Treatment of Graves disease

• reduce thyroid hormone synthesis

  • inhibit thyroid hormone formation

    • antithyroid drugs: propylthiouracil (PTU), methimazole

  • reduce amount of thyroid tissue

    • radioactive iodine

    • surgery

• inhibit beta-sympathetic activity

  • propranolol

• vitamin replacement—A, D, E, K

Antithyroid drugs e.g. PTU, methimazole

• decrease T4/T3 formation

• inhibit peroxidase, which is normally responsible for

  • iodine organification

  • coupling

• PTU inhibits T4 to T3 conversion

• mild immunosuppresive

• lower levels of thyroid-stimulating immunoglobulin (TSI), the autoantibody responsible for Graves disease

• increased remissions

• toxic effects

  • skin rashes

  • agranulocytosis, leukopenia

  • arthralgia

  • fever

  • lupus-like syndrome

  • hepatitis

Radioiodine (RAI)

• 80% are euthryoid after one dose

• however, some patients are permanently hypothyroid after the first dose

Subtotal thyroidectomy

• warranted when there is a large obstructive goiter

• patient needs to be euthyroid at the time of surgery to avoid afib, other complications

Hyperthyroidism: other entities

• toxic multinodular goiter

• solitary toxic adenoma

Category: Endocrinology Notes