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.

Radiotherapy

Radioactive Iodine Therapy

  • Usually 1st-line agent for patients ≥50 yr, & in North America
    • Antithyroid agents are usually 1st-line treatment elsewhere
  • Preferred treatment for females planning pregnancy in the future, individuals w/ comorbidities increasing surgical risk & patients w/ previously operated or externally irradiated necks
  • Can be used as initial treatment or for relapses after trial of antithyroid agents
  • Effects: 80-95% of patients remain euthyroid after treatment
    • Usually takes 4-8 wk to control symptoms
    • Large goiter requires large dose to reduce risk of recurrence
    • 10-30% of patients become hypothyroid w/in 2 yr after treatment; 5% per yr thereafter
  • Pretreatment w/ other agents
    • Antithyroid agents: Usually unnecessary w/ mild-moderate disease, but necessary for severe disease (discontinue for at least 3 days prior to treatment & can be resumed 2-3 days after treatment)
    • Beta-blocker may also be used prior to treatment to control symptoms
  • Posttreatment
    • Antithyroid agents have radioprotective effect; therefore, administer after treatment only in poorly controlled hyperthyroidism
  • Thyroid replacement should be carefully titrated as patient evolves from euthyroidism to hypothyroidism
  • Contraindicated in pregnant women, breastfeeding
    • Pregnancy should be deferred at least 4-6 mth
    • Pregnancy test should be done w/in 48 hr prior to treatment
  • Can induce or worsen ophthalmopathy, particularly in smokers
  • Consent form should be signed before initiating treatment
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