J Yeungnam Med Sci.  2023 Jan;40(1):12-22. 10.12701/jyms.2022.00444.

Long-term management of Graves disease: a narrative review

• Kim HJ

• KMID: 2538781
• DOI: http://doi.org/10.12701/jyms.2022.00444

Abstract

Graves disease (GD) is the most common cause of hyperthyroidism, accounting for more than 90% of cases in Korea. Patients with GD are treated with any of the following: antithyroid drugs (ATDs), radioactive iodine (RAI) therapy, or thyroidectomy. Most patients begin treatment with ATDs, and clinical guidelines suggest that the appropriate treatment period is 12 to 18 months. While RAI treatment and surgery manage thyrotoxicosis by destroying or removing thyroid tissue, ATDs control thyrotoxicosis by inhibiting thyroid hormone synthesis and preserving the thyroid gland. Although ATDs efficiently control thyrotoxicosis symptoms, they do not correct the main etiology of GD; therefore, frequent relapses can follow. Recently, a large amount of data has been collected on long-term ATDs for GD, and low-dose methimazole (MMZ) is expected to be a good option for remission. For the long-term management of recurrent GD, it is important to induce remission by evaluating the patient’s drug response, stopping ATDs at an appropriate time, and actively switching to surgery or RAI therapy, if indicated. Continuing drug treatment for an extended time is now encouraged in patients with a high possibility of remission with low-dose MMZ. It is also important to pay attention to the quality of life of the patients. This review aimed to summarize the appropriate treatment methods and timing of treatment transition in patients who relapsed several times while receiving treatment for GD.

Keyword

Hyperthyroidism; Graves disease; Long-term management; Relapse; Review

Figure

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  Fig. 1. (A–C) Thyroid scans can assist in the differentiation of patients with thyroid diseases. Typical appearances of 99mTc pertechnetate scans are shown in (A) Graves disease, (B) thyroiditis, and (C) toxic nodular goiter. (D–F) Doppler ultrasonography views of Graves disease show a classic finding of increased blood flow in a 28-year-old man. (D) Transverse view of isthmic area and longitudinal views of the (E) right lobe and (F) left lobe of the thyroid gland.

Reference

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