In addition to the symptoms of hyperthyroidism Grave’s disease may cause:

  • Enlargement of the thyroid gland (goiter). The enlarged gland is usually 2-3 times the normal volume.
  • Eye symptoms (Grave’s ophthalmopathy) may be seen approximately in 50% of cases and is more common in cigarette smokers. Symptoms include:
    • Exophthalmos: Bulging out of the eyeball is due to swelling of tissues behind the eyes, which produces a characteristic “staring” or “frightened” appearance. It is seen in both eyes and may cause a feeling of pressure behind the eyes. When exophthalmos is more pronounced, the eyes may not close during sleep. This condition is known as lagophthalmos.
    • Excessive lacrimation (watering of eyes): Because of bulging of eyes and lid retraction there is increased exposure of cornea resulting in watering of eyes which is made worse by wind and bright light.
    • Eye pain and irritation due to inflammation of conjunctiva or ulceration in cornea.
    • Photophobia: Increased sensitivity to light.
    • Double vision: The muscles that move the eyes become unable to function properly, making it difficult or impossible to coordinate eye movements resulting in double vision. It could also occur as a result of co-existing myasthenia gravis (weakness of muscles).
    • In severe cases, even vision may be lost.
  • Skin symptoms (pretibial myxedema) may be seen in 5-10% of cases and is always accompanied by eye symptoms, usually of severe degree. It includes:
    • raised pink colored lesions or purplish plaques (a scaly patch) commonly over the pretibial area (front part of leg or shin) extending to the dorsum (upper part) of the foot.
    • lesion may be itchy and feel hard to touch. The skin in the affected area resembles that of an orange peel (peau d’ orange)
    • Rarely the lesions may also develop on the face, arms and dorsa (back) of hands.
    • Clubbing of fingers may be seen in long standing cases of hyperthyroidism (thyroid acropachy)
    • Whitish patches (vitiligo) common on the back of the neck and upper back.