What is Graves’ Disease? Hyperthyroid Autoimmunity Explained

What is Graves’ Disease? What Every Hyperthyroid Patient Should Know

What is Graves’ Disease?

Graves’ disease is a serious medical condition that will most likely be with you for the rest of your life. 

And because it impacts your thyroid gland, the consequences of this disease will have a lasting impact on you and your health. 

This article will help you to better understand your condition, how to live your best life DESPITE having it, the long-term consequences of this disease, how to look at your thyroid after treatment, and more. 

I can’t begin to tell you how important understanding your condition is because standard doctors will not give you the information I am going to provide you with here. 

And understanding this information could very well be the difference between thriving with your condition or letting it rule your life. 

Let’s break this down so it’s easy to understand:

Graves’ disease is an autoimmune disease of the thyroid gland which results in a condition known as hyperthyroidism. 

In Graves’ disease, your own immune system is attacking your thyroid gland and during this attack it causes your thyroid gland to produce EXTRA thyroid hormone. 

This extra thyroid hormone that is produced during the immune attack causes a state known as hyperthyroidism. 

Hyperthyroidism is just a way to describe how much thyroid hormone is in your body and it means you have TOO much in your system. 

As your thyroid hormone levels rise you will start to experience the symptoms of hyperthyroidism but more on this below. 

This part is pretty straightforward. 

It gets tricky when we talk about treatment, the long-term outlook on your condition, and how to thrive in the face of your disease. 


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What Causes Graves’ Disease?

It’s important that you understand that Graves’ disease is not JUST a thyroid disease. 

In fact, it’s probably better to think of it as a disease of your immune system. 

After all, your immune system is the thing that causes all of your thyroid problems (1). 

If you can manage your immune system (and there are ways to do this) you can reduce the impact and damage that it is causing to your thyroid gland. 

In this section, we are going to focus on the causes of Graves’ disease. 

We don’t know exactly why each person develops Graves’ disease but we do know that there are certain triggers. 

These triggers are sometimes within your control and sometimes they are not. 

Examples of these triggers include:

  • Infections, especially viral or bacterialthese infections (2) can cause problems with your immune system which then causes the development of antibodies to your thyroid gland. 
  • Genetics – you don’t have much control over your genetics but this seems to play a role. 
  • Gut or intestinal issues such as inflammation – Inflammatory conditions of the gut, as well as infections in the gut, can trigger immune dysregulation. 
  • Environmental factorsExposure to chemicals and heavy metals (3) can trigger immune problems. 
  • Dietary causes – Certain foods can lead to inflammation and may even cause problems with your immune system. Foods such as gluten are known to do this. 
  • Nutrient exposure – Exposure to high doses of iodine has been shown to be associated with Graves (4). 

If possible, you should always try to figure out what triggered your Graves’ disease. 

It may not be possible, or it happened so long ago that you’ve forgotten, but spend some time here to see if you can figure it out. 

Sometimes treating this cause can improve if not reverse your disease. 

Symptoms of Graves’ Disease Explained

Because Graves’ disease impacts your thyroid system it can and will cause a diverse set of symptoms. 

Your thyroid helps to manage, and even control, almost every system in the body. 

This includes your hormones, cosmetic features such as your hair or nails, your weight, GI function, and more. 

So it should come as no surprise that if you have Graves’ disease you will experience a wide array of symptoms that will come from nearly every part of your body. 

And because Graves’ disease puts your body in a hyperthyroid state the symptoms tend to be associated with activation in all of these systems. 

What do I mean?

Well, your thyroid helps to control your weight so if you turn up the dial on your metabolism then you can expect some weight loss. 

And this is exactly what we see in people who have Graves’ disease. 

Other symptoms of Graves’ disease include:

  • Hair loss (dry and brittle hair)
  • Diarrhea or increased bowel movements
  • Tremors or trembling/shaking of the hands
  • Anxiety or racing thoughts
  • Rapid heart rate
  • Chest pain
  • Shortness of breath
  • Weight loss (discussed above)
  • Changes in your menstrual cycle and infertility
  • Heat sensitivity (you will feel hot all of the time)
  • Decreased energy
  • Inability to sleep or insomnia
  • Bulging eyes

These symptoms all indicate that your thyroid is in overdrive and that your body is producing too much thyroid hormone. 

The good news is that ALL of these symptoms can be managed by simply managing your thyroid.

Treatments that are available to people who have Graves’ disease center on REDUCING or SLOWING down thyroid function and as this occurs you can expect your symptoms to resolve rather quickly.  

Treatment Options and the Consequences (What Treatment Should you Choose?)

Just because treatment is relatively “easy” doesn’t mean that it is without consequence. 

And this is something that you need to understand if you have Graves’ disease. 

While it is relatively easy to slow down thyroid function in the body, it’s actually quite difficult to get it just right. 

What do I mean?

Well, imagine that your thyroid system is pumping out too much thyroid hormone. 

We can give this a numerical value just to make it easier to understand. 

Let’s say that your thyroid is working at 150% of normal. 

In this case, normal thyroid function would be considered to be 100%. 

So if your thyroid is working as normal then you would have 100% of thyroid function. 

But we know that people with Graves’ disease have MORE thyroid hormone than they need so we can represent their thyroid function as some value that is greater than 100%. 

In this case, we know that your thyroid is working 50% more than it should normally so your thyroid function is at 150% of normal (meaning it is too high). 

So how do you manage this problem?

Well, it would be easy to just drop down the value from 150% to 100% by reducing the production of thyroid hormone by 50%, right?

In theory that is true. 

But let me tell you what actually happens in real life. 

Because prescription medications are more like blunt instruments, it’s very difficult to slow down the thyroid by the amount that you want. 

So as your doctor gives you anti-thyroid medication to slow down your thyroid function, your thyroid function drops BELOW the 100% you were aiming for. 

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Instead of dropping thyroid function from 150% to 100% your doctor accidentally drops your thyroid function from 150% to 75% of normal. 

So instead of giving you normal thyroid function your doctor actually switched you from having too much thyroid hormone to having too little. 

And this happens ALL of the time. 

It’s one of the main reasons that people who have hyperthyroidism often complain of LOW THYROID symptoms (not high thyroid symptoms). 

It’s because of this process. 

With that as a backdrop, let’s talk about the specific therapies that are available to people who have Graves’ disease. 

The most common therapy to use to manage high thyroid is anti-thyroid medication. 

This medication literally blocks thyroid function and lowers thyroid hormone by brute force. 

The most common medication used in the United States is a medication known as methimazole

If you are taking methimazole then your doctor is forcing your thyroid function lower with this medication. 

But anti-thyroid medication is NOT a long-term solution. 

In fact, it’s well known that using anti-thyroid medication for a long period of time can and will cause many problems in the body. 

So a more long-term solution for Graves’ disease is either one of two other options:

Option #1: Thyroid surgery to remove the entire gland (known as thyroidectomy).


Option #2: Radioactive iodine ablation therapy (the use of radioactive iodine to “kill” your thyroid gland).

These are both more long-term solutions compared to the use of anti-thyroid medications but they also can cause issues for people with Graves’. 

All of the therapies used to treat Graves’ ultimately result in you becoming LOW thyroid and this point can be very confusing for many patients. 

Just realize that if your thyroid has been removed or if it has been destroyed, you no longer have hyperthyroidism but instead, you now have hypothyroidism. 

Graves’ Disease vs Hashimoto’s (and other Thyroid Diseases)

Graves’ disease and Hashimoto’s are really two sides of the same coin. 

Both are autoimmune diseases that impact the thyroid but they differ in the antibodies produced and the long-term effect that they have on your thyroid gland. 

Those people who have Graves’ typically have antibodies to something called the TSH receptor (known as thyrotropin antibodies). 

But many patients with Graves’ can ALSO have positive antibodies to other parts of the thyroid including thyroglobulin antibodies and anti-TPO antibodies

These antibodies result in HYPERTHYROIDISM in the long term. 

But the exact opposite is true for women who have Hashimoto’s. 

While Hashimoto’s is ANOTHER autoimmune disease of the thyroid gland, instead of causing HYPERTHYROIDISM these people develop HYPOTHYROIDISM. 

So instead of having high thyroid (like those with Graves’) they actually have low thyroid. 

And they typically only have antibodies to thyroglobulin and thyroid peroxidase

But what’s interesting is that the triggers for both diseases are basically the same. 

So whether or not you develop Graves’ disease or Hashimoto’s probably depends on your genetics and other factors we don’t quite yet understand. 

Diagnosing Graves’ Disease

Compared to other thyroid diseases, diagnosing Graves’ disease is actually quite easy. 

There are 3 main ways to do it: 

#1. Thyroid lab tests. 

The first and easiest step is to simply check thyroid hormone levels in your blood. 

Because Graves’ is associated with high thyroid function you will typically see a SUPPRESSED or LOW TSH, a HIGH free T3, and ELEVATED thyroid antibodies

This pattern is easy to identify and almost universally means that you have Graves’ disease. 

#2. Thyroid Ultrasound. 

You can also look directly at your thyroid gland using an ultrasound machine

Ultrasound doesn’t give you a perfect picture of your gland but it’s great for identifying nodules. 

These nodules can sometimes be the cause of hyperthyroidism and they can be evaluated with a biopsy (known as FNA). 

#3. Radioactive Iodine Uptake (RAIU). 

Lastly, you can also use radioactive iodine to see how active your gland is. 

In this test, you are given radioactive iodine to see how much is taken up by your thyroid gland. 

This is another useful tool to see what part of your thyroid gland is experiencing problems. 

Is Graves’ Disease Fatal and What Should you Expect?

Graves’ disease is NOT a fatal disease!

Graves’ disease CAN cause a life-threatening condition known as thyroid storm but this is VERY rare. 

Nowadays, it’s very uncommon for Graves’ disease to cause this condition (though it does happen from time to time). 

But just because it isn’t fatal doesn’t mean that your outlook is necessarily good. 

The problem that many people with Graves’ disease face is their long-term outlook. 

You will definitely live, no doubt about it, but will you thrive?

And that’s the important question. 

Almost all of the therapies used to treat Graves’ lead to a LOW thyroid state. 

And this state is much more tricky to manage than a high thyroid state and leads to all of the exact opposite symptoms you experienced when you had Graves’ disease. 

Believe it or not, the biggest problem people with hyperthyroidism face after treatment is usually weight gain

This stems from inadequate treatment of their thyroid after it has either been removed or damaged. 

Managing your thyroid function after treatment is VERY important and will determine how you feel in the long term. 

If you spend time on my blog then you will find all sorts of resources designed to help you manage your thyroid after it has been ablated or removed with various types of thyroid medications, various types of supplements, and other therapies such as diet and exercise. 

My advice is to spend some time and become well acquainted with these therapies as you cannot count on your doctor to help you with them. 

Final Thoughts

Graves’ disease is an autoimmune disease of the thyroid gland which causes a hyperthyroid state. 

Treatment is relatively easy but can lead to a different set of problems as your thyroid slows down. 

The long-term outlook of Graves’ disease is very good but managing your quality of life afterward can be difficult. 

Use the resources on my website to help guide you so you can live your best life!

Once you have been treated for Graves’ you will want to focus on therapies such as your diet, how much you exercise, the use of supplements, and the use of specific thyroid medications to get back to that optimal state. 

Now I want to hear from you: 

Are you suffering from Graves’ disease right now?

Where are you at in your treatment?

Are you taking methimazole? Have you already had your thyroid ablated or surgically removed?

How are you currently feeling and how are you holding up?

Leave your questions or comments below! 

#1. https://www.ncbi.nlm.nih.gov/books/NBK285548/

#2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650880/

#3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286962/

#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976240/

a simple guide to graves' disease

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

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32 thoughts on “What is Graves’ Disease? What Every Hyperthyroid Patient Should Know”

  1. Could you post which thyroid meds including the natural ones are made in the good old USA? (I would like to know for many reasons) This information is very difficult to find.

  2. Dear Dr Childs, thank you for this article. I was diagnosed with Graves Disease in 2014 and had a thyroidectomy 3 months later.
    It’s 2020 and I am still hyperthyroid. All my tests show that I have a low TSH and high T4 and T3. I had been on 137 mcg for a couple of years my new Endocrinologist has lowered the dosage to 125 mcg. I have gained 15 pounds in 2 months and I feel lethargic and tired all the time. We repeated the blood work only to show my TSH is still really low and now my dosage has been lowered to 112 mcg. Why am I having Hypothyroid symptoms but my test results show hyper?
    I want to feel better, but how?
    I would love to switch from Levothyroxine to NDT but is that safe with Graves? Please help me!!!
    I have also developed Graves Eye disease and now my eye is bulging and one is dropping.

  3. Help, my thyroid is now moved to hyper. I’ve been taking np 90 mcg and my new dr. Wouldn’t address it. Told me the that Tsh was no big deal but did draw a lab Which I don’t know what it is yet. I think I got some of the Acella np that was the super potent batch…I have lots of symptoms that are distressing..insomnia, muscle weakness in my legs, pounding heartbeat, high anxiety. He was more worried about my cholesterol. Can I just stop this med. the pharmacist was alarmed and told me to bring the med back but what am I supposed to do?

  4. HI Dr Childs;
    It’s great to find a legitimate Dr who specializes in the thyroid realm and not just Hashimotos and hypothyroidism. In 2009 I had the left lobe of my thyroid removed due to a very large growth on it. And after that, nothing was done – I was on my own. While I constantly complained of never ending fatigue, in Canada, they only do the TSH test and I was told it was normal. I felt like a hypochondriac. When I moved to California, I became very ill and had to see a Dr. Going through my history, I was referred to an Endo, who, after testing me, diagnosed me as having Grave’s Disease. I had a radioactive test to confirm Graves. I was going to have my right lobe removed but the new Endo said no way, because my levels were so high, she said she was fearful I wouldn’t make it through the surgery. The new Endo was trying to convince me to go with RAI. I read up on it and said, NO WAY. In the meantime, my weight has continued to escalate. in 2019, my Endo called and told me she was afraid I was going to have a heart attack or stroke because my levels were so high and she convinced me to start taking medication. Propylthyrocil. OH MY GOODNESS!! I felt so ill all of the time and my weight has gone up up up. 5 months later, I became very ill, pain, vomiting, diarrhea and terrible pain in the upper right of my body. It was thought it was my liver. I have NAFLD to begin with. So, I told the Endo I was no longer going to take the Propylthyrocil because I was afraid it was damaging my liver more than it was already. So, I’ve been off the meds for over 1 year, still gaining weight, still battling constant fatigue and wondering what to do next….. Can you make any suggestion please? Thank you.

  5. Hi everyone!

    Thanks for the beautiful information. I am a homeopath from İstanbul Turkey.

    İ’ve been diagnosed with Graves on 2020 August. My TSH was 0.0001 and my T3 level was above 16. I also had severe bulging eyes.

    I used methimazole for 3 months. And stopped due to ıts ill Side effects. I knew they were just suppressing my symptoms. First few weeks of withdrawal was bad!! Then i started using homeopathy, psychotherapy and neuraltherapy. I followed a strict gluten free diet and used wheatgrass juice as a selenium source. And after 3 months my bulging eyes are much better. They were not getting better with the methimazole. I am no longer having tachycardia and diarrhea which i experienced after i stopped taking methimazole.

    I know what i did was crazy and unorthodox. But i can feel its the right choice. Medicines were taking me nowhere. Your work is precious Doctor. Thanks for sharing these with everyone.

    Dont lose hope guys. Just listen to your body and find a good CAM therapist.

  6. I have graves i take methmiazole but I just found out how can I get rid of it naturally and what wil help because my thyroid is overactive

  7. I was diagnosed with Graves a year and a half ago. A new Dr. I was seeing was concerned with my rapid heart rate, which I always have had, which led to this diagnosis. I have had high blood pressure for 20 years, and am 51. I have been taking 5mg Methimazole, 10mg Propranolol, along with my Losartan 100mg daily for 18 months. This past year has been hell. Gained 40 lbs, so tired, achy, bitchy, and just sick and depressed. Recently been having chest pains. Believe in menopause also. Help me! I have a nine year old son and want to run around like I could just 18 months ago.

  8. Diagnosed with Graves in March of this year. Started taking tapizole 5mg. Currently down to 5mg per day. My bu=iggest issue is my liver enzymes have risen and now my endo wants me to have surgery to remove my thyroid. I ad high enzymes of the liver before being diagnosed and now they are even higher. I am scared to have the surgery because I do not want to have hypothyroidism and gain weight and from what I have heard miserable. I just don’t know what to do.

  9. TSH IS 3.778 OUT OF 0.350-5.000 SCALE
    FREE T 4 IS .09 OUT OF .08-1.5 SCALE
    FREE T 3 IS 2.4 OUT OF 2.2-4.0 SCALE
    BLOODWORK DONE 6/18/21







  10. Hi Doc. I was recently diagnosed with Graves disease. I was put on 20mg of carbimozole. In the first month I noticed I gained wait which is the last thing I needed because I am grossly overweight but had lost 20 kgs in a couple of months. So when I saw I was gaining again I reduced my dosage and managed to lose 8 kgs but it’s up going and down with 3 kgs. I feel so tired and feel like my bones are weak as I struggle to support my weight sometimes. I also take the dosage intermittently. Please help as I don’t want to have hypothyroidism

    • Hi Angela,

      Unfortunately, I’m not able to make recommendations on how you can adjust your medication (only your doctor can do that) but what I can tell you is that it seems like you are taking too much methimazole to the point that it is now slowing down your thyroid significantly.

  11. Hi
    I was diagnosed with Graves disease Oct 19 2021.
    I started treatment. My Endocrinologist prescribed Methamozle 10mg 3 times a day and beta blockers 5mg 3 times. A day. Now he adjusted after three weekes my numbers were still not normal but not as high as where I was greater than 24.9 . Now my question is will I always have Graves disease symptoms. When I first started I was miserable. Now I am doing better. But I have my days . Is like high and low. I have little to knowledge about this disease. I am trying to educate myself now. But is perhaps the worst thing I have ever experienced in my life.

  12. Hello Dr. Child’s, diagnosed in 2020 with Graves. I’m now on 2 1/2 mg. of methimazole. Next labs and appointment in a month. Expecting to be taken off of meds.
    Tired, weight gain, depressed. No idea what’s next. Not a fan of surgery or ablation. Pretty disappointed with the lack of education from my endocrinologist. I’m getting more and more frustrated and confused the more info I get. Started taking supplements, and I’m looking into gluten free diet. What will happen when I’m off the meds? Thank you for addressing Graves, as not many resources.

  13. Thank you DR Childs for this article… I recently had a full thyroidectomy performed on me just over 2 weeks ago… But prior to that, I had a biopsy just over a year ago done on 1 of the nodules that were picked up in my scans, and the results of that biopsy were benign… The reason I had my thyroid removed is that I was struggling with breathing, continuously feeling as if something was always stuck in my throat, and alongside other health issues and then after a recent ultra-scans, my DR said my thyroid had tripled in size and was growing downwards below my collarbone that’s why I was having so much discomfort… Yesterday I received a call from my doctor he needed to see me ASAP… that they have received results from the pathology report from my thyroid being removed and the tissues that have been tested indicate malignant and need me to go for CT Scan and further tests, to make sure nothing has spread to other areas of my body and I have a follow-up appointment once they have results, my doctor indicated that he was still waiting for 1 more test result from the lab, and will discuss at my follow-up appointment… and work on a plan moving forward…

    My question is how is it possible that when I had a biopsy that nothing was picked up, I was just told I had a goiter… I have now been diagnosed with graves disease after my entire thyroid had been removed and now further tests are needed because the tissue that was tested has come up malignant.

    On a positive note… I feel totally amazing after the removal of my thyroid, my breathing has improved, I’m not so tired, my bones and muscles are back to normal, more active, lots of energy, my heart and thoughts have stopped racing, no shakes at all… I have changed things in my life to help me move forward… I haven’t felt soo happy in a long time…

    • Hi Anna,

      That’s not that uncommon, actually. When you take out the entire thyroid gland you have a lot more tissue to look at under the microscope.

      When you send out a biopsy to the lab you are just sending out a single sample (or just a few) and it’s possible that the sample just doesn’t contain the bad cells that are causing the issue either because the biopsy was done in the wrong place, or because of bad luck, or because the cells you needed to see where just a few millimeters away.

  14. Hello Dr Childs, thank you for all the resources you make available to us. It’s very helpful. I found you when my blood test showed TSH 0.1 and TPO antibodies at 900 but T4 and T3 are both right in the middle of the normal range. What could this indicate? Does Graves always cause high T3 and T4? If you could point me to an article or a resource, I’d really appreciate it.

    • Hi Mary,

      It depends on the circumstances. Are you currently taking thyroid medication? Did you also get your TSI antibodies evaluated?

      • Thank you for replying, Dr Childs. My endocrinologist wants to put me on methimazole (5mg) but I’m hesitant to take it and supress my T3 and T4 even further. I’m not losing weight (on the contrary, I put on 5 lbs in 2 months), which makes me think that further lowering of the hormones is not necessary. The Dr didn’t test for TSI antibodies, just TPO. Ultrasound showed enlarged gland and iodine uptake was high. Any idea what that may mean? Why are both my TSH low and T3, T4 not high?

  15. I am newly diagnosed with Graves and new to your blog. I have not seen mention of Metoprolol, which I am taking in addition to Methimazole and aspirin. I was in the beginning stages of congestive heart failure due to Afib and treated at the ER leading to my diagnosis. I want to get off all three of these meds ASAP but am nervous about going back into atrial fibrillation. At seven weeks in with theses meds, the doc just upped my dose of Metoprolol to 150 ml. a day for irregular heart rate. I am on 30 mg Methimazole. When and how do I ween off these meds or at least consider the parameters to approach my endocrinologist to do so? Thank you very much! I appreciate your info and supplements.

    • Hi Aimee,

      There are no real parameters to look at because once you start taking methimazole you suppress thyroid function. You can’t look at those values because they are being artificially manipulated. You’ll need to base your decision on other factors such as your symptoms and how aggressive you are with your other therapies and treatments.

  16. Hi, my name is Missy and I am in the process of being diagnosed with hyperthyroidism. I went into the doctor because of an increase in my anxiety for no real reason and for a very high heart with the occasional flash of high blood pressure. Heart Disease is very prevalent in my family, so despite the fact that I have a healthy lifestyle compared to my family, I thought I might be losing the genetic battle. I spent a great deal of time with a new GP, she wanted to start with the thyroid. Turns out my TSH was the undetectable range. She had me come back to test T3 Free and T3 Total. Both were off the charts high (two and three times higher than normal). She believes I have Grave’s Disease and I have now been referred to an endocrinologist to take a closer look. For now, I am take propranolol to help with my heart rate. My biggest question is do I really have to take meds, have the thyroid removed, or destroy the thyroid with the radioactive iodide? Honestly, I do not want to do any of the three. Are the other options that don’t involve any of the above? I have no desire to shift into a hypothyroid state and gain a ton of weight. Call it vanity, but I enjoying being slender and the thought of gaining a bunch of weight is not something I wish to do and I will have a major impact on my mental health. I’m more interested in what natural remedies may be out there and try those for at least 6-8 months. I have read that in about 50% of case hyperthyroidism disappears as randomly as it appeared. Why destroy or remove my thyroid if that is a possibility?

  17. I was diagnosed with GD around 15 yrs ago. I wasn’t given much information at the time and have regretted the decision to have my thyroid ablated ever since. After the procedure, I have experienced a prolonged relationship with chronic stress and each subsequent stress event (illness or emotional) will now trigger an 8-week round of hair loss.
    I’ve not yet found a Dr that has taken this aspect seriously enough to really investigate what’s happening to me and to provide me with sound information, although he does run blood works to periodically check my thyroid hormone levels.

    I am only 43 and have about 20% of the hair I once did. My hair tries to grow back, but lately, the stress events have been closer together, and I’m just so emotionally exhausted from this stress-hair loss cycle.


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