Materiały źródłowe

• #1 Graves Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448195/

  Graves’ disease is the most common cause of hyperthyroidism. […] Clinicians ought to be aware of systemic manifestations of Graves’ disease and the different modalities available for treatment. Early diagnosis and management of Graves’ disease can also prevent severe cardiac complications such as atrial flutter, atrial fibrillation, and high output cardiac failure. […] This activity reviews the evaluation and treatment of Graves’ disease and highlights the role of the interprofessional team in reducing morbidity and improving care for affected patients. […] Treatment for Graves’ disease depends on its presentation. Treatment consists of rapid symptoms control and reduction of thyroid hormone secretion. […] There are three options to reduce thyroid hormone synthesis. These options are: Antithyroid drugs which block thyroid hormone synthesis and release, Radioactive iodine (RAI) treatment of the thyroid gland, Total or subtotal thyroidectomy.

• #2 Graves’ Disease: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15244-graves-disease

  Surgery: A thyroidectomy involves surgically removing all or part of your thyroid gland. […] Antithyroid medication, radioiodine therapy and surgery all have benefits and risks, and theres no consensus in the medical community on which treatment is the best option. Its important to discuss all three options in detail with your provider to make the best choice for you.

• #3 Graves’ Disease: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15244-graves-disease

  Graves disease is a lifelong (chronic) condition. However, treatments can keep your thyroid hormone levels in check. Medical care may even make the disease temporarily go away (remission). […] Treatments for Graves disease include: […] Beta-blockers, such as propranolol and metoprolol, are often the first line of treatment for Graves disease. These medications regulate your heart rate and protect your heart until other hyperthyroidism treatments take effect. These medications dont stop thyroid hormone production. […] Antithyroid medications, such as methimazole (Tapazole) and propylthiouracil, block your thyroids production of thyroid hormone. […] Radioiodine therapy: This therapy involves taking one dose of radioactive iodine in pill or liquid form. Over two to three months, radiation slowly destroys thyroid gland cells.

• #4 What Is Graves’ Disease? | American Association of Clinical Endocrinology

  https://www.aace.com/disease-and-conditions/thyroid/what-graves-disease

  Treatment for Graves disease can include one or a variety of the following: […] Radioactive iodine therapy: Radioactive iodine is a capsule or liquid that destroys the overactive thyroid cells over time. […] Anti-thyroid medications: Used to slow down how much thyroid hormones your body makes. Anti-thyroid medications are currently the most common treatment option. […] Beta blockers: These medications help block the effects of hormones on the body, and are especially helpful in the beginning when waiting for other treatments to take effect. […] Surgery: Surgery usually takes the form of thyroidectomy (complete removal of the thyroid gland). After surgery, medications can be taken to supply the body with normal amounts of thyroid hormone.

• #5 Hyperthyroidism (Overactive Thyroid): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14129-hyperthyroidism

  A surgeon may remove all or part of your thyroid gland through surgery (thyroidectomy). This will correct hyperthyroidism but will usually cause hypothyroidism, requiring lifelong thyroid hormone medication. […] Beta-blockers are medications that can help manage hyperthyroidism symptoms like rapid heartbeat, nervousness and shakiness. But they dont change the level of hormones in your blood. Your provider may recommend beta-blockers alongside another treatment. […] Hyperthyroidism is a treatable condition. Most people do well with treatment. While some forms of treatment require you to take medication for the rest of your life, this will help keep your thyroid hormone levels in a healthy range. […] If you have Graves disease, ask your healthcare provider how you can best manage the condition.

• #6 Graves’ disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/graves-disease/diagnosis-treatment/drc-20356245

  Treatment for Graves’ disease aims to stop the thyroid from making hormones. Treatment also blocks the effect of the hormones on the body. […] With this therapy, you take radioactive iodine, called radioiodine, by mouth. The radioiodine goes into the thyroid cells. Over time, it destroys the cells that make thyroid hormone. This causes your thyroid gland to shrink. Symptoms ease little by little, most often over several weeks to several months. […] Radioiodine therapy may raise the risk of thyroid eye disease or make its symptoms worse. This side effect most often is mild and doesn’t last. But the therapy might not be for you if you have moderate to severe eye symptoms. […] Anti-thyroid medicines block the thyroid from using iodine to make hormones. These prescription medicines include propylthiouracil and methimazole.

• #7 Diagnosis and treatment of Graves disease – PubMed

  https://pubmed.ncbi.nlm.nih.gov/12841824/

  Objective: To review the etiology, diagnosis, and clinical presentation of Graves disease and provide an overview of the standard and adjunctive treatments. Specifically, antithyroid drugs, beta-blockers, inorganic iodide, lithium, and radioactive iodine are discussed, focusing on current controversies. […] Graves disease is the most common cause of hyperthyroidism. The 3 main treatment options for patients with Graves hyperthyroidism include antithyroid drugs, radioactive iodine, and surgery. Although the antithyroid drugs propylthiouracil (PTU) and methimazole (MMI) have similar efficacy, there are situations when 1 agent is preferred. MMI has a longer half-life than PTU, allowing once-daily dosing that can improve patient adherence to treatment. PTU has historically been the drug of choice for treating pregnant and breast-feeding women because of its limited transfer into the placenta and breast milk. Adjuvant therapies for Graves disease include beta-blockers, inorganic iodide, and lithium. beta-Blockers are used to decrease the symptoms of hyperthyroidism. Inorganic iodide is primarily used to prepare patients for thyroid surgery because of its ability to decrease the vascularity of the thyroid gland. Lithium, which acts in a manner similar to iodine, is not routinely used due to its transient effect and the risk of potentially serious adverse effects. In the US, radioiodine therapy has become the preferred treatment for adults with Graves disease. It is easy to administer, safe, effective, and more affordable than long-term treatment with antithyroid drugs. Hypothyroidism is an inevitable consequence of radioiodine therapy. Radioiodine is contraindicated in pregnant women because it can damage the fetal thyroid gland, resulting in fetal hypothyroidism. Bilateral subtotal thyroidectomy, which was once the only treatment available, is now performed only in special circumstances. In addition to the normal risks associated with surgery, laryngeal nerve damage, hypoparathyroidism, and hypothyroidism can occur following that procedure.

• #8 What’s the Best Way to Treat Graves’ Disease? | ColumbiaDoctors

  https://www.columbiadoctors.org/news/whats-best-way-treat-graves-disease

  Treatment of Graves’ disease involves the same medications and interventions used since the 1940s. Over the years, the way these treatments are deployed has changed and Lowe has seen the benefits. […] Currently, the initial treatment for Graves’ disease in the United States is medication. There are two: methimazole and propylthiouracil, both approved more than 70 years ago. […] After 12 to 18 months on medication, if the Graves disease did not go into remission, patients are often advised to have radioactive iodine or surgery to remove the overactive thyroid gland. […] These treatments are considered definitive (Graves will not recur). After, theres permanent hypothyroidism. […] Over the last few decades, doctors in the United States have shifted away from radioactive iodine as the initial treatment. But it remains effective and definitive.

• #9 Hyperthyroidism: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p363.html

  Graves disease requires one of the three treatment options: an antithyroid medication (methimazole [Tapazole] or propylthiouracil), radioactive iodine (I-131) ablation of the thyroid gland, or surgical thyroidectomy. The choice of treatment depends on the benefits vs. risks in a specific clinical situation and on the patient’s preference. […] Antithyroid medications are thionamides; they inhibit thyroid peroxidase, blocking the synthesis of T3 and T4. Thionamides can serve as a long-term therapy or as a bridge to I-131 ablation or thyroidectomy, with the goal of normalizing thyroid function and preventing exacerbation of hyperthyroidism after I-131 ablation or avoiding surgical risks associated with uncontrolled hyperthyroidism. Because Graves disease remits in up to 30% of patients treated with thionamides, these medications can be used as the initial treatment, with ablation or thyroidectomy performed if remission does not occur.

• #10 Graves’ disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/graves-disease/diagnosis-treatment/drc-20356245

  When either of these medicines are used without other treatments, hyperthyroidism may come back. These medicines may work better when they are taken for longer than a year. Anti-thyroid medicines may be used before or after radioiodine therapy as an added treatment. […] Surgery to remove the thyroid, called thyroidectomy, can treat Graves’ disease. You need to take thyroid medicine for the rest of your life after this surgery. […] For symptoms of thyroid eye disease that are worse, treatment might include corticosteroids. Treatment with corticosteroids given through a vein may ease swelling behind the eyeballs. […] This treatment is mainly used if pressure on the optic nerve might cause loss of vision. Possible complications include double vision. […] Thyroid eye disease doesn’t always get better with treatment of Graves’ disease. Symptoms of thyroid eye disease may even get worse for 3 to 6 months. After that, the symptoms of thyroid eye disease most often stay the same for a year or so. Then the symptoms begin to get better, often on their own.

• #11 A Review of Treatment Options for Graves’ Disease

  https://www.uspharmacist.com/article/a-review-of-treatment-options-for-graves-disease

  In Graves disease, propylthiouracil (PTU) and methimazole (MMI) are given to inhibit thyroid production. The primary objective of using antithyroid medications is to induce remission.1 Maximum remission rates of 30% to 50% are observed after 12 to 24 months of therapy. Remission is defined as a normal thyrotropin level while no medication is being taken. Patients who exhibit a smaller goiter (50 g), are older (40 years), have a short disease duration (6 months), have taken antithyroid medication for 1 to 2 years, or have no history of relapse are more likely to experience remission.1-3 […] Patients whose Graves disease is more severe and those who have relapsed after antithyroid therapy are candidates for RAI treatment. RAI given as I is the preferred drug for treating Graves disease in the U.S., as it is rapidly absorbed into and concentrated in thyroid follicular cells. Beta particles emitted from the absorbed I cause follicular-cell necrosis and destruction within weeks to years of treatment.1,4

• #12 Hyperthyroidism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/diagnosis-treatment/drc-20373665

  Although rare, serious liver damage can happen with both anti-thyroid medications. But because propylthiouracil has caused many more cases of liver damage, it’s generally used only when people can’t take methimazole. A small number of people who are allergic to these medicines may develop skin rashes, hives, fever or joint pain. They also can raise the risk of infection. […] Beta blockers. These medicines don’t affect thyroid hormone levels. But they can lessen symptoms of hyperthyroidism, such as a tremor, rapid heart rate and heart palpitations. Sometimes, health care providers prescribe them to ease symptoms until thyroid hormones are closer to a standard level. These medicines generally aren’t recommended for people who have asthma. Side effects may include fatigue and sexual problems.

• #13 Antithyroid Medications for Graves’ Disease

  https://www.uspharmacist.com/article/antithyroid-medications-for-graves-disease

  Graves disease is an autoimmune disorder that occurs when the immune system attacks the thyroid gland and causes it to produce too much thyroid hormone (hyperthyroidism). […] The primary goals of treatment are to eliminate excess thyroid hormone and minimize the long-term consequences of the disease. Treatments include radioactive iodine, antithyroid medications (propylthiouracil, methimazole), and surgery. Beta-blockers may be used to provide symptomatic relief. […] The primary goals of treatment for hyperthyroidism are to eliminate excess thyroid hormone and minimize the long-term consequences. Treatments include radio-active iodine, antithyroid medications (propylthiouracil [PTU], methimazole [MMI]), and surgery. Beta-blockers are sometimes added to provide symptomatic relief. […] ATMs may be used before or after RIT as a supplemental treatment. Adverse effects of both drugs include rash, joint pain, liver failure, and a decrease in disease-fighting white blood cells.

• #14 Graves Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448195/

  All three options have pros and cons, and there is no consensus on which one is the best option. It is very important to discuss all three options in detail with the patients and make an individualized decision. […] Methimazole (MMI) and propylthiouracil (PTU) are two anti-thyroid drugs available in the USA. […] Before starting thionamide treatment, patients should be informed about possible side effects including allergic reactions, neutropenia, and hepatotoxicity. […] RAI Therapy is preferred for non-pregnant adult patients older than 21 years, patients not planning to get pregnant within the next six to 12 months after treatment, patients with risky comorbid conditions for surgery, and patients with contraindications for thioamides. […] Thyroidectomy is preferred for patients with very large goiter (more than 80 grams), anterior neck compressive symptoms, co-existing suspicious thyroid cancer, large thyroid nodules (greater than 4 cm), cold nodules, co-existing parathyroid adenoma, very high TRAb, and moderate to severe Graves orbitopathy.

• #15 Graves Disease Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/120619-treatment

  Treatment involves alleviation of symptoms and correction of the thyrotoxic state. Adrenergic hyperfunction is treated with beta-adrenergic blockade. Correcting the high thyroid hormone levels can be achieved with antithyroid medications that block the synthesis of thyroid hormones or by treatment with radioactive iodine. […] The most commonly used therapy for Graves disease is radioactive iodine. Indications for radioactive iodine over antithyroid agents include a large thyroid gland, multiple symptoms of thyrotoxicosis, high levels of thyroxine, and high titers of TSI. […] Many physicians in the United States prefer to use radioactive iodine as first-line therapy, especially in younger patients, because of the high relapse rate (50%) associated with antithyroid therapy. […] Radioiodine treatment can be performed in an outpatient setting.

• #16 Graves’ Disease: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15244-graves-disease

  Graves disease is a lifelong (chronic) condition. However, treatments can keep your thyroid hormone levels in check. Medical care may even make the disease temporarily go away (remission). […] Treatments for Graves disease include: […] Beta-blockers, such as propranolol and metoprolol, are often the first line of treatment for Graves disease. These medications regulate your heart rate and protect your heart until other hyperthyroidism treatments take effect. These medications dont stop thyroid hormone production. […] Antithyroid medications, such as methimazole (Tapazole) and propylthiouracil, block your thyroids production of thyroid hormone. […] Radioiodine therapy: This therapy involves taking one dose of radioactive iodine in pill or liquid form. Over two to three months, radiation slowly destroys thyroid gland cells.

• #17 Graves’ disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/graves-disease/diagnosis-treatment/drc-20356245

  Treatment for Graves’ disease aims to stop the thyroid from making hormones. Treatment also blocks the effect of the hormones on the body. […] With this therapy, you take radioactive iodine, called radioiodine, by mouth. The radioiodine goes into the thyroid cells. Over time, it destroys the cells that make thyroid hormone. This causes your thyroid gland to shrink. Symptoms ease little by little, most often over several weeks to several months. […] Radioiodine therapy may raise the risk of thyroid eye disease or make its symptoms worse. This side effect most often is mild and doesn’t last. But the therapy might not be for you if you have moderate to severe eye symptoms. […] Anti-thyroid medicines block the thyroid from using iodine to make hormones. These prescription medicines include propylthiouracil and methimazole.

• #18 Graves Disease – Comparison of Treatment Options | CVI Thyroid Center

  https://cvithyroidcenter.com/graves-treatment-options-comparison-best/

  Radioactive iodine therapy involves the oral administration of a radioactive iodine-131 pill, which selectively accumulates in the thyroid gland and destroys thyroid tissue. RAI is highly effective in achieving long-term control of hyperthyroidism, with remission rates ranging from 60% to 90%. However, this is a radiation dose that is not exact and as such it carries a risk of permanent hypothyroidism due to complete thyroid tissue destruction, necessitating lifelong thyroid hormone replacement therapy. Additionally, RAI may exacerbate thyroid eye disease in some patients. […] Thyroidectomy, or surgical removal of part or all of the thyroid gland, is typically reserved for patients who cannot tolerate or fail to respond to antithyroid medications or RAI, as well as those with large goiters or compressive symptoms. Thyroidectomy provides definitive treatment for Graves disease and can rapidly normalize thyroid hormone levels. However, it carries risks of surgical complications such as bleeding, infection, and damage to adjacent structures, as well as the potential for postoperative hypoparathyroidism and recurrent laryngeal nerve injury affecting the voice.

• #19 Graves Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448195/

  All three options have pros and cons, and there is no consensus on which one is the best option. It is very important to discuss all three options in detail with the patients and make an individualized decision. […] Methimazole (MMI) and propylthiouracil (PTU) are two anti-thyroid drugs available in the USA. […] Before starting thionamide treatment, patients should be informed about possible side effects including allergic reactions, neutropenia, and hepatotoxicity. […] RAI Therapy is preferred for non-pregnant adult patients older than 21 years, patients not planning to get pregnant within the next six to 12 months after treatment, patients with risky comorbid conditions for surgery, and patients with contraindications for thioamides. […] Thyroidectomy is preferred for patients with very large goiter (more than 80 grams), anterior neck compressive symptoms, co-existing suspicious thyroid cancer, large thyroid nodules (greater than 4 cm), cold nodules, co-existing parathyroid adenoma, very high TRAb, and moderate to severe Graves orbitopathy.

• #20 Graves’ disease – Wikipedia

  https://en.wikipedia.org/wiki/Graves%27_disease

  Treatment with antithyroid medications must be administered for six months to two years to be effective. […] The most common method of iodine-131 treatment is to administer a specified amount in microcuries per gram of thyroid gland based on palpation or radiodiagnostic imaging of the gland over 24 hours. […] Contraindications to RAI are pregnancy (absolute), ophthalmopathy (relative; it can aggravate thyroid eye disease), or solitary nodules. […] A 2013 review article concludes that surgery appears to be the most successful in the management of Graves’ disease, with total thyroidectomy being the preferred surgical option.

• #21 Graves’ disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/graves-disease/diagnosis-treatment/drc-20356245

  Treatment for Graves’ disease aims to stop the thyroid from making hormones. Treatment also blocks the effect of the hormones on the body. […] With this therapy, you take radioactive iodine, called radioiodine, by mouth. The radioiodine goes into the thyroid cells. Over time, it destroys the cells that make thyroid hormone. This causes your thyroid gland to shrink. Symptoms ease little by little, most often over several weeks to several months. […] Radioiodine therapy may raise the risk of thyroid eye disease or make its symptoms worse. This side effect most often is mild and doesn’t last. But the therapy might not be for you if you have moderate to severe eye symptoms. […] Anti-thyroid medicines block the thyroid from using iodine to make hormones. These prescription medicines include propylthiouracil and methimazole.

• #22 Diffuse Toxic Goiter (Graves Disease) Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/120140-treatment

  Regardless of the therapy used, long-term follow-up is necessary to monitor thyroid status for posttreatment hypothyroidism as well as relapse into hyperthyroidism. […] Treatment with radioactive iodine (RAI), which is taken up by the thyroid, delivers localized damage to the thyroid tissue to reduce thyroid hormone production. […] RAI is not recommended for patients with moderate-to-severe Graves ophthalmopathy due to the increased risk for progression of eye disease, but posttreatment glucocorticoid prophylaxis has been shown to reduce the risk for progression in patients with mild active eye disease. […] Given the risk for transient increase in thyroid hormone levels following RAI treatment as prestored thyroid hormone is released, methimazole (MMI) can be used both before and after treatment for patients with severe hyperthyroidism and for those at greater risk for complications of thyrotoxicosis.

• #23 A Review of Treatment Options for Graves’ Disease

  https://www.uspharmacist.com/article/a-review-of-treatment-options-for-graves-disease

  Normal thyroid function can occur as early as 6 to 8 weeks after treatment in 50% to 75% of patients. However, hypothyroidism results in more than 90% of patients within the first year after treatment, with a 2% to 3% rate each year thereafter.1,3,9 Lifelong thyroid supplementation and monitoring are necessary after treatment. Initially, monitoring occurs monthly; once a euthyroid state is obtained, monitoring is reduced to every 6 to 12 months. Mild thyroid-gland tenderness and dysphagia may occur. Reports of carcinomas or congenital defects are mixed; some studies report an increased risk, while others suggest no association. One study, however, reported an increased risk in all-cause mortality, including mortality from cardiovascular and cerebrovascular disease.1,2 […] Hyperthyroidism is suspected during pregnancy when there is persistent tachycardia along with an inability to gain weight despite a good appetite. No increase in maternal morbidity and mortality is seen. However, around 20% of patients experience thyroid storm during the postpartum period if left untreated. Other side effects, such as low fetal birthweight, premature delivery, fetal loss, and pre-eclampsia, may occur if the disease is left untreated. Fetal and neonatal hyperthyroidism may occur owing to TSAb crossing the placenta.1,3

• #24 Hyperthyroidism (Overactive Thyroid): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14129-hyperthyroidism

  Hyperthyroidism is treatable typically with medications. […] Its important to get medical treatment if you develop signs of hyperthyroidism so you can get back to feeling like yourself. […] There are many treatment options for hyperthyroidism. Depending on the cause, some options may be better for you than others. Your healthcare provider will discuss each option with you and help you determine the best treatment plan. […] Methimazole (Tapazole) and propylthiouracil (PTU) block the ability of your thyroid to make hormones. These medications are the most common treatment for hyperthyroidism. They can usually control thyroid function within two to three months. Your symptoms may get better within days to weeks. […] RAI therapy involves taking radioactive iodine by mouth in a single capsule or liquid dose. The radioactive iodine targets your thyroid cells specifically and destroys them. RAI usually leads to permanent destruction of your thyroid, which will cure hyperthyroidism. Most people who receive this treatment must take thyroid hormone medication (levothyroxine) for the rest of their lives to maintain normal thyroid hormone levels.

• #25 Graves’ disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/graves-disease/diagnosis-treatment/drc-20356245

  When either of these medicines are used without other treatments, hyperthyroidism may come back. These medicines may work better when they are taken for longer than a year. Anti-thyroid medicines may be used before or after radioiodine therapy as an added treatment. […] Surgery to remove the thyroid, called thyroidectomy, can treat Graves’ disease. You need to take thyroid medicine for the rest of your life after this surgery. […] For symptoms of thyroid eye disease that are worse, treatment might include corticosteroids. Treatment with corticosteroids given through a vein may ease swelling behind the eyeballs. […] This treatment is mainly used if pressure on the optic nerve might cause loss of vision. Possible complications include double vision. […] Thyroid eye disease doesn’t always get better with treatment of Graves’ disease. Symptoms of thyroid eye disease may even get worse for 3 to 6 months. After that, the symptoms of thyroid eye disease most often stay the same for a year or so. Then the symptoms begin to get better, often on their own.

• #26 Graves Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448195/

  All three options have pros and cons, and there is no consensus on which one is the best option. It is very important to discuss all three options in detail with the patients and make an individualized decision. […] Methimazole (MMI) and propylthiouracil (PTU) are two anti-thyroid drugs available in the USA. […] Before starting thionamide treatment, patients should be informed about possible side effects including allergic reactions, neutropenia, and hepatotoxicity. […] RAI Therapy is preferred for non-pregnant adult patients older than 21 years, patients not planning to get pregnant within the next six to 12 months after treatment, patients with risky comorbid conditions for surgery, and patients with contraindications for thioamides. […] Thyroidectomy is preferred for patients with very large goiter (more than 80 grams), anterior neck compressive symptoms, co-existing suspicious thyroid cancer, large thyroid nodules (greater than 4 cm), cold nodules, co-existing parathyroid adenoma, very high TRAb, and moderate to severe Graves orbitopathy.

• #27 Diffuse Toxic Goiter (Graves Disease) Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/120140-treatment

  The FDA recommends the following criteria be considered for prescribing PTU: Reserve PTU use during the first trimester of pregnancy, or in patients who are allergic to or intolerant of MMI. […] Surgical treatment with total or subtotal thyroidectomy is recommended for patients with a very enlarged thyroid (80 g), those who have suspected or confirmed concurrent thyroid malignancy, those who also require surgery for hyperparathyroidism, those who do not tolerate antithyroid drug therapy or are not ideal candidates for radioactive iodine (RAI) therapy, and patients who plan to become pregnant within 6 months. […] Patients should be made euthyroid prior to surgery to minimize anesthetic risks, cardiovascular and hemodynamic complications, and the risk of thyroid storm. […] Cessation of smoking has a beneficial effect on the course of ophthalmopathy.

• #28 Graves Disease Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/120619-treatment

  Hypothyroidism may ensue in the first year in up to 90% of patients given higher doses of radioiodine. […] Approximately one third of patients develop transient hypothyroidism. […] Long-term follow-up is mandatory for all patients. […] One concern with the use of radioiodine in persons with Graves disease is its controversial potential for exacerbating existing Graves ophthalmopathy. […] Thyroidectomy is not the recommended first-line therapy for hyperthyroid Graves disease in the United States. […] Surgery is a safe alternative therapeutic option in patients who are noncompliant with or cannot tolerate antithyroid drugs, have moderate to severe ophthalmopathy, have large goiters, or refuse or cannot undergo radioiodine therapy. […] Surgery provides rapid treatment of Graves disease and permanent cure of hyperthyroidism in most patients, and it has „negligible mortality and acceptable morbidity” by experienced surgeons.

• #29 Graves Disease Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/120619-treatment

  Preoperative preparation to render the patient euthyroid is essential in order to prevent thyrotoxic crisis (thyroid storm). […] If the goal of surgery is to avoid recurrent hyperthyroidism, near-total thyroidectomy has been advocated as the procedure of choice. […] Regardless of the extent of surgery, all patients require long-term follow-up.

• #30 Treatment of Grave’s Disease in Adults | IntechOpen

  https://www.intechopen.com/chapters/76539

  Beta-blockers are an adjuvant to antithyroid drugs, radioactive iodine, or surgery. They have been used for more than 20 years to modify the severity of general symptoms due to excess thyroid hormones by blocking the hyperadrenergic effects. […] Ablative treatment with radioiodine or thyroidectomy result in better cure rates and overcome the risk of non-compliance with thionamides, but both treatments incur the need for permanent levothyroxine therapy. […] Iodine therapy represents a cost-effective treatment option for Graves Disease. […] Thyroidectomy is the oldest form of Graves treatment and has been found to be as effective as ATDs and radioiodine in normalizing serum thyroid hormone levels within 6 weeks of therapy. […] Total thyroidectomy is preferred to subtotal thyroidectomy. Total thyroidectomy versus subtotal thyroidectomy is a balance between risk of recurrence of hyperthyroidism and incidence of hypothyroidism.

• #31 Graves’ Disease > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/graves-disease

  Surgery, during which all of the thyroid is removed (total thyroidectomy). Once the thyroid gland has been removed, thyroid hormone cannot be produced, thereby eliminating hyperthyroidism. If the entire gland is removed, patients will need to take levothyroxine, the thyroid hormone replacement medication, for the rest of their lives. […] Different treatments are available for people with Graves ophthalmopathy, including artificial tears and oral or intravenous corticosteroids, to manage eye-related symptoms. These treatments may help to preserve the patients vision. Tepezza (teprotumumab) is a monoclonal antibody treatment that treats Graves ophthalmopathy.

• #32 A Review of Treatment Options for Graves’ Disease

  https://www.uspharmacist.com/article/a-review-of-treatment-options-for-graves-disease

  Once a diagnosis has been made, the patients treatment plan needs to be determined. Treatment options focus on the individual, taking into consideration the patients age, comorbidities, preference, and convenience. Three treatment options currently exist: thyroidectomy, antithyroid medications, and RAI.1-3,8 […] A nonpharmacologic approach rarely used in the U.S. for Graves disease is surgical removal of the thyroid gland, which produces a euthyroid or hypothyroid state. Surgery is considered in patients who have a large goiter, have severe ophthalmopathy, are young, are pregnant or lactating, or have relapsed after a trial of antithyroid medications.1,2,4,9 With an 80% to 90% cure rate, surgical removal is considered safe and effective when performed by an experienced surgeon.1 However, the surgery comes with its own risks, including vocal-cord injury, hypoparathyroidism (1%-2%), transient hypocalcemia, bleeding, and infection. Permanent hypothyroidism is a direct result for the majority of patients who undergo surgery, and lifelong thyroid-hormone supplementation and monitoring are required.1,3,4

• #33 Treatment of Grave’s Disease in Adults | IntechOpen

  https://www.intechopen.com/chapters/76539

  Multiple factors influence the management of patients with Graves Disease including patient and physician preferences, access to medical services and patients features such as age, complications and comorbidities. […] Antithyroid drugs are the initial treatment for hyperthyroidism due to Graves Disease, with the exception of patients who have contraindications. Methimazole is preferred as the first line of treatment due to a lower risk of liver toxicity and propylthiuracil as the second line of treatment, with the exceptions previously described. […] The use of combined therapy with methimazole and levothyroxine has been evaluated in some studies, however it has been found that it does not increase the rate of remission of the disease with the probability of increasing adverse effects, with the exception of one study which demonstrated a probable benefit in bone mineralization with the use of combination therapy.

• #34 Graves’ Disease: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15244-graves-disease

  Surgery: A thyroidectomy involves surgically removing all or part of your thyroid gland. […] Antithyroid medication, radioiodine therapy and surgery all have benefits and risks, and theres no consensus in the medical community on which treatment is the best option. Its important to discuss all three options in detail with your provider to make the best choice for you.

• #35 Graves disease: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000358.htm

  Some of the eye problems related to Graves disease often improve after treatment with medicines (including selenium), radiation, or surgery. […] Sometimes, prednisone is needed to reduce eye irritation and swelling. Prednisone is a steroid medicine that suppresses the immune system. Other treatments to suppress the immune system may be needed. Ask your provider if these would help you. […] Sunglasses, cool compresses, and eye drops may reduce eye irritation. In rare cases, surgery or radiation therapy (different from radioactive iodine) may be needed to prevent further damage to the eye and loss of vision.

• #36 Graves’ Disease Treatment, Diagnosis, Symptoms & Prognosis

  https://www.emedicinehealth.com/graves_disease/article_em.htm

  Antithyroid medications: Propylthiouracil and Tapazole (methimazole) prevent the thyroid from producing thyroid hormone. […] Surgery: A thyroidectomy entails the surgical removal of the complete or part of the thyroid gland. […] For moderate Graves’ ophthalmopathy symptoms, use over-the-counter artificial tears all day long and lubricating gels at night. […] If the symptoms are more severe, the doctor might advise the following: […] Graves’ ophthalmopathy does not always show immediate improvement with treatment. Symptoms may even get worse for three to six months. Then, the symptoms usually normalize and get better for a year or more, often without treatment. […] Treatment for Graves disease frequently works successfully. Underactive thyroid is frequently brought on by either thyroid surgery or radioactive iodine (hypothyroidism).

• #37 Graves Disease Symptoms & Treatment | Paul Fitzgerald, M.D.

  http://fitzgeraldmd.com/thyroid/graves-disease

  Treatment for hyperthyroidism is directed at the cause of the problem. For Graves disease, patients and their physicians have the option of treatment with thionamides (eg. methimazole or PTU), surgery, or radioactive iodine. Symptomatic relief may be obtained from the beta blocker propranolol. […] For mild-to-moderate Graves eye disease, selenium supplementation 200 mcg/d has been shown to improve outcome. But when Graves exophthalmus becomes very noticeable or affects vision, aggressive treatment with prednisone must be commenced immediately. For patients with active prednisone-resistant Graves eye disease, off-label use of other drugs, such as the IL-6 inhibitor Actemra (tocilizumab) may slow the disease. Some patients require additional therapy with radiation therapy to the retro-orbital muscles. If eye protrusion becomes permanent and to correct diploplia (double vision), orbital decompression surgery can be performed.

• #38 Graves Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448195/

  Rapid achievement of euthyroid level should be sought in patients with Graves orbitopathy. […] Treatment of moderate to severe active Graves orbitopathy requires up to 100 mg of oral prednisone daily for one to two weeks, then tapered over six to 12 weeks or intravenous (IV) methylprednisolone 500 mg/wk for six weeks followed by 250 mg/wk for six weeks. […] The condition is best addressed with radioactive iodine.

• #39 Graves’ disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/graves-disease/diagnosis-treatment/drc-20356245

  When either of these medicines are used without other treatments, hyperthyroidism may come back. These medicines may work better when they are taken for longer than a year. Anti-thyroid medicines may be used before or after radioiodine therapy as an added treatment. […] Surgery to remove the thyroid, called thyroidectomy, can treat Graves’ disease. You need to take thyroid medicine for the rest of your life after this surgery. […] For symptoms of thyroid eye disease that are worse, treatment might include corticosteroids. Treatment with corticosteroids given through a vein may ease swelling behind the eyeballs. […] This treatment is mainly used if pressure on the optic nerve might cause loss of vision. Possible complications include double vision. […] Thyroid eye disease doesn’t always get better with treatment of Graves’ disease. Symptoms of thyroid eye disease may even get worse for 3 to 6 months. After that, the symptoms of thyroid eye disease most often stay the same for a year or so. Then the symptoms begin to get better, often on their own.

• #40 Graves Disease Symptoms & Treatment | Paul Fitzgerald, M.D.

  http://fitzgeraldmd.com/thyroid/graves-disease

  Treatment for hyperthyroidism is directed at the cause of the problem. For Graves disease, patients and their physicians have the option of treatment with thionamides (eg. methimazole or PTU), surgery, or radioactive iodine. Symptomatic relief may be obtained from the beta blocker propranolol. […] For mild-to-moderate Graves eye disease, selenium supplementation 200 mcg/d has been shown to improve outcome. But when Graves exophthalmus becomes very noticeable or affects vision, aggressive treatment with prednisone must be commenced immediately. For patients with active prednisone-resistant Graves eye disease, off-label use of other drugs, such as the IL-6 inhibitor Actemra (tocilizumab) may slow the disease. Some patients require additional therapy with radiation therapy to the retro-orbital muscles. If eye protrusion becomes permanent and to correct diploplia (double vision), orbital decompression surgery can be performed.

• #41 Graves disease: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000358.htm

  Some of the eye problems related to Graves disease often improve after treatment with medicines (including selenium), radiation, or surgery. […] Sometimes, prednisone is needed to reduce eye irritation and swelling. Prednisone is a steroid medicine that suppresses the immune system. Other treatments to suppress the immune system may be needed. Ask your provider if these would help you. […] Sunglasses, cool compresses, and eye drops may reduce eye irritation. In rare cases, surgery or radiation therapy (different from radioactive iodine) may be needed to prevent further damage to the eye and loss of vision.

• #42 Graves’ Disease > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/graves-disease

  Surgery, during which all of the thyroid is removed (total thyroidectomy). Once the thyroid gland has been removed, thyroid hormone cannot be produced, thereby eliminating hyperthyroidism. If the entire gland is removed, patients will need to take levothyroxine, the thyroid hormone replacement medication, for the rest of their lives. […] Different treatments are available for people with Graves ophthalmopathy, including artificial tears and oral or intravenous corticosteroids, to manage eye-related symptoms. These treatments may help to preserve the patients vision. Tepezza (teprotumumab) is a monoclonal antibody treatment that treats Graves ophthalmopathy.

• #43 Understanding Graves’ Disease — Treatment

  https://www.webmd.com/women/understanding-graves-disease-treatment

  At the beginning of the treatment, you will be given a capsule or liquid containing the radioactive iodine. […] Antithyroid drugs such as methimazole (Tapazole) and propylthiouracil (Propacil), which interfere with thyroid hormone production, can be used to treat Graves’ disease. […] Radioactive iodine treatments and antithyroid drugs are usually effective in slowing down thyroid hormone output, but in some cases surgery is the best approach for Graves’ disease. […] Because many conventional remedies severely limit the thyroid’s ability to manufacture thyroid hormone, they increase the chances that you will develop hypothyroidism, a potentially serious condition marked by insufficient thyroid hormone production. […] Graves’ disease patients with eye problems can be treated with the biologic teprotumumab (Tepezza). […] Vision problems and severe cases of eye protrusion can often be corrected through radiation therapy and surgery.

• #44 Graves’ disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/graves-disease/diagnosis-treatment/drc-20356245

  When either of these medicines are used without other treatments, hyperthyroidism may come back. These medicines may work better when they are taken for longer than a year. Anti-thyroid medicines may be used before or after radioiodine therapy as an added treatment. […] Surgery to remove the thyroid, called thyroidectomy, can treat Graves’ disease. You need to take thyroid medicine for the rest of your life after this surgery. […] For symptoms of thyroid eye disease that are worse, treatment might include corticosteroids. Treatment with corticosteroids given through a vein may ease swelling behind the eyeballs. […] This treatment is mainly used if pressure on the optic nerve might cause loss of vision. Possible complications include double vision. […] Thyroid eye disease doesn’t always get better with treatment of Graves’ disease. Symptoms of thyroid eye disease may even get worse for 3 to 6 months. After that, the symptoms of thyroid eye disease most often stay the same for a year or so. Then the symptoms begin to get better, often on their own.

• #45 New treatment on the horizon for Graves’ disease | Research and Innovation

  https://projects.research-and-innovation.ec.europa.eu/en/projects/success-stories/all/new-treatment-horizon-graves-disease

  Treatment options for the immune system disorder Graves’ disease have remained unchanged for over 70 years, and all bring serious side effects. […] Treatment options for Graves disease have not changed since the 1940s. Today, patients must choose between three therapies that tackle the symptoms, rather than the cause of the disease, all of which have significant side effects. […] However, the EU-funded DAVIAD project is now offering hope for a safer, more effective treatment. […] The DAVIAD project team set out to develop a drug that switches off only the sections of the immune system that are causing the disease, leaving the rest still functioning. This strategy is designed to minimise those side effects that are common among current treatment options. […] This was a step forward in our mission to create a drug that treats the underlying cause of Graves disease instead of just the symptoms, says project coordinator Hayley French of Apitope. In our promising early-phase results, we have shown both encouraging safety and efficacy. […] For people suffering from Graves, the projects progress has finally created hope that the disease can be challenged and, for the first time in over 70 years, a new, more effective treatment could be on the horizon.

• #46 Graves’ Disease: Is It Time for Targeted Therapy? A Narrative Review

  https://www.mdpi.com/1648-9144/61/3/500

  Recent in vitro and in vivo research aims to introduce and establish new treatments for the management of GD. […] Emerging approaches include restoring immune tolerance through immunomodulatory TSHR peptides and targeting TSHR signaling via rituximab, iscalimab, and belimumab. […] However, most clinical studies on these novel treatments are still in early phases, predominantly open-label phase I and II trials. […] To confirm their efficacy and safety, further randomized controlled trials are essential, offering hope for more targeted and personalized management strategies which can be introduced in our clinical practice in the future.

• #47 Become a member

  https://www.btf-thyroid.org/research-news-graves-disease

  A company called Apitope has been working on a new treatment for GD that involves antigen-specific immunotherapy. This is a treatment which seeks to reinstate immune tolerance to the target (in this case TSHR). […] This new treatment called ATX-GD-59 is a combination of two peptides and is based upon synthetic copies of the parts of the TSHR that the immune system recognises as a target (epitopes). […] From the ten participants who finished the course of treatment, seven (70%) showed an improvement in their thyroid function (levels of free thyroid hormones decreased) and the drug was safe and well-tolerated. […] The 70% improvement in thyroid function was impressive and Apitope is currently seeking further investment to conduct additional clinical studies. […] Future studies may also include other groups of patients with GD particularly young patients; patients with severe GD and those with thyroid eye disease (Graves orbitopathy); to realise the full therapeutic potential of this new treatment. […] Importantly, if immune tolerance can be restored, the underlying thyroid endocrine function is likely to remain intact for many years offering the potential for a more effective treatment of Graves disease.

• #48 Become a member

  https://www.btf-thyroid.org/research-news-graves-disease

  There have been no new treatment options for hyperthyroid patients with GD for more than 60 years. At present, antithyroid drugs (ATD), mostly carbimazole, are the usual first-line treatment. Radioactive iodine and total thyroidectomy (thyroid removal) are reserved as second-line treatment options in most UK health settings. […] Given ATDs induce drug-free remission in only 50% of patients, and both radioiodine and thyroidectomy result in lifelong hypothyroidism, there is no ideal treatment for GD and a new approach is urgently needed. […] This phase I study is investigating a potential new drug, K1-70, to treat patients who have Graves disease, and patients who would benefit from controlling Thyroid Stimulating Hormone Receptor (TSHR) activity. […] A Safety Review Committee found the drug to have been safe and well-tolerated in all the patients treated so far.

• #49 Graves Disease – Comparison of Treatment Options | CVI Thyroid Center

  https://cvithyroidcenter.com/graves-treatment-options-comparison-best/

  Emerging interventions such as thyroid artery embolization and biological therapies offer promising alternatives for select patients. Thyroid artery embolization is a non-surgical treatment that involves the selective occlusion of a few of the thyroid arteries to reduce blood flow to some of the thyroid gland. Studies suggest that thyroid artery embolization can achieve significant reductions in thyroid hormone levels and symptom improvement in some patients. […] Thyroid artery embolization represents a promising alternative for the management of Graves disease, offering a minimally invasive, targeted approach to reducing thyroid hormone production. While further research is needed to establish its long-term efficacy and safety, current studies suggest that TAE may provide rapid symptom relief and preserve thyroid function compared to traditional treatments.

• #50 NONSURGICAL TREATMENTS IN HYPERTHYROIDISM

  https://www.thyroid-goiter.com/hyperthyroidism

  In Graves disease, the classic treatment options are antithyroid medications, radioactive iodine and surgery. Generally, antithyroid pills are tried first. If this fails or is not sufficient, patients are treated either with radioactive iodine or surgical operation. […] Another option in the management of Graves disease is embolization, in which 3 out of 4 feeding vessels of thyroid gland are plugged with a simple angiography procedure. After embolization, the thyroid tissue fed by the occluded vessels becomes smaller in size and hormonally less active. […] Embolization has been successfully used in the treatment of Graves disease in many centers for the last 2 decades. Studies indicate that in nearly 70-80% of the patients, hormone levels return to normal, symptoms of hyperthyroidism diminish, the size of the thyroid becomes normal and antibodies against the thyroid tissue (TRaB) decrease in the blood. The side effects of embolization procedure are generally mild and typically include neck pain, fatigue and subclinical hyperthyroidism that lasts for some weeks. The most important advantages of embolization are as follows: There is no incision or suture in the neck, No general anesthesia is required, Hospital stay is only one night, It may correct hyperthyroidism without surgery and radiation, Since the thyroid gland is preserved no hypothyroidism occurs after the treatment. […] Basedow Graves disease can be treated with embolization.

• #51 Graves’ Disease – Focused Ultrasound Foundation

  https://www.fusfoundation.org/diseases-and-conditions/graves-disease/

  Focused ultrasound is a noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with relapsed or persistent Graves disease. This novel technology focuses beams of ultrasound energy precisely and accurately on targets in the thyroid gland without damaging surrounding normal tissue. […] Graves disease is typically treated with anti-thyroid hormonal therapy and beta blockers, but the treatment for relapsed or persistent Graves disease typically involves taking radioactive iodine or having surgery. […] For certain patients, focused ultrasound may provide a noninvasive alternative to surgery with less risk of complications such as risk to adjacent (normal) tissues at a lower cost. Focused ultrasound also does not use any radioactive materials and can be done without incurring the risk of general anesthesia. […] At the present time, there are no clinical trials recruiting patients for focused ultrasound treatment of Graves disease. […] To our knowledge, the treatment for Graves disease is not covered by medical insurance companies.

• #52 Graves’ Disease: Is It Time for Targeted Therapy? A Narrative Review

  https://www.mdpi.com/1648-9144/61/3/500

  Recent in vitro and in vivo research aims to introduce and establish new treatments for the management of GD. […] Emerging approaches include restoring immune tolerance through immunomodulatory TSHR peptides and targeting TSHR signaling via rituximab, iscalimab, and belimumab. […] However, most clinical studies on these novel treatments are still in early phases, predominantly open-label phase I and II trials. […] To confirm their efficacy and safety, further randomized controlled trials are essential, offering hope for more targeted and personalized management strategies which can be introduced in our clinical practice in the future.

• #53 Graves’ Disease: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15244-graves-disease

  Graves disease is a lifelong (chronic) condition. However, treatments can keep your thyroid hormone levels in check. Medical care may even make the disease temporarily go away (remission). […] Treatments for Graves disease include: […] Beta-blockers, such as propranolol and metoprolol, are often the first line of treatment for Graves disease. These medications regulate your heart rate and protect your heart until other hyperthyroidism treatments take effect. These medications dont stop thyroid hormone production. […] Antithyroid medications, such as methimazole (Tapazole) and propylthiouracil, block your thyroids production of thyroid hormone. […] Radioiodine therapy: This therapy involves taking one dose of radioactive iodine in pill or liquid form. Over two to three months, radiation slowly destroys thyroid gland cells.

• #54 Thionamides in the treatment of Graves’ disease – UpToDate

  https://www.uptodate.com/contents/thionamides-in-the-treatment-of-graves-disease

  Studies using long-term antithyroid drugs for 5 to 10 years or longer have reported remission rates as high as 84 percent. […] Patients treated with thionamides take three to eight weeks or longer to become euthyroid because they block new hormone synthesis, and any already formed thyroxine (T4) and triiodothyronine (T3) stored in the colloid must be secreted and metabolized for clinical improvement to occur.

• #55 Treatment of Graves’ Disease: Faster Remission or Longer but Safe, That Is the Question

  https://www.e-enm.org/journal/view.php?number=2587

  Graves disease (GD) exhibits fluctuations due to an active autoimmune process. […] There are three treatment modalities for GD that have remained unchanged for nearly 80 years: antithyroid drugs (ATD), radioactive iodine (RAI) therapy, and surgery. […] ATD is the most commonly used first-line treatment for GD in many countries. […] Moreover, there is increasing evidence that long-term ATD treatment may safely and effectively decrease relapses. […] Although the risk of recurrence during ATD treatment ranges from 30% to 70%, long-term therapy reduces this risk to 15%. […] Furthermore, although definitive treatments such as RAI or surgery are usually recommended for patients with recurrent GD, the current trend in clinical practice is to restart ATD as a secondary treatment option. […] Clinical experience over the past 70 years has proven that RAI is highly effective and safe.

• #56 A Review of Treatment Options for Graves’ Disease

  https://www.uspharmacist.com/article/a-review-of-treatment-options-for-graves-disease

  Normal thyroid function can occur as early as 6 to 8 weeks after treatment in 50% to 75% of patients. However, hypothyroidism results in more than 90% of patients within the first year after treatment, with a 2% to 3% rate each year thereafter.1,3,9 Lifelong thyroid supplementation and monitoring are necessary after treatment. Initially, monitoring occurs monthly; once a euthyroid state is obtained, monitoring is reduced to every 6 to 12 months. Mild thyroid-gland tenderness and dysphagia may occur. Reports of carcinomas or congenital defects are mixed; some studies report an increased risk, while others suggest no association. One study, however, reported an increased risk in all-cause mortality, including mortality from cardiovascular and cerebrovascular disease.1,2 […] Hyperthyroidism is suspected during pregnancy when there is persistent tachycardia along with an inability to gain weight despite a good appetite. No increase in maternal morbidity and mortality is seen. However, around 20% of patients experience thyroid storm during the postpartum period if left untreated. Other side effects, such as low fetal birthweight, premature delivery, fetal loss, and pre-eclampsia, may occur if the disease is left untreated. Fetal and neonatal hyperthyroidism may occur owing to TSAb crossing the placenta.1,3

• #57 Graves Disease Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/120619-treatment

  Patients currently taking antithyroid drugs must discontinue the medication at least 2 days prior to taking the radiopharmaceutical. […] Thyroid function test results generally improve within 6-8 weeks of therapy, but this can be highly variable. […] With radioactive iodine, the desired result is hypothyroidism due to destruction of the gland, which usually occurs 2-3 months after administration. […] Following up with the patient and monitoring thyroid function monthly or as the clinical condition dictates is important. […] When patients become hypothyroid, they require lifelong replacement with thyroid hormone. […] The possibility exists that radioactive iodine can precipitate thyroid storm by releasing thyroid hormones. […] If thyroid function does not normalize within 6-12 months of treatment, a second course at a similar or higher dose can be given.

• #58 Graves’ disease: Symptoms, treatment, and causes

  https://www.medicalnewstoday.com/articles/170005

  The American Thyroid Association recommends beta-blockers as an initial treatment for hyperthyroidism. These medications prevent thyroid hormone from carrying out its usual functions as it circulates in the bloodstream. […] Surgery is a less common treatment for Graves disease, but doctors may recommend it for people who are pregnant or have large goiters, or when other treatments have been unsuccessful. […] Treatment may include medications to reduce the production of thyroid hormone, radioiodine therapy, or surgery to remove the thyroid. […] The treatments may result in low thyroid levels or hypothyroidism. This is easier to manage than hyperthyroidism, and it involves taking a daily pill.

• #59 Treatment of Graves’ Disease: Faster Remission or Longer but Safe, That Is the Question

  https://www.e-enm.org/journal/view.php?number=2587

  Graves disease (GD) exhibits fluctuations due to an active autoimmune process. […] There are three treatment modalities for GD that have remained unchanged for nearly 80 years: antithyroid drugs (ATD), radioactive iodine (RAI) therapy, and surgery. […] ATD is the most commonly used first-line treatment for GD in many countries. […] Moreover, there is increasing evidence that long-term ATD treatment may safely and effectively decrease relapses. […] Although the risk of recurrence during ATD treatment ranges from 30% to 70%, long-term therapy reduces this risk to 15%. […] Furthermore, although definitive treatments such as RAI or surgery are usually recommended for patients with recurrent GD, the current trend in clinical practice is to restart ATD as a secondary treatment option. […] Clinical experience over the past 70 years has proven that RAI is highly effective and safe.

• #60 Long-term management of Graves disease: a narrative review

  https://www.e-jyms.org/journal/view.php?doi=10.12701/jyms.2022.00444

  RAI treatment or surgery is recommended if a drug is not available or if patients adherence is poor. […] According to clinical guidelines, definitive treatment can be considered in cases where TRAb levels are positive despite a period of ATD therapy. […] However, treatment with ATDs may be continued for an additional 12 months. […] Even in patients who have relapsed after the cessation of MMZ, definitive treatment is generally recommended. […] The final diagnosis was nodular hyperplasia after surgery. […] This means that her QoL has improved significantly even though she has gained 4 kg over 2.5 years after the surgery. […] The most important contraindications are the serious side effects of ATD treatment. […] According to a recent large amount of data on long-term ATD treatment for GD, it is expected that low-dose MMZ maintenance will have few side effects and can reduce the risk of recurrence.

• #61 Diagnosis and treatment of Graves disease – PubMed

  https://pubmed.ncbi.nlm.nih.gov/12841824/

  Despite extensive experience with medical management, controversy prevails regarding choosing among the various drugs for treatment of Graves disease. None of the treatment options, including antithyroid drugs, radioiodine, and surgery, is ideal. Each has risks and benefits, and selection should be tailored to the individual patient.

• #62 Graves’ Disease: Is It Time for Targeted Therapy? A Narrative Review

  https://www.mdpi.com/1648-9144/61/3/500

  Recent in vitro and in vivo research aims to introduce and establish new treatments for the management of GD. […] Emerging approaches include restoring immune tolerance through immunomodulatory TSHR peptides and targeting TSHR signaling via rituximab, iscalimab, and belimumab. […] However, most clinical studies on these novel treatments are still in early phases, predominantly open-label phase I and II trials. […] To confirm their efficacy and safety, further randomized controlled trials are essential, offering hope for more targeted and personalized management strategies which can be introduced in our clinical practice in the future.

• #63 Graves Disease Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/120619-treatment

  Hypothyroidism may ensue in the first year in up to 90% of patients given higher doses of radioiodine. […] Approximately one third of patients develop transient hypothyroidism. […] Long-term follow-up is mandatory for all patients. […] One concern with the use of radioiodine in persons with Graves disease is its controversial potential for exacerbating existing Graves ophthalmopathy. […] Thyroidectomy is not the recommended first-line therapy for hyperthyroid Graves disease in the United States. […] Surgery is a safe alternative therapeutic option in patients who are noncompliant with or cannot tolerate antithyroid drugs, have moderate to severe ophthalmopathy, have large goiters, or refuse or cannot undergo radioiodine therapy. […] Surgery provides rapid treatment of Graves disease and permanent cure of hyperthyroidism in most patients, and it has „negligible mortality and acceptable morbidity” by experienced surgeons.

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