Endocrine Abstracts (2017) 51 CME4 | DOI: 10.1530/endoabs.51.CME4

Thyrotoxicosis - diagnosis and management

Tim Cheetham


Newcastle.


Key discussion points

• Make sure you know what it is that you are treating – is this Graves’ hyperthyroidism (with associated TSH receptor antibodies) or simply a brief, hyperthyroid phase of autoimmune thyroid disease (without TSH receptor antibodies) that will settle down spontaneously?

• Ideally obtain the result of the thyroid receptor antibody titre pre intervention with carbimazole.

• Unrecognised Graves’ can have a profound impact on educational attainment. Time with unrecognised Graves’ can compromise an individual’s ability to learn to a major degree.

• All treatment modalities – carbimazole, radioiodine (RI) and surgery – have their advantages and disadvantages. Tailoring therapy to the individual according to factors such as age, goitre size and future plans is important.

• ‘Block and replace’ antithyroid drug therapy may be appropriate in some instances despite the increased likelihood of adverse events.

• Some patients with Graves’ will not only remit but will also become hypothyroid.

• Life on long-term thyroid hormone replacement post-surgery or post-RI is not perfect – we need new treatments for Graves’ hyperthyroidism that increase the likelihood of long-term remission.

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