Graves' disease in adults Antithyroid drugs, radioactive iodine, or sometimes thyroidectomy. 2017


What is the best treatment for adults with Graves' disease in 2016? To answer this question, we reviewed the literature using the standard Prescrire methodology. When the symptoms of hyperthyroidism are poorly tolerated, a beta-blocker relieves tachy- cardia, anxiety and tremor. Three treatments have been shown to be effec- tive in controlling hyperthyroidism: antithyroid drugs, radioiodine, and thyroidectomy. Carbimazole and its metabolite thiamazole are the antithyroid drugs with the best harm-benefit balance, except during the first trimester of preg- nancy. About 50% of patients are cured after 12 to 18 months of treatment. Antithyroid drugs carry a risk of rare but serious adverse effects, including agranulocytosis. Hepa- titis is more frequent with propylthiouracil. Radioiodine is administered as a single oral dose, in order to destroy the thyroid gland. Perma- nent cure is achieved in about 80% of cases, usu- ally after 1 or 2 months. Permanent hypothyroid- ism is frequent, occurring at various intervals after treatment. Radioiodine may exacerbate pre-existing oph- thalmopathy or provoke its onset, especially among smokers. Corticosteroid therapy reduces this risk. Protective measures are used for a few days or weeks in order to avoid radiation exposure among close contacts. Radioiodine is contraindi- cated during pregnancy. Surgical thyroidectomy may be total with little risk of recurrence, or subtotal with about an 8% risk of recurrence. The complications of surgery mainly consist of. hypoparathyroidism and permanent paralysis of the recurrent laryngeal nerve, which occur after 1% to 5% of procedures. In practice, the choice of treatment depends on the patient's preferences and situation, including a woman's desire to conceive, size of the goitre, the degree of hyperthyroidism, and the presence of ophthalmopathy.

UI MeSH Term Description Entries
D007037 Hypothyroidism A syndrome that results from abnormally low secretion of THYROID HORMONES from the THYROID GLAND, leading to a decrease in BASAL METABOLIC RATE. In its most severe form, there is accumulation of MUCOPOLYSACCHARIDES in the SKIN and EDEMA, known as MYXEDEMA. It may be primary or secondary due to other pituitary disease, or hypothalamic dysfunction. Central Hypothyroidism,Primary Hypothyroidism,Secondary Hypothyroidism,TSH Deficiency,Thyroid-Stimulating Hormone Deficiency,Central Hypothyroidisms,Deficiency, TSH,Deficiency, Thyroid-Stimulating Hormone,Hormone Deficiency, Thyroid-Stimulating,Hypothyroidism, Central,Hypothyroidism, Primary,Hypothyroidism, Secondary,Hypothyroidisms,Primary Hypothyroidisms,Secondary Hypothyroidisms,TSH Deficiencies,Thyroid Stimulating Hormone Deficiency,Thyroid-Stimulating Hormone Deficiencies
D007457 Iodine Radioisotopes Unstable isotopes of iodine that decay or disintegrate emitting radiation. I atoms with atomic weights 117-139, except I 127, are radioactive iodine isotopes. Radioisotopes, Iodine
D005767 Gastrointestinal Diseases Diseases in any segment of the GASTROINTESTINAL TRACT from ESOPHAGUS to RECTUM. Cholera Infantum,Gastrointestinal Disorders,Functional Gastrointestinal Disorders,Gastrointestinal Disorders, Functional,Disease, Gastrointestinal,Diseases, Gastrointestinal,Functional Gastrointestinal Disorder,Gastrointestinal Disease,Gastrointestinal Disorder,Gastrointestinal Disorder, Functional
D006111 Graves Disease A common form of hyperthyroidism with a diffuse hyperplastic GOITER. It is an autoimmune disorder that produces antibodies against the THYROID STIMULATING HORMONE RECEPTOR. These autoantibodies activate the TSH receptor, thereby stimulating the THYROID GLAND and hypersecretion of THYROID HORMONES. These autoantibodies can also affect the eyes (GRAVES OPHTHALMOPATHY) and the skin (Graves dermopathy). Basedow's Disease,Exophthalmic Goiter,Goiter, Exophthalmic,Graves' Disease,Basedow Disease,Hyperthyroidism, Autoimmune,Basedows Disease,Disease, Basedow,Disease, Basedow's,Disease, Graves,Disease, Graves',Exophthalmic Goiters,Goiters, Exophthalmic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000319 Adrenergic beta-Antagonists Drugs that bind to but do not activate beta-adrenergic receptors thereby blocking the actions of beta-adrenergic agonists. Adrenergic beta-antagonists are used for treatment of hypertension, cardiac arrhythmias, angina pectoris, glaucoma, migraine headaches, and anxiety. Adrenergic beta-Antagonist,Adrenergic beta-Receptor Blockader,Adrenergic beta-Receptor Blockaders,beta-Adrenergic Antagonist,beta-Adrenergic Blocker,beta-Adrenergic Blocking Agent,beta-Adrenergic Blocking Agents,beta-Adrenergic Receptor Blockader,beta-Adrenergic Receptor Blockaders,beta-Adrenoceptor Antagonist,beta-Blockers, Adrenergic,beta-Adrenergic Antagonists,beta-Adrenergic Blockers,beta-Adrenoceptor Antagonists,Adrenergic beta Antagonist,Adrenergic beta Antagonists,Adrenergic beta Receptor Blockader,Adrenergic beta Receptor Blockaders,Adrenergic beta-Blockers,Agent, beta-Adrenergic Blocking,Agents, beta-Adrenergic Blocking,Antagonist, beta-Adrenergic,Antagonist, beta-Adrenoceptor,Antagonists, beta-Adrenergic,Antagonists, beta-Adrenoceptor,Blockader, Adrenergic beta-Receptor,Blockader, beta-Adrenergic Receptor,Blockaders, Adrenergic beta-Receptor,Blockaders, beta-Adrenergic Receptor,Blocker, beta-Adrenergic,Blockers, beta-Adrenergic,Blocking Agent, beta-Adrenergic,Blocking Agents, beta-Adrenergic,Receptor Blockader, beta-Adrenergic,Receptor Blockaders, beta-Adrenergic,beta Adrenergic Antagonist,beta Adrenergic Antagonists,beta Adrenergic Blocker,beta Adrenergic Blockers,beta Adrenergic Blocking Agent,beta Adrenergic Blocking Agents,beta Adrenergic Receptor Blockader,beta Adrenergic Receptor Blockaders,beta Adrenoceptor Antagonist,beta Adrenoceptor Antagonists,beta Blockers, Adrenergic,beta-Antagonist, Adrenergic,beta-Antagonists, Adrenergic,beta-Receptor Blockader, Adrenergic,beta-Receptor Blockaders, Adrenergic
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000380 Agranulocytosis A decrease in the number of GRANULOCYTES; (BASOPHILS; EOSINOPHILS; and NEUTROPHILS). Granulocytopenia,Agranulocytoses,Granulocytopenias
D013956 Antithyroid Agents Agents that are used to treat hyperthyroidism by reducing the excessive production of thyroid hormones. Antithyroid Agent,Antithyroid Drug,Goitrogen,Goitrogens,Thyroid Antagonists,Antithyroid Drugs,Antithyroid Effect,Antithyroid Effects,Agent, Antithyroid,Agents, Antithyroid,Antagonists, Thyroid,Drug, Antithyroid,Drugs, Antithyroid,Effect, Antithyroid,Effects, Antithyroid
D013965 Thyroidectomy Surgical removal of the thyroid gland. (Dorland, 28th ed) Thyroidectomies

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