Graves’ Disease Specialists at GoodHormoneHealth

Graves’ disease, an autoimmune disorder characterized by antibodies stimulating the thyroid and resulting in hyperthyroidism, primarily affects the thyroid gland. However, it can also manifest in other areas of the body, notably the eyes, leading to bulging eyes or exophthalmos and occasionally impacting the skin, causing Graves’ dermopathy, characterized by an orange peel-like appearance, typically observed on the calf. This complex condition typically requires specialized care from an endocrinologist rather than a primary care physician. 

Dr. Friedman, renowned for his expertise in Graves’ disease, attends to hundreds of patients annually, both in his practice and at his position in Los Angeles County. Notably, Dr. Friedman adopts a distinctive approach to treatment, eschewing the common rush towards radioactive iodine or surgery, which can inadvertently induce hypothyroidism, often exacerbating the condition. Instead, he specializes in meticulous medication titration, ensuring optimal management of Graves’ disease.

Dr. Friedman and his colleagues have recently published a paper in Current Trends in Internal Medicine. www.doi.org/10.29011/2638-003X.100106 entitled “An Effective Straightforward Protocol for the Treatment of Graves’ Hyperthyroidism for PrimaryCare Providers,” outlining his approach to treating hyperthyroidism.


The symptoms of Grave’s Disease that results in hyperthyroidism include:


  • Enlarged thyroid (goiter)
  • Bulging eyes (exophthalmos)
  • Anxiety
  • Palpitations
  • Weight loss
  • Loose stools
  • Sweating
  • Shaking
  • Irritability
  • Insomnia

Causes and Risk Factors

Gender Predominance

Graves’ disease predominantly affects women, with approximately 80% of hyperthyroidism patients seen by Dr. Friedman being female.

Age Range

While the condition can manifest from adolescence to old age, Dr. Friedman commonly observes patients in their 20s, 30s, and 40s.

Association with Autoimmune Disorders

Graves’ disease often coexists with other autoimmune conditions, either within the patient’s family history or present in the individual. Notably, a family history of autoimmune thyroid diseases, such as Hashimoto’s hypothyroidism, is frequently observed in Graves’ disease patients. Moreover, conditions like celiac disease, pernicious anemia, Addison’s disease, and type 1 diabetes may also accompany Graves’ disease.

Autoimmune Mechanism

Graves’ disease is characterized by an autoimmune response wherein the body produces TSH-receptor antibodies that attack the thyroid gland. Dr. Friedman routinely conducts laboratory tests to confirm the presence of these antibodies. Although similar antibodies are associated with Hashimoto’s disease, they function differently; in Graves’ disease, they overstimulate the thyroid, whereas in Hashimoto’s, they hinder thyroid hormone production, leading to hypothyroidism.

How Is Graves’ Disease Diagnosed?

To diagnose Graves’ disease, healthcare providers typically employ several key diagnostic tests and procedures:

Thyroid Function Tests

These tests are crucial in identifying Graves’ disease. In this condition, the thyroid-stimulating hormone (TSH) is usually suppressed, while levels of free thyroxine (T4) and triiodothyronine (T3) are elevated. Notably, the elevation of free T3 may exceed that of free T4.

TSH-Receptor Antibody Measurement:

Measurement of TSH-receptor antibodies is another essential test. A positive result indicates the presence of Graves’ disease, providing further confirmation.

Thyroid Ultrasound

This imaging technique is valuable for visualizing the thyroid gland’s structure and identifying characteristic features of Graves’ disease. These features include diffuse enlargement and a smooth appearance on ultrasound.

It’s important to differentiate Graves’ disease from other forms of hyperthyroidism, such as toxic multinodular goiter, single hot nodule, or thyroiditis. These conditions present distinct ultrasound findings and may require different treatment approaches. While Dr. Friedman primarily encounters Graves’ disease cases, accurate diagnosis ensures appropriate management.

Dr. Friedman relies on reputable laboratories such as LabCorp or Quest for accurate diagnostic testing and monitoring of Graves’ disease. Additionally, he frequently performs thyroid ultrasounds at hospitals to ensure precise evaluation and diagnosis.

How Is Graves’ Disease Treated?

When it comes to managing Graves’ disease, several treatment options are available, each with its own considerations:


Dr. Friedman advocates for medication as the primary treatment option, supported by years of research and clinical experience. Methimazole is his preferred choice due to its safety profile compared to older medications like PTU. Dr. Friedman employs a carefully structured protocol for methimazole dosage adjustment and typically conducts thyroid tests every 1 to 3 months to monitor progress.

Radioactive Iodine and Surgery

While radioactive iodine therapy and surgery are alternative options, Dr. Friedman tends to avoid them due to their potential to induce hypothyroidism, which can be as challenging as hyperthyroidism itself.


In addition to medication, Dr. Friedman often recommends supplements like selenium or myoinositol to complement treatment. These supplements can offer additional support in managing Graves’ disease, although they may be unfamiliar to many healthcare providers.

Individualized Treatment Plan

Dr. Friedman emphasizes the importance of an individualized treatment approach tailored to each patient’s unique needs. He closely monitors symptoms and laboratory tests to ensure patients achieve optimal outcomes and experience rapid improvement.

By prioritizing medication, adopting a personalized treatment strategy, and closely monitoring patients’ progress, Dr. Friedman aims to provide effective management of Graves’ disease and facilitate swift recovery for his patients.

Living with Graves’ Disease 

Under Dr. Friedman’s treatment, most individuals with Graves’ disease experience positive outcomes. They typically see a restoration of normal thyroid function and a rapid resolution of symptoms. Dr. Friedman is vigilant in preventing hypothyroidism, ensuring patients maintain optimal thyroid levels throughout treatment. 

While Dr. Friedman focuses on thyroid management, he may refer patients to an eye specialist if necessary to address associated eye conditions. Additionally, his recommended lifestyle changes for Graves’ disease align with those for other endocrine conditions, emphasizing a balanced diet rich in vegetables, regular exercise, stress reduction, and fostering social connections. These holistic approaches contribute to overall well-being and support patients in managing their condition effectively.

Possible Complications of Graves’ Disease

Untreated or inadequately treated Graves’ disease can lead to various complications, including:

Cardiovascular Issues

Patients may develop heart problems such as atrial fibrillation, which increases the risk of strokes or blood clots.

Reduced Quality of Life

Untreated hyperthyroidism symptoms can significantly impact a patient’s quality of life, leading to discomfort and decreased well-being.

Mismanagement Risks

A significant concern is patients encountering endocrinologists who may not fully grasp the potential risk of hypothyroidism resulting from unnecessary thyroid removal or radioactive iodine treatment. Dr. Friedman has not encountered cases of thyroid storm, suggesting that early diagnosis and effective medication-based treatment are becoming more common.

Despite these risks, patients with Graves’ disease can generally expect to live a normal lifespan. Many patients can safely conceive and carry pregnancies without complications. Dr. Friedman adjusts medication regimens during pregnancy and recommends more frequent appointments to ensure optimal management and the well-being of both the mother and baby.

Contact Dr. Friedman for a Consultation

Overall, consulting a specialist like Dr. Friedman, who specializes in Graves’ disease, is highly recommended. Dr. Friedman will provide expert guidance on medication usage and ensure prompt symptom relief. To schedule a consultation with Dr. Friedman, please visit appointment booking.

Dr. Friedman’s web site does not offer medical advice. These materials are offered for information purposes only. Do not act or rely upon information from goodhormonehealth.com without seeking professional medical advice. Additionally, the transmission of information from the website, goodhormonehealth.com to you, is not intended to create nor does create a physician-patient relationship between you and Dr. Friedman.