Graves' Disease - Treatment

Treatment

Means to interrupt the autoimmune processes of Graves' disease are unknown, so treatment must be indirect. The thyroid gland is the target, via three different methods (which have not changed fundamentally since the 1940s): Antithyroid drugs (which reduce the production of thyroid hormone), partial or complete destruction of the thyroid gland by ingestion of radioactive iodine (radioiodine), and partial or complete surgical removal of the thyroid gland (thyroidectomy).

No treatment for Graves' hyperthyroidism is preferred; it is not straightforward and often involves complex decision-making. The physician must weigh the advantages and disadvantages of the different treatment options and help the patient arrive at an individualized, appropriate and cost-effective therapeutic strategy. Kaplan summarizes, "the choice of therapy varies according to nonbiological factors - physicians' training and personal experience; local and national practice patterns; patient, physician, and societal attitudes toward radiation exposure; and biological factors including age, reproductive status, and severity of the disease".

Therapy with radioiodine is the most common treatment in the United States, while antithyroid drugs and/or thyroidectomy are used more often in Europe, Japan, and most of the rest of the world. However, due to the varying success of every treatment option, patients are often subjected to more than one when the first attempted treatment does not prove entirely successful; the risk of relapse or subsequent hypothyroidism is substantial.

In the short term, treatment of hyperthyroidism usually produces a parallel decrease in endocrine and psychiatric symptoms. When prolonged treatment normalizes thyroid function, some psychiatric symptoms and somatic complaints may persist. In spite of modern therapeutic modalities, Graves' disease is accompanied by seriously impaired quality of life. Several recent studies stress the importance of early prevention, speedy rehabilitation, and thorough follow-up of hyperthyroid patients. Patients who do not have a spontaneous remission with the use of antithyroid drugs become lifelong thyroid patients.