Graves’
disease is the most common cause of
hyperthyroidism which is caused by stimulating
autoantibodies against
thyroid-stimulating hormone receptor. There is no
etiology-specific
treatment for Graves’
disease.Current Concepts Graves’
disease can be treated with
antithyroid drugs (ATDs), radioactive
iodine, or
thyroidectomy. ATDs are the most preferred first-line
therapy, because they do not cause either permanent
hypothyroidism or exacerbation of orbitopathy, despite low remission rate. ATDs have serious adverse reactions including
agranulocytosis and fulminant hepatic
necrosis requiring
liver transplantation.
Methimazole (MMI) is recommended in every
patient starting ATD
therapy, except during the
first trimester of
pregnancy and in cases of
thyroid storm, because of relatively lower
incidence and severity of serious adverse reactions compared with
propylthiouracil.
Treatment should be continued for 12 to 18 months, then discontinued if the levels of
thyroid-stimulating hormone and
thyroid-stimulating hormone receptor
antibodies are normalized. In cases of
relapse of
hyperthyroidism, radioactive
iodine or
thyroidectomy can be recommended for definitive
therapy; however, recent studies support longer-term
maintenance of low
dose MMI as a favorable alternative
therapy. All ATDs may induce
congenital anomalies when exposed during early
pregnancy. Every
female patient of reproductive age should be advised to postpone
pregnancy until their
thyroid function is maintained within
normal range and to stop ATDs when
pregnancy is confirmed to avoid the
risk of
congenital anomalies.Discussion and
Conclusion:
Longer-term low
dose MMI
therapy can be a good choice for Graves’
hyperthyroidism with
relapse. Before
pregnancy,
hyperthyroidism should be controlled to stop ATDs during
pregnancy.