graves'%20disease
GRAVES' DISEASE
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'%20disease Treatment

Principles of Therapy

Treatment methods will depend on:
  • Clinical presentation
  • Age of patient
    • Elderly without cardiac problems and children: Antithyroid agents - first-line agent
    • Elderly with cardiac problems: Radioactive iodine
  • Clinician preference
    • Patient’s input

Pharmacotherapy

Antithyroid Agents
  • Preferred therapy in pregnant women and children, patients with high likelihood of remission, elderly, or others with comorbidities increasing surgical risk or with limited life expectancy
  • May also be a treatment option for patients with previously operated or irradiated necks or lack access to an experienced/high-volume thyroid surgeon, patients with moderate-severe active Graves' orbitopathy and those needing rapid biochemical disease control
  • 30-40% of patients remain euthyroid 10 years after antithyroid treatment
    • Remission is most likely to occur in patients with mild hyperthyroidism and small goiters
    • Patients unable to attain remission after 12-18 months of antithyroid therapy can continue antithyroid therapy for another 12 months or opt for radioactive Iodine (RAI) or thyroidectomy
    • 10-15% of patients become hypothyroid 15 years after treatment
  • Usually takes 4-8 weeks to control symptoms
    • May use beta-blockers to control symptoms during this period, but not always needed
  • Contraindicated in patients with previous known major adverse reactions to antithyroid drugs
Carbimazole and Methimazole
  • Inhibit thyroid peroxidase and hence the synthesis of thyroid hormone
  • Fewer tablets are needed for initial treatment compared with Propylthiouracil (PTU)
  • In most circumstances, preferred thionamide antithyroid agent than PTU
Propylthiouracil (PTU)
  • Inhibits thyroid peroxidase and hence the synthesis of thyroid hormone, and blocks the extrathyroidal deiodination of thyroxine (T4) to triiodothyronine (T3)
    • Preferred over Methimazole during first trimester of pregnancy, thyrotoxic crises and in patients with adverse reactions with Methimazole that are not candidate for radioiodine therapy or surgery 
Beta-blockers
  • Eg Atenolol, Bisoprolol, Metoprolol, Propranolol
  • Should be given to elderly patients with symptomatic thyrotoxicosis and to other thyrotoxic patients with heart rate >90 beats/min or coexistent cardiovascular disease
    • Should be considered in all patients with symptomatic thyrotoxicosis
  • Decreases heart rate, systolic blood pressure, muscle weakness and tremor
  • Shows improvement in the degree of irritability, emotional lability and exercise tolerance
  • Helps prevent episodes of hypokalemic periodic paralysis
  • High-dose Propranolol inhibits peripheral conversion of T4 to T3
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
6 days ago
Regular practice of yoga postures confers benefits for glucose control, oxidative stress, inflammatory response, and sleep quality in patients with type 2 diabetes, a study has found.
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
6 days ago
Women with central adiposity, regardless of menopausal status, are at risk of developing breast cancer, according to a study.