Thyroid Series: Graves’ Disease Part #1 Root Causes

Graves, Graves'

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GRAVES disease is an autoimmune disorder that causes hyperthyroidism, or overactive thyroid. In Graves, the immune system makes antibodies that falsely act like TSH, causing the thyroid to create more thyroid hormone than needed.

Graves affects 1% to 1.5% of the population (Wiersinga, 2019).

Approximately 3% of women and 0.5% of men develop Graves disease (Wiersinga, 2019). It is more common in women than in men (National Institue of Health, 2020).

  • Graves disease is the most common cause of thyroid overactivity (hyperthyroidism) (National Institue of Health, 2020).
  • Having one autoimmune condition like Graves disease increases the risk of developing other autoimmune disorders, including rheumatoid arthritis, pernicious anemia, celiac disease, type 1 diabetes and others.
  • Untreated Graves disease can lead to a number of issues including heart disorders, osteoporosis and ‘thyroid storm’ (American Thyroid Association, 2020). This is when a sudden and drastic increase in thyroid hormones cause accelerated hyperthyroidism or thyrotoxic crisis, requiring emergency medical attention (American Thyroid Association, 2020).


  • Pretibial myxoedema or lesions of the skin, as a result of thyroid disease
  • Anxiety, nervousness
  • Fatigue, muscle weakness
  • Hair and nail changes
  • Weight loss
  • Increased heart rate
  • Increased systolic blood pressure
  • Heat intolerance
  • Tremors
  • Change in libido
  • Increased temperature, sweating
  • Frequent bowel movements
  • Headaches
  • Hives
  • Nausea and vomiting
  • Swollen lymph nodes
  • Increased appetite
    • Enlarged thyroid gland, called a goiter
    • Bulging eyes or Graves ophthalmopathy: 25 to 50% of people with Graves disease have eye problems (National Institue of Health, 2020). This can include swelling and inflammation, redness, dryness, puffy eyelids, and a gritty sensation like having sand or dirt in the eyes.


As an autoimmune disease, Graves is caused by the Triad of Autoimmunity. The Triad of Autoimmunity is:

  • A Genetic Tendency
  • An Environmental Trigger
  • A Leaky Gut

As an immune system issue, we need to review gut health and other impacts on immunity. The environmental triggers are different for each person but are likely to be gut imbalances, infections, nutritional deficiencies, toxic exposures and stress.

All Health Begins in the Gut – Hippocrates

GUT HEALTH:  As an autoimmune disease, Grave’s is linked to poor gut health. Leaky gut, or intestinal permeability, is involved, as well as other possible GI problems.

Our article here shows how leaky gut can lead to an overactivated immune system that can attack the thyroid gland.

These are the types of GI issues to look into:

  • Intestinal permeability or leaky gut
  • Dysbiosis
  • Gluten, molecular mimicry & celiac disease
  • Helicobacter pylori (H. pylori) infection
  • Anything else that leads to leaky gut is an issue for autoimmune thyroid disease, such as SIBO (Small Intestinal Bacterial Overgrowth), excess alcohol consumption or industrial food processing, infection, iodine, certain drugs, smoking and stress (Shukla SK, 2018).

Viral or bacterial INFECTIONS


  • Excess iodine
  • Vitamin D
  • Selenium
  • Food sensitivities and inflammatory foods


  • Cigarette smoking

Emotional STRESS


There are two antibodies to look for when testing for Graves:

  • TSI (thyroid stimulating immunoglobulin)
  • TRAb (thyroid stimulating hormone receptor antibodies)

STANDARD TREATMENT FOR GRAVES (Graves Disease Foundation, 2020)

  • Anti-thyroid drugs
    • Total thyroidectomy surgery
    • Radioactive iodine (RAI)
      • Radioactive iodine therapy or surgery cause hypothyroidism, requiring thyroid medications for life.

According to conventional medicine, there is no ‘cure’ for Graves (Wiersinga W. , 2019). Medical guidelines state that the aim of a thyroidectomy or RAI treatment in Graves should be permanent hypothyroidism, requiring lifelong Levothyroxine medication to maintain thyroid function (Wiersinga W. , 2019). Creating another disease in order to treat the original disease is not a cure (Wiersinga W. , 2019).

However, in Functional Medicine (FM), we cannot agree with this approach. It is entirely possible to stop the autoimmune attack on the thyroid. Depending on how far the condition has progressed, a case of Graves may be reversable or, at the very least, can be better managed with functional medicine, diet and lifestyle approaches.

** Please read our blog next week on **

Solutions to Graves disease using Functional Medicine

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