Management of Graves’ Hyperthyroidism: More Than a Century of Progression

Abstract

<jats:p>Context: There are three therapeutic modalities for the management of Graves’ disease (GD), including thyroid surgery, radioactive iodine (RAI), and antithyroid drugs (ATDs). We aimed to briefly review the history of these treatment strategies and their advantages and disadvantages. Evidence Acquisition: We searched PubMed for English language articles using pertinent search terms. Results: Each treatment modality for GD is accompanied by several advantages and disadvantages. Nowadays, ATDs are the most commonly prescribed therapy for GD worldwide. The lack of well-designed, large RCTs comparing three different treatments for hyperthyroidism concerning various short-term and long-term outcomes has led to remarkable uncertainty in the preference of each of these treatments, as is evident in relevant guidelines from different societies. Recently, the efficacy and safety of long-term use of ATDs have been documented. Conclusions: Pros and cons of each therapeutic modality for Graves’ hyperthyroidism should be taken into account during the physician-patient discussion to select the primary treatment. Considering recent data about the long-term efficacy and safety of ATDs, it seems that the appropriate selection of Graves’ patients for long-term ATD therapy can be a new avenue in the treatment and even cure of GD.</jats:p>

RAI Therapy for Graves’ Hyperthyroidism

“…The aim of this therapy is to radiate thyroid cells rendering the patient eu/hypothyroid. Although for many years it has been the most preferable treatment in USA, currently there is a tendency toward ATD therapy [20]. RAI treatment is performed after failure of ATD therapy to control hyperthyroidism or when the latter is contraindicated.…”

“…While several studies have been conducted, regarding the association between the optimal dose of radioiodine, thyroid's volume (based on ultrasound) and radioiodine turnover [31], there is lack of consensus for the proper dose regimen. The majority is in favor of rendering the patient hypothyroid [20] applying high radioiodine doses [32] to avoid the possibility of treatment's failure or relapse of the disease. Many nuclear departments apply fixed doses [33].…”

A Clinical Debate: What Is the Therapeutic Choice for Recurrent Graves’ Hyperthyroidism?

“…The introduction of two modes of treatment for hyperthyroidism in 1940s, thionamide ATD through inhibition of thyroid hormone synthesis and radioactive iodine (RAI) therapy via ablation of thyroid tissue, have been considered as great progress for management of GD (44). However, none of these therapeutic approaches or thyroidectomy has been able to re-establish normal lifelong thyroid function in all patients permanently (45).…”

A New Perspective in the Management of Graves’ Hyperthyroidism

“…Radioactive iodine (RAI) treatment and antithyroid drug (ATD) administration were introduced in the mid-1940s for the management of hyperthyroidism (3,4). None of the therapeutic approaches for the treatment of Graves' disease could establish normal thyroid function in the majority of patients permanently.…”