**7.2 Thyroid storm**

If Graves' Disease left untreated or treated inadequately, can cause a rare but life-threatening complication called Thyroid Storm also known as thyrotoxic crisis or accelerated hyperthyroidism and requires immediate emergency care. The sudden and drastic raise in thyroid hormones causes fever, sweating, vomiting, diarrhea, delirium, severe weakness, seizures, irregular heartbeat, yellow skin and eyes (jaundice), severe low blood pressure, and coma.

#### **7.3 Heart disorders**

Untreated, Graves' Disease can lead to heart rhythm disorders, changes in the structure and function of the heart muscles leads to inability of the heart to pump enough blood to the cells to meet the metabolic demand. Hyper secretion of thyroid hormone causes left ventricular thickening which may lead to heart failure and cardiac-related death. Thyrotoxicosis also has been associated with dilated cardiomyopathy, [96] right sided heart failure with pulmonary hypertension, diastolic dysfunction and atrial fibrillation [97]. An irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart-related problems such as angina.

#### **7.4 Brittle bones**

Untreated hyperthyroidism increase in the rate of bone resorption can lead to weak, brittle bones (osteoporosis). Too much thyroid hormone interferes with body's ability to incorporate calcium into bones. Patients with Graves' Disease have significantly increased in serum calcium and phosphate, plasma FGF-23 compared to healthy individuals and amongst FGF-23 is physiologically related to serum phosphate homeostasis in untreated Graves' Disease [98].

#### **7.5 Maternal/fetal complications**

Possible complications of Graves' Disease during pregnancy include miscarriage, preterm birth, fetal thyroid dysfunction, poor fetal growth, maternal heart failure

and preeclampsia. Preeclampsia is a maternal condition that results in high blood pressure and other serious signs and symptoms.
