vrijdag 8 januari 2016

A review of the management of Graves disease

Graves disease is the most common cause of persistent hyperthyroidism in adults. Approximately 3% of women and 0.5% of men will develop Graves disease during their lifetime.

Management of Graves Disease. A Review
Henry B. Burch, David S. Cooper

Mijn behandeling, mijn keus: wat moet ik weten?
Sarah Chapman

Als je schildklier te veel hormoon maakt
Schildkliertje

Observations

We searched PubMed and the Cochrane database for English-language studies published from June 2000 through October 5, 2015. Thirteen randomized clinical trials, 5 systematic reviews and meta-analyses, and 52 observational studies were included in this review. Patients with Graves disease may be treated with antithyroid drugs, radioactive iodine (RAI), or surgery (near-total thyroidectomy).

Antithyroid drugs

The optimal approach depends on patient preference, geography, and clinical factors. A 12- to 18-month course of antithyroid drugs may lead to a remission in approximately 50% of patients but can cause potentially significant (albeit rare) adverse reactions, including agranulocytosis and hepatotoxicity. Adverse reactions typically occur within the first 90 days of therapy.

RAI or surgery

Treating Graves disease with RAI and surgery result in gland destruction or removal, necessitating life-long levothyroxine replacement.
  • Use of RAI has also been associated with the development or worsening of thyroid eye disease in approximately 15% to 20% of patients. Surgery is favored in patients with concomitant suspicious or malignant thyroid nodules, coexisting hyperparathyroidism, and in patients with large goiters or moderate to severe thyroid eye disease who cannot be treated using antithyroid drugs.
  • However, surgery is associated with potential complications such as hypoparathyroidism and vocal cord paralysis in a small proportion of patients.

Pregnancy

In pregnancy, antithyroid drugs are the primary therapy, but some women with Graves disease opt to receive definitive therapy with RAI or surgery prior to becoming pregnant to avoid potential teratogenic effects of antithyroid drugs during pregnancy.

Conclusions and relevance

Management of Graves disease includes treatment with antithyroid drugs, RAI, or thyroidectomy. The optimal approach depends on patient preference and specific patient clinical features such as age, history of arrhythmia or ischemic heart disease, size of goiter, and severity of thyrotoxicosis. Physicians should be familiar with the advantages and disadvantages of each therapy to best counsel their patients.

Geen opmerkingen:

Een reactie plaatsen

Let op!

Raadpleeg altijd een arts als je twijfelt over je gezondheid. De informatie op dit blog kan niet worden beschouwd als vervanging van een consult of een behandeling.