From the Guidelines
Graves' disease should be treated with antithyroid medications, such as methimazole, or nonreversible thyroid ablation therapy, particularly for patients with a TSH level that is undetectable or less than 0.1 mIU/L, as recommended by the USPSTF 1. The primary goal of treatment is to reduce thyroid hormone production and alleviate symptoms.
- Antithyroid medications, such as methimazole (10-30 mg daily) or propylthiouracil (100-300 mg daily divided into multiple doses), are commonly used to treat Graves' disease.
- Beta-blockers, like propranolol (20-40 mg 3-4 times daily), may be added to control symptoms such as rapid heart rate and tremors.
- Treatment usually continues for 12-18 months, after which some patients achieve remission.
- For those who don't respond to medication or experience recurrence, more definitive treatments include radioactive iodine therapy (typically a single oral dose of I-131) or thyroidectomy (surgical removal of the thyroid gland).
- After these definitive treatments, patients typically require lifelong thyroid hormone replacement with levothyroxine.
- Regular monitoring of thyroid function is essential throughout treatment, as recommended by the USPSTF 1. However, the USPSTF found no direct evidence that treatment of thyroid dysfunction based on risk level alters final health outcomes 1. It is essential to note that the optimal screening interval for thyroid dysfunction is unknown, and long-term randomized, blinded, controlled trials of screening for thyroid dysfunction would provide the most direct evidence on any potential benefits of this widespread practice 1.
From the FDA Drug Label
Propylthiouracil is a prescription medicine used to treat people who have Graves’ disease with hyperthyroidism or toxic multinodular goiter. Propylthiouracil is used when:
- certain other antithyroid medicines do not work well
- thyroid surgery or radioactive iodine therapy is not a treatment option.
- to decrease symptoms of hyperthyroidism in preparation for a thyroidectomy (removal of the thyroid gland) or radioactive iodine therapy.
Propylthiouracil is used to treat Graves’ disease with hyperthyroidism. The medication is prescribed when other antithyroid medicines are not effective, or when surgery or radioactive iodine therapy is not a viable option. It is also used to decrease symptoms of hyperthyroidism before a thyroidectomy or radioactive iodine therapy 2.
From the Research
Treatment Options for Graves' Disease
- Antithyroid drugs, such as methimazole and propylthiouracil, can be used to treat Graves' disease, with about 50% of patients being cured after 12 to 18 months of treatment 3
- Radioactive iodine ablation is a widely used treatment for Graves' disease, with a high success rate, but it can lead to permanent hypothyroidism 3, 4, 5
- Surgical thyroidectomy is also an option, with a low risk of recurrence, but it carries risks such as hypoparathyroidism and permanent paralysis of the recurrent laryngeal nerve 3, 4
Predictors of Remission
- A study found that minimum maintenance therapy with anti-thyroid drugs to keep euthyroid for 6 months is a practical measure for predicting remission in Graves' disease, with an 81% prediction rate 6
- The measurement of TSH-binding inhibitory immunoglobulin (TBII) or thyroid-stimulating antibodies (TSAb) gave little additional information for predicting remission 6
- A higher dose of radioactive iodine per gram of thyroid tissue (≥14.8 MBq or 0.4 mCi) was found to be an independent predictor of response to therapy 7
Response to Radioactive Iodine Therapy
- A study found that 85.9% of patients with Graves' disease responded to radioactive iodine therapy, with 88.9% becoming hypothyroid and 11.1% becoming euthyroid 7
- The majority of patients (90.4%) responded to therapy within 6 months, with a quicker response for those treated with higher doses per gram of thyroid tissue 7