Clinical diagnosis and treatment of refractory hyperthyroidism / 中国实用内科杂志

ABSTRACT

Graves' disease(GD) is the most common cause of endogenous thyrotoxicosis, and current therapeutic options for GD include antithyroid drugs(ATD), radioactive iodine and thyroidectomy. Refractory hyperthyroidism is a rare condition in which hy¬perthyroidism fails to respond to the conventional therapy of anti-thyroidal med¬ications. Enlarged goiter size, high titers of thyrotropin receptor antibodies(TRAb) at diagnosis and/or at the end of the treatment, TSH suppression after drug withdrawal and compliance to the treatment have all been proposed as risk factors that predict the relapse of GD. we propose that a patient-centered professionalism should be consistently followed, and that refractory hyperthyroidism because of unsuitable therapeutic strategies should be strictly avoided in the clinical practice. For the patients with refractory hyperthyroidism, radical treatment is recommended, however,continued long-term low-dose ATD can be considered.