Endocrinol Metab.  2019 Mar;34(1):29-38. 10.3803/EnM.2019.34.1.29.

Graves' Disease: Can It Be Cured?

• Wiersinga

• KMID: 2441676
• DOI: http://doi.org/10.3803/EnM.2019.34.1.29

Abstract

Whether or not Graves' hyperthyroidism can be really cured, depends on the definition of "cure." If eradication of thyroid hormone excess suffices for the label "cure," then all patients can be cured because total thyroidectomy or high doses of 1¹³¹I will abolish hyperthyroidism albeit at the expense of creating another disease (hypothyroidism) requiring lifelong medication with levothyroxine. I would not call this a "cure," which I would like to define as a state with stable thyroid stimulating hormone (TSH), free thyroxine, and triiodothyronine serum concentrations in the normal range in the absence of any thyroid medication. Surgery and radioiodine are unlikely to result in so-defined cures, as their preferable aim as stated in guidelines is to cause permanent hypothyroidism. Discontinuation of antithyroid drugs is followed by 50% recurrences within 4 years; before starting therapy the risk of recurrences can be estimated with the Graves' Recurrent Events After Therapy (GREAT) score. At 20-year follow-up about 62% had developed recurrent hyperthyroidism, 8% had subclinical hypothyroidism, and 3% overt hypothyroidism related to TSH receptor blocking antibodies and thyroid peroxidase antibodies. Only 27% was in remission, and might be considered cured. If the definition of "cure" would also include the disappearance of thyroid antibodies in serum, the proportion of cured patients would become even lower.

Keyword

Graves hyperthyroidism; Cure; Thyroidectomy; Radioactive iodine; Antithyroid agents; Remission; Long term outcome

MeSH Terms

Antibodies
Antibodies, Blocking
Antithyroid Agents
Follow-Up Studies
Graves Disease*
Humans
Hyperthyroidism
Hypothyroidism
Iodide Peroxidase
Receptors, Thyrotropin
Recurrence
Reference Values
Thyroid Gland
Thyroidectomy
Thyrotropin
Thyroxine
Triiodothyronine
Antibodies
Antibodies, Blocking
Antithyroid Agents
Iodide Peroxidase
Receptors, Thyrotropin
Thyrotropin
Thyroxine
Triiodothyronine

Figure

• 

  Fig. 1 Hypothetical curves reflecting the natural history of Graves' hyperthyroidism. A minority of patients (green line) have a single episode of hyperthyroidism. The majority (blue line) has a prolonged course following a relapsing and remitting course over many years. In some patients (red line) the disease never remits but continues to express herself clinically. In the long-term the natural course along the green and blue curves could evolve towards spontaneous development of hypothyroidism.

• 

  Fig. 2 Chance of remission of Graves' hyperthyroidism after a course of antithyroid drugs. ATD, antithyroid drug.

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