Treatment Guideline Chart
Graves' disease is an autoimmune disorder that results into overproduction of thyroid hormones.
Thyrotoxicosis signs and symptoms include hyperactivity, irritability, insomnia, dysphoria, sweating, heat intolerance, palpitations, weakness, fatigue, weight loss despite increased appetite, diarrhea, steatorrhea polyuria, decreased libido, tachycardia, tremor, goiter, alopecia, gynecomastia, eyelid lag or retraction and rarely periodic paralysis.
Clinical features in thyrotoxic patient that suggests Graves's disease are ophthalmopathy, thyroid dermopathy, thyroid acropachy, diffuse goiter, antibodies to thyroid peroxidase or thyroglobulin and thyroid radionuclide scan demonstrating a diffuse goiter.

Graves' Disease References

  1. Baskin HJ, Cobin RH, Duick DS, et al; American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002 Nov;8(6):457-469. PMID: 15260011
  2. MedWorm
  3. Malaysian Endocrine and Metabolic Society. Practice guidelines for thyroid disorders: the Malaysian consensus. Academy of Medicine Malaysia. 2000.
  4. Bahn Chair RS, Burch HB, Cooper DS, et al, American Thyroid Association, American Association of Clinical Endocrinologists. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011 Jun;21(6):593-646. PMID: 21510801
  5. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-1421. doi: 10.1089/thy.2016.0229. Accessed 22 Jun 2018. PMID: 27521067
  6. Bartalena L, Baldeschi L, Boboridis K, et al. The 2016 European Thyroid Association/European Group on Graves' Orbitopathy guidelines for the management of Graves' orbitopathy. Eur Thyroid J. 2016 Mar;5(1):9-26. doi: 10.1159/000443828. Accessed 4 Feb 2019. PMID: 27099835
  7. Campbell K, Doogue M. Evaluating and managing patients with thyrotoxicosis. Aust Fam Physician. 2012 Aug;41(8):564-572. PMID: 23145395
  8. Davies TF, Burch HB. Clinical features and diagnosis of Graves’ orbitopathy (ophthalmopathy). UpToDate. Feb 2018. Accessed 28 Jan 2019.
  9. Davies TF, Burch HB. Treatment of Graves’ orbitopathy (ophthalmopathy). UpToDate. 14 May 2020. Accessed 6 Oct 2020.
  10. Davies TF. Pathogenesis of Graves’ disease. UpToDate. Nov 2017. Accessed 28 Jan 2019.
  11. Kahaly GJ, Bartalena L, Hegedüs L, et al. 2018 European Thyroid Association guideline for the management of Graves’ hyperthyroidism. Eur Thyroid J. 2018 Aug;7(4):167-186. doi: 10.1159/000490384. PMID: 30283735
  12. Ross DS, Sugg SL. Surgical management of hyperthyroidism. UpToDate. Sep 2018. Accessed 01 Feb 2019.
  13. Ross DS. Diagnosis of hyperthyroidism. UpToDate. Oct 2017. Accessed 31 Jan 2019.
  14. Ross DS. Graves’ hyperthyroidism in nonpregnant adults: overview of treatment. UpToDate. 28 Jul 2020. Accessed 6 Oct 2020.
  15. Ross DS. Overview of the clinical manifestations of hyperthyroidism in adults. UpToDate. Mar 2018. Accessed 31 Jan 2019.
  16. Ross DS. Radioiodine in the treatment of hyperthyroidism. UpToDate. Aug 2018. Accessed 01 Feb 2019.
  17. Ross DS. Thionamides in the treatment of Graves’ disease. UpToDate. Sep 2018. Accessed 28 Jan 2019.
  18. Ross DS. Thyroid Storm. UpToDate. Jan 2019. Accessed 01 Feb 2019.
  19. Satoh T, Isozaki O, Suzuki A, et al. 2016 Guidelines for the management of thyroid storm from the Japan Thyroid Association and Japan Endocrine Society (First Edition). Endocr J. 2016 Dec;63(12):1025-1064. doi: 10.1507/endocrj.EJ16-0336. PMID: 27746415
  20. Subekti I, Pramono LA. Current diagnosis and management of Graves’ disease. Acta Med Indones. 2018 Apr;50(2):177-182. PMID: 29950539
  21. Bartsch DK, Luster M, Buhr HJ, et al. Indications for the surgical management of benign goiter in adults. Dtsch Arztebl Int. 2018 Jan;115(1-2):1-7. doi: 10.3238/arztebl.2018.0001. PMID: 29345225
  22. British Association of Endocrine and Thyroid Surgeons (BAETS). Guidelines for the surgical management of endocrine disease and training requirements for endocrine surgery. BAETS. 2003. Accessed 11 Mar 2019.
  23. Mumtaz M, Lin LS, Hui KC, et al. Radioiodine I-31 for the therapy of Grave’s disease. Malays J Med Sci. 2009 Jan;16(1):25-33.
  24. Ziessman HA, O’Malley JP, Thrall JH. Endocrine system. In: Ziessman HA, O’Malley JP, Thrall JH. Nuclear Medicine: The Requisites. 4th ed. Philadelphia, Pennsylvania, USA: Saunders, Elsevier; 2014. Accessed 27 Jun 2019:66-97.
  25. Malaysian Endocrine and Metabolic Society (MEMS). Clinical practice guidelines: management of thyroid disorders. MEMS. 2019. Accessed 5 Oct 2020.
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