Reflections on the Management of Graves’ Hyperthyroidism

Daumerie, Chantal; Orgiazzi, Jacques

doi:10.1159/000491585

Cited by 2 publications

(2 citation statements)

References 3 publications

(3 reference statements)

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“…The recurrence rate has been estimated to be about 50%, with a high variation between 30 and 70% (39,40,41,42). Consequently, the recurrence of GH after ATDs discontinuation remains the main drawback of the medical treatment resulting in potential disappointment for the patient (43). On the contrary, ablative treatments eliminate any risk of recurrence but at the expense of the development of permanent hypothyroidism.…”

Section: Prediction Of the Risk Of Recurrence After Antithyroid Drugsmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Predictive scores in autoimmune thyroid disease: are they useful?

Effraimidis

2019

European Journal of Endocrinology

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Prediction models are of a great assistance for predicting the development of a disease, detecting or screening undiagnosed patients, predicting the effectiveness of a treatment and helping toward better decision-making. Recently, three predictive scores in the field of autoimmune thyroid disease (AITD) have been introduced: The Thyroid Hormones Event Amsterdam (THEA) score: a predictive score of the development of overt AITD, the Graves’ Events After Therapy (GREAT) score: a prediction score for the risk of recurrence after antithyroid drugs withdrawal and the Prediction Graves’ Orbitopathy (PREDIGO) score: a prediction score for the development of Graves’ orbitopathy in newly diagnosed patients with Graves’ hyperthyroidism. Their construction, clinical applicability, the possible preventative measurements which can be taken to diminish the risks and the potential future developments which can improve the accuracy of the predictive scores are discussed in this review.

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Section: Prediction Of the Risk Of Recurrence After Antithyroid Drugsmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Predictive scores in autoimmune thyroid disease: are they useful?

Effraimidis

2019

European Journal of Endocrinology

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“…Treatment modalities for the management of Graves' hyperthyroidism include anti-thyroid drugs (ATD), radioactive iodine (RAI) therapy, or total thyroidectomy. ATD is favored as first line therapy in Europe, with remission achieved in approximately half of patients after a 12-18 month duration of treatment (6,12,13). Traditionally, radioactive iodine has been preferred in USA (7), although recent American Thyroid Association (ATA) guidelines have suggested that ATD can also be considered as first line (14).…”

Section: Introductionmentioning

confidence: 99%

Pharmacodynamic Response to Anti-thyroid Drugs in Graves' Hyperthyroidism

et al. 2020

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Objective: Graves' disease is the commonest cause of hyperthyroidism in populations with sufficient dietary iodine intake. Anti-thyroid drugs (ATD) are often used as the initial treatment for Graves' hyperthyroidism, however there is a paucity of data relating the dose of ATD therapy to the effect on thyroid hormone levels, increasing the risk of both over-and under-treatment. We aimed to determine the pharmacodynamic response to the ATD carbimazole. Design: Retrospective cohort study. Methods: Participants were patients (n = 441) diagnosed with Graves' disease at Imperial College Healthcare NHS Trust between 2009 and 2018. The main outcome measure was change in thyroid hormone levels in response to ATD. Results: Baseline thyroid hormone levels were positively associated with TSH receptor antibody titres (P < 0.0001). Baseline free triiodothyronine (fT3) were linearly related to free thyroxine (fT4) levels in the hyperthyroid state (fT3 = fT4 * 0.97-11), and fell proportionately with carbimazole. The percentage falls in fT4 and fT3 per day were associated with carbimazole dose (P < 0.0001). The magnitude of fall in thyroid hormones after the same dose of carbimazole was lower during follow up than at the initiation visit. The fall in thyroid hormone levels approximated to a linear response if assessed at least 3 weeks after commencement of carbimazole. Following withdrawal of antithyroid drug treatment, the risk of relapse was greater in patients with higher initial fT4, initial TSH receptor antibody titre, males, smokers, and British Caucasian ethnicity. Conclusion: We identify a dose-response relationship for fall in thyroid hormones in response to carbimazole to aid in the selection of dose for Graves' hyperthyroidism.

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Reflections on the Management of Graves’ Hyperthyroidism

Cited by 2 publications

References 3 publications

MANAGEMENT OF ENDOCRINE DISEASE: Predictive scores in autoimmune thyroid disease: are they useful?

MANAGEMENT OF ENDOCRINE DISEASE: Predictive scores in autoimmune thyroid disease: are they useful?

Pharmacodynamic Response to Anti-thyroid Drugs in Graves' Hyperthyroidism

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