after childbirth, Hereditary factors are the major risk factor for the development of Graves disease, with "79% of the liability to the development of GD ... attributable to genetic factors”. Smoking and exposure to second-hand smoke is associated with the eye manifestations but not the thyroid manifestations.
This leads to an enlargment of the thyroid and very high levels of circulating thyroid hormones
The hormonal dysregulation induces heartbeat, muscle weakness, disturbed sleep, and irritability.