptoms such as irritation, night sweats, and weight loss can also occur postpartum, so don't hesitate to speak with your endocrinologist if you're having symptoms. At that point, your doctor may decide to restart you on medication that you took during your pregnancy or increase the dose of what you're currently taking, Alkhaddo adds.

6. Contrast Dye

If you get an imaging test, such as an X-ray , ultrasound , MRI (magnetic resonance imaging) or CT (computed tomography) scan , for any reason, you may be given contrast dye orally or intravenously, which helps radiologists better visualize organs and tissues.

The contrast dye may contain iodine, which can cause a flare-up weeks or even months after the test, Alkhaddo says.

Make sure your healthcare and imaging teams are aware of your health history beforehand, so they can make an informed decision about the appropriate imaging and management of the thyroid condition and side effects.

The Takeaway

When you have Graves' disease, following your treatment plan and taking steps to avoid potential triggers can help you manage your symptoms. Certain triggers, such as caffeine, smoking, stress, and some supplements, can worsen symptoms or trigger flare-ups. Familiarizing yourself with these triggers, and knowing how to address them, can help you better manage your condition.

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Sources

1. Graves' Disease. National Institute of Diabetes and Digestive and Kidney Diseases . November 2021.
2. Cao J et al. The Risk Factors for Graves' Ophthalmopathy. Graefe's Archive for Clinical and Experimental Ophthalmology . April 2022.
3. Caffeine: How Much Is Too Much? Mayo Clinic . March 19, 2022.
4. Graves' Disease. Mayo Clinic . June 14, 2024.
5. Thyroid Storm. Cleveland Clinic . June 8, 2022.
6. Iodine. National Institutes of Health Office of Dietary Supplements . May 1, 2024.
7. Thyroid Disease & Pregnancy. National Institute of Diabetes and Digestive and Kidney Diseases . December 2017.
8. Graves' Disease. Office on Women's Health . February 22, 2021.
9. Nguyen CT et al. Graves' Hyperthyroidism in Pregnancy: A Clinical Review. Clinical Diabetes and Endocrinology . 2018.
10. Having an Exam That Uses Contrast Dye? Here's What You Need to Know. University of Virginia Health Inside View . July 3, 2017.

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