Endocrine Abstracts (2017) 49 MTE7 | DOI: 10.1530/endoabs.49.MTE7

When and which treatment to use in Graves disease?

Tomasz Bednarczuk


Graves’ disease (GD) is a heterogeneous autoimmune disorder affecting, with varying degrees of severity, the thyroid, eyes and skin. GD is the most common cause of hyperthyroidism. The incidence peaks between 30 and 50 years of age, but people may be affected at any age. Hyperthyroidism is caused by autoantibodies stimulating the TSH receptor on thyroid cells. The severity of thyrotoxicosis in GD is variable and the response to anti-thyroid drugs is difficult to predict. Graves’ orbitopathy (GO) is the most common and serious extrathyroidal manifestation of GD, significantly impairing the quality of life of affected patients. Clinically apparent orbitopathy occurs in 25%–50% of patients. Pretibial myxedema and acropachy are much less common, occurring in less than 2% of patients. The reasons for this variation in the clinical presentation of GD are largely unclear. There are three treatment options for Graves’ hyperthyroidism: (1) blocking of hormone synthesis by antithyroid drugs (ATD), (2) destruction of the thyroid by radioactive iodine (RAI) and (3) partial or total surgical ablation of the thyroid. Additionally, patients can take β blockers for symptomatic relief. Although all three options are effective, no treatment is ideal and thus indicated in all patients with GD. Selection of therapy depends on multiple considerations, including: patient’s age, severity of thyrotoxicosis, presence of goiter, orbitopathy, pregnancy, comorbidities. The treatment selection must also take into account the patient’s preference. Before deciding on a treatment plan, the treating physician and patient should discuss each of the treatment options, including the logistics, local availability, advantages, disadvantages, potential side effects and costs.

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