Graves’ Disease

An image of a woman with graves disease smiling.

Photo by Brandon Jones

Photo by Brandon Jones

After more than 20 years of living with the discomfort of Graves’ and thyroid eye disease (TED), wife, mom and dentist Layla Lohmann finally found a treatment that worked. Now she’s sharing her story in the hope she can help others—and is spreading the message that there is a way to see clearly again. 

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Health Monitor Living Graves’ Disease

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Getting the facts on Graves
Graves’ disease—an autoimmune disorder that causes an overproduction of thyroid hormones (hyperthyroidism)—affects nearly 1 in 100 Americans, and is responsible for about 4 out of 5 cases of hyperthyroidism. Think you might have it? Read on for the facts about the condition, as well as the common symptoms and who is at risk.

An image of a doctor speaking to a woman about treatment for graves disease.

Understanding the treatment options
Learn how you can fight back against Graves’ and thyroid eye disease with the latest treatments.

An image of a woman smiling with graves disease.

“TED doesn’t define us!”
From finding a treatment that works to self-care makeup tricks and soothing ice packs, Layla, Suzy and Christine share the tips that help them thrive despite thyroid eye disease. See if their strategies can help you, too.

An illustration of a woman experiencing pain.

Anxious? Feeling down?
You can get off the emotional roller coaster
Graves’ disease comes with a lot of difficult symptoms, but some of the toughest are mental—things like anxiety about the future and even an increased risk for depression. If you’re facing these challenges, you’re far from alone—and luckily, there are ways to help you cope. Read on to learn more, and hopefully discover a few methods that can help you get back to feeling your best—inside and out!

An image of a man with graves disease eye.

Think you know all the facts on Graves’?
Answer the questions in this quiz to find out if you’re up-to-date on your knowledge of Graves’ disease.

Getting the
facts on Graves’

An image of a woman smiling with her dog.

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Graves’ disease—an autoimmune disorder that causes an overproduction of thyroid hormones (hyperthyroidism)—affects nearly 1 in 100 Americans, and is responsible for about 4 out of 5 cases of hyperthyroidism. Think you might have it? Read on for the facts about the condition, as well as the common symptoms and who is at risk.


What is Graves’ disease?

In Graves’ disease, the immune system suddenly starts producing an antibody that causes the thyroid—the small, butterfly-shaped gland at the base of the neck—to produce too many hormones.

Because thyroid hormones help control many functions throughout the body, the symptoms can be wide-ranging, but typically include:

  • Anxiety
  • Irritability
  • Fatigue and difficulty sleeping
  • Shaky hands
  • Heat sensitivity and sweating
  • Rapid heartbeat
  • Unexplained weight loss
  • An enlarged thyroid gland
  • Irregular periods
  • Lowered sex drive
  • Frequent bowel movements
  • Bulging eyes (read more on this below)
  • Reddened skin on legs and feet (aka Graves’ dermopathy)

Researchers still are unsure what triggers Graves’ in some people, but it’s likely a combination of genetics and environmental factors. Some risk factors are out of your control, such as:

  • Family history. If another member of your family has Graves’ or Hashimoto’s—another autoimmune condition that causes too little thyroid hormone—you are at increased risk.
  • Gender. People assigned female at birth are much more likely to develop Graves’ than those assigned male at birth.
  • Age. It is more common in younger people and usually develops before age 40.
  • Having other autoimmune disorders. These can include type 1 diabetes, rheumatoid arthritis and vitiligo.

The following risk factors, on the other hand, can be mitigated:

  • Smoking. If you need help quitting smoking, visit
  • Chronic stress. For help managing stress, consider relaxing activities such as meditation, acupuncture and yoga.


Graves’ disease also occurs in about 1 in 1,500 people who are pregnant, possibly due to a hormone produced by the placenta. If you’re already at higher risk for Graves’ due to other factors listed above, be sure to have your hormone levels closely monitored.

An image of a woman working on her computer with head pain.

TED: A common companion

About half of people with Graves’ disease go on to develop a condition called thyroid eye disease (TED), also known as Graves’ ophthalmopathy. TED is also an autoimmune disease, but instead of the thyroid being under attack, in this case, it’s the muscle and fat tissue behind the eyes. As a result, inflammation and scarring occur, leading to eye changes such as bulging eyes (proptosis), misaligned eyes (strabismus) and double vision (diplopia).

Symptoms of TED include:

  • Dry, gritty-feeling eyes
  • Red, swollen eyes and eyelids
  • Watery eyes
  • Eye pain
  • Sensitivity to light
  • Bulging eyes (proptosis)
  • Double vision (diplopia)
  • Eyelids unable to close properly (retraction)

TED can come on strong

TED often starts suddenly, causing symptoms like redness, dryness and swelling, and can quickly get worse, setting the stage for scarring and serious vision damage. This is known as the acute phase of TED, which can last anywhere from six months to two years. The acute phase of TED is followed by a chronic, or “inactive” phase, but that doesn’t mean the disease has gone away or that you won’t have symptoms. In fact, if it’s left untreated, TED can flare again when exposed to a trigger like stress or cigarette smoking.

What that means for you

Whether you have just been diagnosed with Graves’ or TED, or have been living with either or both for a while, it can be helpful to learn the latest about the conditions and how they can be managed. Click here to find out about the common treatment options, or here to get inspired by others living with the condition. And most of all, make sure you’re open and honest about how you’re feeling with your healthcare team—there’s no reason to suffer with the symptoms in silence!

Understanding the treatment options

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Graves’ disease

Treatment for Graves’ involves slowing down production of your thyroid hormones, or preventing those hormones from reacting with your body. They include:

Radioactive iodine therapy

For this treatment, you swallow iodine pills that are mildly radioactive. Iodine is absorbed by the thyroid, where it’s normally used to create hormones. The radiation slowly eliminates thyroid cells, leading to a lowered hormone production. This treatment can worsen thyroid eye disease (TED), so it’s typically not used if TED has already developed, nor can it be used by those pregnant, trying to become pregnant or those breastfeeding.

Iodine blockers

These include propylthiouracil and methimazole, both of which work by interfering with the thyroid’s ability to use iodine to produce hormones. Propylthiouracil can cause liver damage and is less often prescribed, except in pregnant women, as methimazole can increase the risk for birth defects.

Beta blockers

These drugs block thyroid hormones from interacting with the rest of the body, but don’t treat the hyperthyroidism itself.


This surgical procedure involves removing part or all of the thyroid, and will require you to take synthetic thyroid hormones indefinitely. 

Thyroid eye disease (TED)

TED, which occurs in about half of those with Graves’, requires its own treatment—preferably in the acute phase. That’s the best way to minimize scarring and prevent serious eye damage. Current treatments can relieve the symptoms of TED, and one medication is now FDA-approved to address TED at the source. Options include:

Eye drops or gels.

These can relieve the dry, gritty feeling that comes with TED, and in the case of eyelids that won’t close (retracted eyelids), lubricated gels can keep eyes moist overnight.


Although steroids can help bring down swelling, over the long term, they can cause weight gain and increase the risk of infection. So it’s common to start at a high dose and slowly taper off.

Orbital radiotherapy (ORT).

With this treatment, radiation is aimed at the inflamed area behind the eye to help reduce bulging and other symptoms.


When TED is in the chronic phase, these surgeries may be performed in the following order:

  1. Orbital decompression surgery to help the eyelids close better, minimize bulging, ease eye pain and potentially improve double vision.
  2. Strabismus surgery to help correct remaining double vision after the first surgery and improve forward vision.
  3. Eyelid repositioning surgery to return eyelids to a more normal position and relieve dryness.
  4. Face sculpting to help the eyes and face look better.

Monoclonal antibody.

One treatment has been FDA approved to treat TED at the source. It works by blocking the IGF1 receptor, a protein that leads to the overgrowth of fat and muscle behind the eye. As a result, the bulging, redness, pain and swelling go down. The drug can improve double vision (in some cases, making it go away) and may even help improve physical appearance so surgery isn’t needed. The medication is given by infusion, one every three weeks, for a total of eight infusions.


An illustration of medication.
An illustration of medication.
An illustration of medication.
An illustration of medication.
An illustration of medication.
An illustration of medication.

“TED doesn’t define us!”

An image of a woman outside smiling.

Photo by Brandon Jones

Photo by Brandon Jones

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From finding a treatment that works to self-care makeup tricks and soothing ice packs, Layla, Suzy and Christine are sharing how they manage to thrive despite thyroid eye disease. See if their tips could help you!

“My future finally looks bright!”

After more than 20 years living with the discomfort of thyroid eye disease (TED), Layla Lohmann found a treatment that worked. Now she’s sharing her story in the hope she can help others—and spreading the message that there is a way to see clearly again. 

—by Beth Shapouri

Today, Layla Chafi Lohmann’s eyes feel good—she’s able to go outside without having to avoid sunny days, she’s waking up without feeling like there’s grit in her eyes and she’s free of headaches caused by double vision. But it wasn’t long ago that she thought these symptoms were just “a part of life” and one more thing she had to deal with on a daily basis.

Layla’s journey with thyroid eye disease (TED) began when she was 12-years-old following a diagnosis of Graves’ disease, a condition where the immune system attacks the thyroid and causes an overproduction of thyroid hormones. One of the first symptoms of her Graves’, in fact, were the telltale bulging eyeballs associated with TED, which is when that same immune malfunction that causes the body to attack the thyroid also attacks the muscle and tissue behind the eyes.

At the time, there was little doctors could offer Layla to treat the TED, but they did opt to remove her thyroid when she was 15.

“I mistakenly believed that removing my thyroid would cure both conditions, so even though I was still experiencing severe dry eye, redness and tenderness after the surgery, I just chalked it up to allergies.”  

“I needed a better answer!”

Fast forward to 2015, Layla (now a dentist) was married to her husband, David, and pregnant with her son, Lucas, when her eye symptoms took a sudden turn for the worse, including debilitating headaches and double vision.

“That’s when my doctor explained how TED works—that even though my thyroid was gone, the immune malfunction that caused my Graves’ was still active in my body and was attacking my eyes.”  

Luckily, after she gave birth, the symptoms subsided, making it a bit more bearable for Layla with the help of steroids and eye drops. And her downward vision wasn’t impacted, which was very important for her career as a dentist. 

But while her ophthalmologist assured her the eye symptoms would not likely surge again even with another pregnancy, that turned out to be untrue when she became pregnant with her daughter, Nora. In fact, she says, “The first sign I had that made me suspect I might be pregnant again was that the double vision suddenly returned!” 

While her symptoms decreased again after she gave birth, they still disrupted her day-to-day life. “I didn’t enjoy going to my son’s soccer games because being outside in the sun hurt my eyes.” Not only did she hate missing out on those moments, she says, “it really opened up how I felt as a kid where people would call me lazy for staying indoors and not participating in things.”

So she went back to her doctor and asked if there was anything else she could try. And that’s when he mentioned there was a new biologic medication that had recently been approved to treat TED.

“I said sign me up!” laughs Layla.

“I couldn’t believe the difference” 

Layla started the infusions and by the third round, to her amazement, she found relief.

“I was in shock! It eased symptoms I didn’t even realize I was having, like the dry eye in the mornings, because I’d lived with them so long I thought they were normal and everyone felt that way. For the first time in 26 years, my eyes weren’t bothering me!”

That’s why Layla was dismayed when production of the drug (among others) was ceased in 2020 so manufacturers could concentrate on producing the COVID-19 vaccine. Even after it was put back on the market, she found she had to battle her insurance for continued access when her symptoms would return. 

Frustrated, Layla decided she needed to take action and became a patient advocate with the TED Community Organization to fight not just for her own access to her medication but for other patients, too.

“I’m a healthcare provider with resources, and if this is what I have to go through to get access to this medication, I can’t imagine somebody who doesn’t have my support. That’s why I’m fighting these battles,” she says.

“Now I’m looking forward”

Today, Layla is continuing to get infusions of the medication, and is still working to help others gain access to the drug that she says “changed my whole life.”

“I’m in a good place right now. I go to my son’s soccer games, I go outside and play with my kids. It’s been so empowering—this medication has just been a game-changer.”

An image of a woman outside smiling.

Photo by Brandon Jones

Photo by Brandon Jones

Here, Layla shares her top tips for conquering TED…

Find help for access. 

If you’re having trouble getting your insurance company to cover your medication, Layla suggests contacting patient advocacy groups like the Patient Access Network Foundation ( or asking the manufacturer of the drug your doctor recommends if they have any patient liaisons. She explains these advocates are great because, “While I’m taking care of my kids, my husband, and myself, this person was taking care of me and trying to get me the medication that I need!”

Communicate with your kids.

Children often don’t have a filter, which means kids of people who have TED sometimes hear things about their mom or dad’s eyes at school. For her son, who is now 8, she says letting him know he doesn’t have to protect her is important. “I try to talk to him to normalize it,” she explains. “I say, ‘Mommy’s eyes sometimes pop out, and people will say things to you. If anyone makes you feel uncomfortable, just let me know, and we’ll talk it out together.”

Try tinted glasses.

Layla finds wearing blue light-blocking tinted glasses indoors to help on the days when her eyes are feeling sensitive to help reduce glare. This has been an upgrade from when she used to wear sunglasses indoors! “People just thought I was trying to be cool!” she laughs.

Hear more about Layla’s journey with thyroid eye disease in her own words.

“Be patient and research!”

Overwhelmed with juggling her role as a mom to her then 2-year-old son, Harvey, and her job as a makeup artist, Suzy Gerstein first took the symptoms she experienced in 2014 as simple fatigue.

“I wasn’t sleeping,” she recalls. “It was easy to chalk things up to being tired, but I knew other members of my family had had thyroid issues, so that possibility was also on my mind.”

When she developed a lump in her throat and stopped being able to fully close her eyelids, she knew something serious was going on and made an appointment with her doctor.

That resulted in a triple whammy diagnosis: Graves’ disease, thyroid eye disease (TED) and thyroid cancer.

She had surgery to remove her thyroid but was also eager to have surgery to help her eye issues. “I constantly felt like I had an eyelash in my eye,” she recalls. “And as someone who works in an aesthetic-based industry, I also had the trauma of a changing face.” 

A year after being pronounced cancer-free, she underwent her eye surgery. She now wishes she had been a little less eager and had taken more time to meet with surgeons and understand the procedure. She was surprised both by the level of pain and the uneven results and lid drooping she experienced after. Now seven surgeries in (and with a doctor she’s comfortable with), she says, “I’m finally happy with how it’s healed.”

Along the way, she’s also come to redefine beauty and is giving herself more grace. “I look at a recent picture and I’m like, Okay, I like her more. She’s got some scars, but she’s earned them. There’s a beauty to that.”

Here, Suzy shares the other methods she used to get control of her TED…

Think gentle with eye makeup.

Suzy found staying away from waterproof eyeliner—especially along the inner line of her eyes—helped ease her eye issues, as does skipping mascara some days to give her eyes a break. To take her makeup off at night, she exclusively uses micellar water, which is gentle and easily removes anything she’s applied. “It feels nice and refreshing, and I don’t have to tug at my eyes, which is a big no-no.” Her favorite: Micellar Cleansing Water All-in-1 Waterproof Makeup Remover ($12.99,

Find ways to destress.

After her diagnosis, Suzy had to teach herself how to slow down. “There was a time I disliked massages because I literally couldn’t sit still for that long and just relax. I would be crawling out of my skin!” But she kept at it and found she loves the art of Gua Sha massage (in which the skin is scraped with a special tool) as well as acupuncture. “I also used to fight breath work and meditation, but now I get it. It really is important to treat your whole self and your well-being, especially when battling a chronic illness.”

Don’t be afraid to ask for help.

If Suzy had to do it all over again, she says she’d lean more on others. “I would have had more childcare and more familial support,” she says. These days she’s gotten better at speaking up when she needs a break, and she’s found the people around her eager to help. “People want to be there for you—let them! Tell them how! You think you’re being a burden, but actually they are grateful. It probably makes you feel good to help people—this is also true for the others in your life!”

An image of a family smiling.

Photo by David Engelhardt

Photo by David Engelhardt

An image of a woman posing.

Photo by David Engelhardt

Photo by David Engelhardt

An image of a woman riding a bike.



“Seek your own joy!”

Today, Christine Gustafson is the founder of the TED Community Organization, but in 2009, she was simply a patient with both Graves’ disease and TED. And the day-to-day reality of living with bulging, swollen eyes was taking its toll.

“I was actually frightening little children!” she recalls. “I felt very isolated and alone.” In fact, it would be another 12 years before she met another patient in her shoes.

She underwent her first eye surgery to correct the bulging in 2012 and has since had six more, including decompression surgery, in which the space behind the eyes is cleared out to allow the eyes to move back. She faced complications along the way like double and even chaotic vision in which things in her line of sight would appear chopped up or out of order, but she tried to stay positive.

Luckily, her last surgery in 2022 was a success—not only are her eyes symmetrical, but she now has nearly 20/20 vision and no longer sees double. That same year she decided to pay it forward by founding the TED Community Organization to create “a one-stop place for education, support and community” after trying to help a fellow patient she met online find educational resources. “It became clear that this was a great need and something I could help with,” she explains. She says of her fellow patients, “We need each other. We seem to do better in a community!”

An image of a woman posing outside.



Here, Christine shares some of the advice she wished she’d had when first diagnosed…

Plan for discomfort.

Having strategies on-hand can be a lifesaver when eye discomfort from TED hits. Christine now makes sure she always has the following stocked up in her house: “soothing eye drops, ice packs that I can put over my eyes to ease swelling, and pain medication.”  

Find support.

“Embarrassment and loneliness are primary to a TED diagnosis. Connecting with the TED community is a very important way for those affected by the condition to overcome these sizable roadblocks to a solution,” she says. That’s, after all, why she started the TED Community Organization. To find out more, visit

Live your own personal best life.

Christine feels strongly that while TED impacts so many parts of a patient’s life, it’s important to try to find joy wherever you can. “I am very dedicated to building a good life for myself.” Calling herself “a student of self-care,” she says, “I am very active with swimming each day, bicycling, and walking whenever I can. And I work quite hard at building and maintaining all kinds of relationships.”

Anxious? Feeling down?

You can get off the emotional roller coaster.

An illustration of a woman in pain.

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Graves’ disease comes with a lot of difficult symptoms, but some of the toughest are emotional—things like anxiety about the future and even an increased risk for depression. If you’re facing these challenges, you’re far from alone—and luckily, there are ways to help you cope. Read on to learn more, and hopefully discover a few methods that can help you get back to feeling your best, inside and out! —by Nancy Morgan

Battling depression? Try this…

  • Focus on small gains. Making a delicious meal, taking a walk, tidying a drawer or calling a friend can give you a sense of accomplishment and help you feel good about yourself.
  • Do something that gives you pleasure—or that used to! And if you can’t do it today, plan for it so you have something to look forward to. Easy things you don’t have to plan for might include listening to music, tending to indoor plants or doing something creative, like writing a poem, painting or taking photos.   
  • Become an early riser. People who reported greater exposure to morning light (between 8 a.m. and noon) not only fell asleep more easily and slept more soundly, but they were also less likely to report feelings of depression, according to a study in the Sleep Health. Morning sunlight helps regulate your body’s natural sleep-wake cycle and boosts production of serotonin, the happiness hormone.

Struggling with anxiety? Try this…

  • Breathe! When you notice signs of anxiety, such as racing thoughts, irritability or excessive worry, inhale deeply then silently counting to five. Hold your breath for two counts, then slowly exhale. By slowing your breathing rate and pattern, you can stimulate the body’s relaxation response.
  • Bring yourself back to the present moment. If your mind starts racing, reassure yourself with a mantra: I am going to be okay. Or try to put things in perspective: I’m feeling anxiety that might be caused by my Grave’s. I’m going to breathe through it/distract myself until I feel more centered.
  • Get classical. If you’re able to tune out for a few minutes, try listening to some Bach or Vivaldi. Classical music can slow your heart rate, lower levels of stress hormones and prompt the release of dopamine, a feel-good hormone that counteracts anxiety. Researchers credit the tempo of classical music: At 60 to 100 beats a minute, it’s similar to a normal heart rate.


In a recent study published in Frontiers of Endocrinology, researchers found that for people living with Graves’:

45% reported feeling depressed

19% avoided public situations due to anxiety


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Special thanks to our medical reviewer:
Lilly Wagner, MD,
Assistant Professor of Ophthalmology Consultant, Ophthalmic Plastic and Reconstructive Surgery Mayo Clinic; Rochester, MN

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This publication is not intended to provide advice on personal matters, or to substitute for consultation with a physician.


Health Monitor Medical Advisory Board

Michael J. Blaha, MD, Director of Clinical Research, Ciccarone Center for the Prevention of Cardiovascular Disease; Professor of Medicine; Johns Hopkins

Leslie S. Eldeiry, MD, FACE, Clinical Assistant Professor, Part-time, Department of Medicine, Harvard Medical School; Department of Endocrinology, Harvard Vanguard Medical Associates/Atrius Health, Boston, MA; Chair, Diversity, Equity and Inclusion Committee, and Board Member, American Association of Clinical Endocrinology

Marc B. Garnick, MD Gorman Brothers Professor of Medicine at Harvard Medical School, Director of Cancer Network Development, Beth Israel Deaconess Medical Center, Editor-in-chief of Harvard Medical School’s Annual Report on Prostate Diseases

Angela Golden, DNP, FAANP, Family Nurse Practitoner, former president of the American Association of Nurse Practitioners (AANP)

Mark W. Green, MD, FAAN, Emeritus Director of the Center for Headache and Pain Medicine and Professor of Neurology, Anesthesiology, and Rehabilitation at the Icahn School of Medicine at Mount Sinai

Mark G. Lebwohl, MD, Dean for Clinical Therapeutics, professor and chairman emeritus at Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York

Maryam Lustberg, MD, Associate Professor of Internal Medicine (Medical Oncology) Director, Center for Breast Cancer Chief, Breast Medical Oncology Yale School of Medicine

William A. McCann, MD, MBA, Chief Medical Officer, Allergy Partners, Asheville, NC

Mary Jane Minkin, MD, FACOG, Clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine

Rachel Pessah-Pollack, MD, FACE, Clinical Associate Professor, Division of Endocrinology, Diabetes & Metabolism, NYU School of Medicine, NYU Langone Health

Julius M. Wilder, MD, PhD, Assistant Professor of Medicine; Chair, Duke Dept of Medicine Diversity, Equity, Inclusion, and Anti-racism Committee; Vice Chair, Duke Dept of Medicine Minority Retention and Recruitment Committee; Co-Director for the Duke CTSI- Community Engaged Research Initiative