scholarly journals 2022 European Thyroid Association Guideline for the management of pediatric Graves’ disease

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Christiaan F Mooij ◽  
Timothy D Cheetham ◽  
Frederik A Verburg ◽  
Anja Eckstein ◽  
Simon H Pearce ◽  
...  
Keyword(s):  
Treatment Options ◽  
Behavioral Changes ◽  
Definitive Treatment ◽  
Dose Titration ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Large Goiter ◽  
Management Recommendations ◽  
Receptor Antibodies ◽  
Serum Tsh

Hyperthyroidism caused by Graves’ disease (GD) is a relatively rare disease in children. Treatment options are the same as in adults – antithyroid drugs (ATD), radioactive iodine (RAI) or thyroid surgery, but the risks and benefits of each modality are different. The European Thyroid Association guideline provides new recommendations for the management of pediatric GD with and without orbitopathy. Clinicians should be alert that GD may present with behavioral changes or declining academic performance in children. Measurement of serum TSH receptor antibodies is recommended for all pediatric patients with hyperthyroidism. Management recommendations include the first-line use of a prolonged course of methimazole/carbimazole ATD treatment (3 years or more), a preference for dose titration instead of block and replace ATD, and to avoid propylthiouracil use. Where definitive treatment is required either total thyroidectomy or RAI is recommended, aiming for complete thyroid ablation with a personalized RAI activity. We recommend avoiding RAI in children under 10 years of age but favor surgery in patients with large goiter. Pediatric endocrinologists should be involved in all cases.

scholarly journals Remission Rate of Graves' Disease and the Trend of Changes in Serum TSH Receptor Antibodies in Prolonged Antithyroid Drug Treatment

2020 ◽  
Vol 18 (Suppl) ◽  
Author(s):  
Danilo Villagelin ◽  
Roberto Bernardo Santos ◽  
João Hamilton Romaldini
Keyword(s):  
Drug Treatment ◽  
Remission Rate ◽  
Antithyroid Drug ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Remission Rates ◽  
Thyrotropin Receptor Antibodies ◽  
Antithyroid Drug Treatment ◽  
The Impact ◽  
Receptor Antibodies

Context: Graves’ disease is an autoimmune disease caused by thyrotropin receptor antibodies (TRAb). These antibodies can be measured and used for the diagnosis, prediction of remission, and risk of Graves’ orbitopathy development. There are three treatments for Graves’ disease that have remained unchanged for the last 75 years: Antithyroid drugs, radioiodine, and surgery. Antithyroid drugs are the first treatment option worldwide and are usually used for 12 - 18 months. Recent reports suggest the use of antithyroid drugs for more than 18 months with better outcomes. This review focuses on two aspects of treatment with antithyroid drugs: The impact of using antithyroid drugs for more than 12 - 18 months on remission rates and the trend of TRAb during prolonged antithyroid drug treatment. Evidence Acquisition: A review was performed in Medline on the published work regarding the duration of ATD treatment and remission of Graves' disease and also ATD treatment and TRAb status during the 1990 - 2019 period. Results: Remission rates are variable (30% - 80%), and many clinical and genetic factors serve as predictors. The long-term use of antithyroid drugs appears to increase remission rates. TRAb values usually decline during ATD treatment, but the trend could occur in two ways: Becoming negative or showing a fluctuating pattern. However, approximately 10% of the patients will remain TRAb-positive after five years of treatment with antithyroid drugs. Conclusions: Antithyroid drugs can be used for long periods with an increase in remission rates, and a gradual decrease in TRAb levels, with the disappearance of TRAb in 90% of the patients after 60 months.

Aeromedical Decision Making for Military Aircrew with Graves’ Disease

2021 ◽  
Vol 92 (12) ◽  
pp. 980-986
Author(s):  
Edwin Hong-Teck Loh ◽  
Feng Wei Soh ◽  
Brian See ◽  
Benjamin Boon Chuan Tan
Keyword(s):  
Decision Making ◽  
Air Force ◽  
Case Series ◽  
Definitive Treatment ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
First Line Therapy ◽  
The Mean ◽  
Stable Maintenance ◽  
The Impact

BACKGROUND: Graves’ Disease (GD) is a common cause of hyperthyroidism. Although definitive treatment with radioactive iodine (RAI) is preferred for military aircrew, there are cultural and individual differences in receptivity toward RAI, and clinical guidelines that recommend antithyroid drugs (ATD) as the first line therapy. We examined a case series of Republic of Singapore Air Force (RSAF) aviators with GD treated with ATD and the impact of their condition on aeromedical disposition.CASE SERIES: All RSAF aircrew diagnosed with GD and treated with ATD over a 15-yr period were retrospectively identified and analyzed to determine the impact on their fitness for flying duties. The mean age of the 13 aircrew was 33 ± 7.1 yr (range, 25–47 yr), with 11 (84.6%) being males. There were 10 (76.9%) who had ATD as the only treatment while 3 (23.1%) were initially treated with ATD but subsequently underwent RAI or surgery. Of the 10 treated with only ATD, 3 (30.0%) were returned to restricted flying, 6 (60.0%) were returned to unrestricted flying, and 1 (10.0%) is still undergoing ATD titration. There were 10 (76.9%) aircrew who were returned to some form of flying duties while on low doses of ATD.DISCUSSION: This case series suggests that ATD is a viable treatment modality in the aeromedical management of military aviators with GD and it is possible to return military aircrew on a stable maintenance dose of ATD to flying duties. A framework is proposed to support the aeromedical decision-making process for military aircrew in the treatment of GD.Loh EH-T, Soh FW, See B, Tan BBC. Aeromedical decision making for military aircrew with Graves’ disease. Aerosp Med Hum Perform. 2021; 92(12):980–986.

DEMOGRAFINIŲ VEIKSNIŲ SĄSAJOS SU KLINIKINE GREIVSO LIGOS IŠRAIŠKA IR BAIGTIMI

2013 ◽  
Vol 23 (2) ◽  
pp. 76-80
Author(s):  
Dalia Daukšienė ◽  
Narseta Mickuvienė
Keyword(s):  
Clinical Features ◽  
Disease Onset ◽  
Antithyroid Drug ◽  
Treatment Withdrawal ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyroid Disorder ◽  
Age And Gender ◽  
Large Goiter ◽  
And Gender

Graves‘ disease is an autoimmune thyroid disorder characterized by the presence of autoantibodies against thyrotropin receptor. Antithyroid drugs are effective in controlling hyperthyroidism, but only one-third of patients achieve long-term remission after antithyroid drug treatment withdrawal. Influence of demographic factors (such as age and gender) on clinical features and outcome of Graves’ disease remains unclear despite decades of scientific research. The aim of the study was to determine the influence of age and gender on clinical features and outcome of Graves’ disease. Matherial and methods. We performed a retrospective study of 194 adult patients with newly diagnosed Graves’ disease. Outcome after antithyroid drugs was defined as remission or failed. Results. The mean age of males was greater than females (p=0,022). Males and females had the same outcome after medical therapy. The presence of large goiter was associated with lower mean age at diagnosis in both females and males. Patients less than 40 yr. of age were more likely to have large goiter (grade III) than smaller goiter (grade I/II) compared with older patients (OR 2.81, 95% CI 1.35 –5.84). Age at disease onset had no significant relationship with the medical treatment failure. Conclusions. Age less than 40 yr. is a significant predictor for the presence of large goiter at diagnosis. Age and gender did not predict the outcome of Graves’ disease.

New Thoughts about the Cause and Treatment of the Severe Ocular Manifestations of Graves' Disease

1974 ◽  
Vol 19 (4) ◽  
pp. 165-169 ◽  
Author(s):  
I. R. McDougall ◽  
J. P. Kriss
Keyword(s):  
Corticosteroid Treatment ◽  
Immunosuppressive Drugs ◽  
Definitive Treatment ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
High Dose ◽  
Ocular Manifestations ◽  
Dose Corticosteroid

The ocular manifestations of Graves' disease are probably due to autoimmunity. Thyroglobulin and complexes of thyroglobulin and antithyroglobulin have a predilection to attach to extraocular muscle membranes in vitro. It is suggested that in vivo these molecules are directed, probably via lymphatics, to the orbit where they attach to the muscle cell membranes. B lymphocytes, which have been shown to be capable of combining with both thyroglobulin and complexes, attach on to these molecules. The tissue damage is probably caused by the complexes, the lymphocytes, or both. Treatment of hyperthyroidism in a patient with ophthalmopathy should be cautious and with antithyroid drugs. This will reduce, though not completely eliminate, the possibility of a post-treatment exacerbation. If for some reason definitive treatment of the hyperthyroidism is essential, worsening of the ophthalmopathy may be prevented by prescribing steroids or immunosuppressive drugs at the time of surgical or radioiodine treatment. When progressive eye disease has arisen, orbital radiotherapy is a safe effective alternative to high dose corticosteroid treatment or surgical decompression.

scholarly journals Current and Future Treatments for Graves’ Disease and Graves’ Ophthalmopathy

2018 ◽  
Vol 50 (12) ◽  
pp. 871-886 ◽  
Author(s):  
Anupam Kotwal ◽  
Marius Stan
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Geographic Location ◽  
Antithyroid Drugs ◽  
Term Therapy ◽  
Graves Disease ◽  
Graves Ophthalmopathy ◽  
Technological Advances ◽  
Potential Risks ◽  
Long Term Therapy

AbstractThe course and pathogenesis of Graves’ disease and Graves’ ophthalmopathy are interdependent, influencing each other’s therapeutic choices. Multiple factors including geographic location, access to medical services, patient and physician preferences influence the management of these conditions. Graves’ disease is classically managed with one of three treatment options – antithyroid drugs, radioactive iodine, and thyroidectomy. In recent years, there has been a shift towards antithyroid drugs, including long term therapy with these agents, given the advantage of avoiding hypothyroidism and the apparent safety of this approach. In addition, new therapies are (slowly) emerging, focusing on immunomodulation. Technological advances are opening doors to non-pharmaceutical interventions that aim to deal with both structural thyroid abnormalities as well as biochemical abnormalities of hyperthyroidism. Graves’ ophthalmopathy management is guided by its activity and severity status, with treatment options including smoking cessation, control of hyperthyroidism, local eye measures, glucocorticoids, selenium, orbital radiotherapy, and surgery. In addition to these established treatment choices, new immunotherapy-based approaches are being tested. Some of them (tocilizumab and teprotumumab) are very promising but further evaluation is needed before we can establish their role in clinical care. Agents identified as beneficial in Graves’ disease management will likely be tested in Graves’ ophthalmopathy as well. In the coming years, our main clinical responsibility will be to find the proper balance between the benefits and potential risks of these incoming therapies, and to identify the subgroups of patients where this ratio is most likely to favor a safe and successful therapeutic outcome.

Diagnosis and Treatment of Graves Disease

2003 ◽  
Vol 37 (7-8) ◽  
pp. 1100-1109 ◽  
Author(s):  
Darcie D Streetman ◽  
Ujjaini Khanderia
Keyword(s):  
Thyroid Gland ◽  
Radioactive Iodine ◽  
Radioiodine Therapy ◽  
Patient Adherence ◽  
Treatment Options ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Extensive Experience ◽  
Long Term Treatment ◽  
Β Blockers

OBJECTIVE: To review the etiology, diagnosis, and clinical presentation of Graves disease and provide an overview of the standard and adjunctive treatments. Specifically, antithyroid drugs, β-blockers, inorganic iodide, lithium, and radioactive iodine are discussed, focusing on current controversies. DATA SOURCES: Primary articles were identified through a MEDLINE search (1966–July 2000). Key word searches included β-blockers, Graves disease, inorganic iodide, lithium, methimazole, and propylthiouracil. Additional articles from these sources and endocrinology textbooks were also identified. We agreed to include articles that would highlight the most relevant points, as well as current areas of controversy. DATA SYNTHESIS: Graves disease is the most common cause of hyperthyroidism. The 3 main treatment options for patients with Graves hyperthyroidism include antithyroid drugs, radioactive iodine, and surgery. Although the antithyroid drugs propylthiouracil (PTU) and methimazole (MMI) have similar efficacy, there are situations when 1 agent is preferred. MMI has a longer half-life than PTU, allowing once-daily dosing that can improve patient adherence to treatment. PTU has historically been the drug of choice for treating pregnant and breast-feeding women because of its limited transfer into the placenta and breast milk. Adjuvant therapies for Graves disease include β-blockers, inorganic iodide, and lithium. β-Blockers are used to decrease the symptoms of hyperthyroidism. Inorganic iodide is primarily used to prepare patients for thyroid surgery because of its ability to decrease the vascularity of the thyroid gland. Lithium, which acts in a manner similar to iodine, is not routinely used due to its transient effect and the risk of potentially serious adverse effects. In the US, radioiodine therapy has become the preferred treatment for adults with Graves disease. It is easy to administer, safe, effective, and more affordable than long-term treatment with antithyroid drugs. Hypothyroidism is an inevitable consequence of radioiodine therapy. Radioiodine is contraindicated in pregnant women because it can damage the fetal thyroid gland, resulting in fetal hypothyroidism. Bilateral subtotal thyroidectomy, which was once the only treatment available, is now performed only in special circumstances. In addition to the normal risks associated with surgery, laryngeal nerve damage, hypoparathyroidism, and hypothyroidism can occur following that procedure. CONCLUSIONS: Despite extensive experience with medical management, controversy prevails regarding choosing among the various drugs for treatment of Graves disease. None of the treatment options, including antithyroid drugs, radioiodine, and surgery, is ideal. Each has risks and benefits, and selection should be tailored to the individual patient.

Graves’ disease in a five-month-old boy with an unusual treatment course

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Svetlana Azova ◽  
Farrah Rajabi ◽  
Biren P. Modi ◽  
Laura Mansfield ◽  
Maureen M. Jonas ◽  
...  
Keyword(s):  
De Novo ◽  
Thyroid Autoimmunity ◽  
Mitochondrial Disorder ◽  
Male Infant ◽  
Left Ventricular ◽  
Definitive Treatment ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
First Line Therapy ◽  
Hpt Axis

AbstractObjectivesGraves’ disease (GD) is rare in children under age five years. Antithyroid drugs are typically first-line therapy but carry the risks of agranulocytosis and liver dysfunction.Case presentationA male infant with multiple congenital anomalies, left ventricular hypertrophy, and neurologic dysfunction developed GD at five months of life. The presence of chronic hepatitis complicated medical management. Potassium iodide was effective temporarily, but urgent thyroidectomy was required at nine months of age. Postoperatively, the patient developed a thyroid function pattern consistent with impaired pituitary sensitivity to thyroid hormone (TH) that responded to the addition of liothyronine. Exome sequencing revealed a heterozygous de novo duplication of the ATAD3 gene cluster, suggesting a possible mitochondrial disorder.ConclusionsThis case describes the youngest child to date to be diagnosed with endogenous GD and to successfully undergo definitive treatment with thyroidectomy. An underlying defect in mitochondrial function is suspected, suggesting a potential novel pathophysiologic link to early-onset thyroid autoimmunity. Additionally, this case illustrated the development of impaired pituitary sensitivity to TH following thyrotoxicosis of postnatal onset, which may contribute to our understanding of hypothalamic-pituitary-thyroid (HPT) axis development.

scholarly journals RAI Therapy for Graves’ Hyperthyroidism

2021 ◽  
Author(s):  
Ioannis Iakovou ◽  
Evanthia Giannoula ◽  
Paraskevi Exadaktylou ◽  
Nikitas Papadopoulos
Keyword(s):  
Therapeutic Effect ◽  
Therapeutic Dose ◽  
Initial Treatment ◽  
Radioiodine Therapy ◽  
Treatment Options ◽  
Symptomatic Improvement ◽  
Therapeutic Management ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Common Cause

Graves’ Disease is the most common cause of hyperthyroidism. It has multiple manifestations and it requires appropriate diagnostic and therapeutic management. Once it has been established that the patient is hyperthyroid and the cause is GD, the patient and physician must choose between three effective and relatively safe initial treatment options: antithyroid drugs (ATDs), radioiodine (RAI) therapy, or thyroidectomy. RAI has been used to treat hyperthyroidism for more than seven decades. It is well tolerated and complications are rare, except for those related to orbitopathy. Most patients are effectively treated with one therapeutic dose of I-131. The patient usually notes symptomatic improvement within 3 weeks of therapy. However, the full therapeutic effect takes 3 to 6 months because stored hormone must first be released. Radioiodine therapy may not initially be effective in up to 10% of patients. They require repeat treatment, usually with a higher administered dose.

scholarly journals Presentation and Outcome of Severe Graves’ Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A842-A843
Author(s):  
Priya Mohan Babu ◽  
Suhani Bahl ◽  
Florin Capatana ◽  
Khaliq Hamdan ◽  
Ishrat Khan ◽  
...  
Keyword(s):  
Thyroid Hormones ◽  
Treatment Initiation ◽  
Treatment Regime ◽  
Definitive Treatment ◽  
Dose Titration ◽  
Graves Disease ◽  
Detection Range ◽  
Multisystem Involvement ◽  
Significant Difference ◽  
Large Goitre

Abstract Introduction: Subjects with “severe” Graves’ disease (GD) are known to have adverse outcomes. They have multisystem involvement (orbitopathy, dermopathy), more severe clinical features, large goitres and a higher relapse rate. Also, their response to thionamides is slower. There is a developing consensus that early definitive treatment improves prognosis in them. Methods: We retrospectively analysed the electronic case records and biochemistry databases of all subjects seen in our University Health Board between January 2017 and October 2019 with GD. Severe GD was defined by (1) a thyrotropin receptor antibody (TRAb) value greater than 10U/l (normal range: less than 0.9), (2) with any one of the following - (a) free thyroxine (T4) above 50pmol/l (reference range 9-19.1), (b) a combination of T4 more than 40 pmol/l with triiodothyronine (T3) above the detection range of the assay (46.1 pmol/l), (c) the presence of a large goitre, (d) active Graves’ orbitopathy (GO) or (e) dermopathy. We compared subjects with severe GD to those who did not fulfil the above criteria i.e. non-severe GD. Results: 176 GD subjects were seen during this period - 52 (29.5%) with severe and 124 (70.5%) with non-severe GD. However, 19 severe and 26 non-severe GD subjects were on active thionamide treatment at the time of analysis, and complete details were unavailable in 41 subjects. There was a significant difference in the following features between the severe and non-severe GD groups respectively (1) their median age (39 vs.52 years), (2) median TRAb levels (25.5 vs.18.5 U/l) (3) higher prevalence of GO (38.5 vs.13.3%) and active GO (15.4 vs.0%), (4) the presence of moderate/large goitre (51.3 vs.3.3%), (5) higher number failing to normalize biochemically within the first 6 months after treatment initiation (53.9 vs.39%), (6) the presence of a family history, and (8) a higher number requiring definitive treatment within 12 months of starting treatment (9.6vs.0.81%)(p=0.001-0.026 for the above). There was no difference between the two groups in gender, treatment regime i.e. dose titration regime or block and replacement regime, number biochemically normalizing within 12 months, and those who had more than 18 months of treatment and their relapse rates (55 vs. 59.1%, p=0.84). Conclusions: We have shown that those with severe GD were younger, have higher TRAb concentrations with multisystem involvement, and delayed initial normalization of thyroid hormones. A greater number of them require definitive treatment within 12 months of treatment initiation. However, the majority in both groups normalize thyroid hormones within 12 months irrespective of the treatment regime used. Early definitive treatment is required in a significantly higher percentage of subjects with severe GD and needs to be considered in them.

scholarly journals Variation in the use of definitive treatment options in the management of Graves' disease: a UK clinician survey

2016 ◽  
Vol 93 (1098) ◽  
pp. 198-204 ◽  
Author(s):  
Jessica Hookham ◽  
Emma E Collins ◽  
Amit Allahabadia ◽  
Sabapathy P Balasubramanian
Keyword(s):  
Treatment Options ◽  
Definitive Treatment ◽  
Graves Disease
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