Signs of Graves Disease

Signs of Graves Disease

Fascinating that people around the world continue to identify and document signs and symptoms of thyroid disorders. Yet you just try this at your next GP appointment "I think I might have Graves because my signature has changed ..." :-)

If hyperthyroidism impacts on handwriting, I am convinced that so too does hypothyroidism.

Thyroid. 2014 Apr 2. [Epub ahead of print]


Papi G Md1, Botti C, Corsello SM, Ciardullo AV, Pontecorvi A, Hegedus L.

Author information

1Catholic University of Rome, Chair of Endocrinology, Largo Gemelli 1, Rome, Italy, 00168, 3478896941 ;


Background. Thyroid hormones are crucial for metabolism of all tissues in man, including the nervous system and the muscles, and could thus affect handwriting which is the synthesis of complex and fine movements. Hyperthyroidism, characterized by symptoms such as tremor and weakness, could affect handwriting although this has not been studied yet. The aim of this study was to evaluate handwriting characteristics before and after therapy of hyperthyroid Graves' disease (GD).

Methods. 22 patients (15 women, 7 men) with untreated GD (median age: 44 yrs; range: 20-70 yrs) were asked to write a "standard text" before and 12 months after being rendered euthyroid. The letters underwent a standardized detailed analysis by a handwriting expert, through inspection and stereoscopic microscope and magnifying glass.

Results. All patients demonstrated handwriting variations, perceptible even to direct observation. Graphological examination showed statistically significant changes after becoming euthyroid, in the following parameters: size of letters (4.5±1.1 vs 5.9±1.3 mm; P<0.01), distance between letters (62.9±1.1 vs 55.2±0.8; P<0.01), width of letters (1.75±0.06 vs 2.2±0.06 mm; P<0.01), distance between words (216.2±3.2 vs 198.7±2.4 mm; P<0.01), extension of letters (8.7±0.2 vs 7.7±0.2 mm; P<0.01), angles (17±0.3 vs 15.8±0.4; P<0.01), and groove depth (0.2±0.05 vs 0.4±0.05 mm; P<0.01).

Conclusions: Hyperthyroid GD was associated with significant changes in handwriting in all patients. Following recovery from hyperthyroidism, a state of hypertrophic and contracted handwriting resulted in greater fluency and fluidity. Variations in handwriting should be included as signs/symptoms in GD.



[PubMed - as supplied by publisher]


Image is of the signature of 41st USA president George Bush who developed Graves.

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18 Replies

  • At the age of 14 or 15 I had to learn to write all over again, guided by my art teacher, because my handwriting had become illegible. As you know, I was diagnosed at 13 with Graves'. I had never imagined there was any connection!


  • I print, always have done to the dismay of many a teacher but before the diagnose I started joining up and it was really sloppy to the point I could barely read it. I tried printing but it was as though my brain refused. I wondered if I had suffered a stroke?

    Never knew it was Graves related. Thanks for solving and another piece of the jigsaw.

  • my writing is illegible unless I write really slowly.i so often cant read my own that I rewrite lists over and over.i find it impossible to sign on the machines delivery people have,could be related to graves /thyroid-have symptoms but gp wont recongise them.

  • Thank you for this, I have been having trouble writing for four or five years now and have found it frustrating and embarassing. I thought I'd had a mini stroke as the neurologist didn't think it was Parkinsons or MS. I also find it difficult to wash glasses as I have a tendency to break them because I cannot control the pressure I apply :-( It is good to know that it may be reversible x

  • Before I was diagnosed Hypo and on thyroxine my handwriting got worse and worse over a few months and looked really messy, as soon as I was diagnosed and put on thyroxine my handwriting went back to normal x

  • Wow! That is absolutely amazing and so accurate. My handwriting has changed (I really mean deteriorated!) so much. I thought it was either because I use the computer so much I was just out of practise or else because of my Dupytren's even though my bad hand is not in the hand I write with.

    Thank you again Rod for a masterpiece of research :-)

  • I had very neat handwritig and it degenerated into scrawl as my undiagnosed hypothyroidism worsened. It has improved with treatment on levothyroxine but I have to concentrate hard to keep it looking nice. I had read hypothyroidism affects handwriting which does not surprize me in the least given what else it affects so profoundly. Fascinating post ;-) thanks

  • This is a really interesting thread.

    I was diagnosed hyperactive thyroid condition in 2011 and treated with Carbimazole.

    My handwriting was shocking and deteriorated badly with the hand tremor and brain fog. After medication my handwriting greatly improved but after a short while in remission the overactive symptoms returned including illegible handwriting!

    I am taking Carbimazole once again and my handwriting is acceptable once more because my shakiness is controlled and my brain-fog days have lessened. I definintely agree that there is a very real connection between the thyroid condition and signatures.

    As always Rod, you are a mine of information and very many thanks for sharing this.x

  • I emailed the author(s):

    Thank you - fascinating.

    What I want to know is are you or have you done something similar with regard to hypothyroidism?

    Also, how specific are the changes? Could you look at the precise changes and say "This person has changes which are not only consistent with Graves, but make Graves a leading candidate for final diagnosis."

    Or would they be the same in many other disorders? Or only in other causes of hyperthyroidism such as some sort of growth that over-produces thyroid hormone?

    And got this reply within an hour or two:

    Dear Sir,

    thank You so much for Your interest in this paper.

    Your questions are fascinating!!

    At the moment, what I can say honestly is the following.

    This represents a first observation in the literature, and thus further studies are needed to confirm our results in a larger cohort of patients. Indeed, due to rigorous selection criteria, we could include only 22 patients in the study (we started it on 2006!!!). Our patients all had OVERT hyperthyroidism and were ALL affected by Graves' disease. Now, we are studying handwriting in patients with overt hyperthyroidism related to nodular thyroid disease, in patients with subclinical hyperthyroidism, and - more importantly (by my point of view) - in patients with hypothyroidism. We hope to have sufficient data within the current year. Keep in touch!

    Best regards


    I shall be sending Giampaolo a link to this post so he can see your responses! Keep them coming. :-)


  • I'll add myself to the 'me too' list of people with hypOthyroidism whose handwriting deteriorated badly. Over time, I struggled more and more to write at all, let alone anything like as neatly as my handwriting once was.

    Both hypO and hypER affect muscle and brain function, which surely must mean that the fine motor skills required for handwriting cannot fail to be affected.

    On appropriate thyroid medication, my handwriting has improved a lot, but still varies from day to day and is never as neat as it once was. Thank goodness for keyboards!

  • I am also a "me too" re. deteriorated handwriting and hypothyroidism. I was never a "neat "writer but wrote in quasi-italics with a firm stroke (and likewise my art teacher said, I also used a paintbrush like a scrubbing brush!) but since my symptoms have become worse, starting about 18 months after adding T3 to my T4 and doing well for a while, muscle weakness and tremor had rendered my writing a messy shadow of its former self. :-(

  • Me too! I'd noticed this for a while, someone at work put a piece of paper on my hand - to show the tremor, of course some folk think it's from alcohol :(

    I write up meetings & look back at the scrawl in horror! as my memory is poo too. Also I can't remember what my signature is supposed to be like so I just do a squiggle & hope for the best! (it's different every time). When the tremor & painful fingers were really bad I bought 'dragon dictate' as typing took ages, thankfully less shaky since nodule op.

    J :D

  • Have felt for a long time that I cannot put enough pressure on the pen to write firmly enough and that the pen has a mind of its own, but my handwriting has only deteriorated in the last 3-4 years (in line with the Levo maybe?). Very interesting to know that there is a reason for it though and not surprising it is our usual thyroid one. Janet.

  • I read that the singer missy elliott had a problem with her handwriting as a problem with Graves

  • So that's why the Bank refused a cheque on my signature! Huh! Didn't stop them from accepting funds on my signature!! What a load of bankers!

    Currently my handwriting is tiny, much smaller than I've ever written. Whilst before the onset of symptoms I used to do calligraphy and designed my own cards. Now can no longer hold a pen steady enough or write with confidence - but that's ageing too.

  • I used to be a Calligrapher too :-( Now I avoid writing at all if I can x

  • Yes, it had crossed my mind too, my handwriting had changed. I thought it was age-related but now it maybe hypo related so I am a little happier.

  • It can be very odd what we end up being happy about. :-)

    (I do understand, though.)


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