From the Guidelines
The primary treatment for Graves' disease is antithyroid medication, typically methimazole or propylthiouracil (PTU), as recommended by the USPSTF 1. The treatment approach for Graves' disease involves:
- Starting with methimazole at 10-30 mg daily, divided into 1-3 doses, or PTU at 100-300 mg daily, divided into 2-3 doses, and continuing treatment for 12-18 months.
- Using beta-blockers, such as propranolol 20-40 mg 3-4 times daily, to manage symptoms like rapid heart rate and tremors.
- Monitoring thyroid function tests every 4-6 weeks initially, then every 2-3 months once stable, and adjusting medication dose based on thyroid function tests and clinical response. For patients who don't respond to medication or have severe disease, radioactive iodine therapy or thyroidectomy may be considered. Lifestyle modifications, such as quitting smoking and ensuring adequate calcium and vitamin D intake, can also help manage symptoms and protect bone health. The USPSTF found that treatment of thyroid dysfunction, including Graves' disease, is generally recommended for patients with a TSH level that is undetectable or less than 0.1 mIU/L, particularly those with overt disease 1. It's essential to note that the optimal screening interval for thyroid dysfunction is unknown, and the USPSTF found no direct evidence that treatment of thyroid dysfunction based on risk level alters final health outcomes 1.
From the FDA Drug Label
Propylthiouracil is indicated: in patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter who are intolerant of methimazole and for whom surgery or radioactive iodine therapy is not an appropriate treatment option. Methimazole tablets, USP are indicated: In patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter for whom surgery or radioactive iodine therapy is not an appropriate treatment option. Propylthiouracil is a prescription medicine used to treat people who have Graves’ disease with hyperthyroidism or toxic multinodular goiter.
The treatment for Graves' disease includes:
- Medications: such as propylthiouracil or methimazole to ameliorate symptoms of hyperthyroidism
- Surgery: thyroidectomy (removal of the thyroid gland)
- Radioactive iodine therapy
These treatments may be used alone or in combination, depending on the patient's specific condition and medical history 2, 3, 2.
From the Research
Treatment Options for Graves' Disease
The treatment for Graves' disease is based on the use of thionamides, namely methimazole and propylthiouracil 4. Other possible medical treatments include:
- Iodine and compounds containing iodine
- Perchlorate
- Lithium (as an adjuvant in patients undergoing radioiodine therapy)
- β-adrenergic antagonists
- Glucocorticoids
- New molecules still under investigation
Antithyroid Drug Treatment
Antithyroid drugs (ATD) are a common treatment option for Graves' disease, with methimazole and propylthiouracil being the most commonly used 5, 6. The choice of ATD depends on various factors, including the patient's condition, pregnancy status, and lactation. Recent studies have shown that the longer the duration of ATD use, the higher the remission rate 6, 7.
Duration of Antithyroid Drug Treatment
The optimal duration of ATD treatment is still a topic of debate. A systematic scoping review found that long-term ATD treatment for more than 60 months is safe and effective, with a high remission rate and cure rate for most patients with Graves' disease 7. Another study suggested that the titration regimen for 12-18 months is the optimal strategy for ATD treatment 8.
Other Treatment Options
Other treatment options for Graves' disease include:
- Radioactive iodine therapy, which is the preferred treatment for adults with Graves' disease in the US 5
- Surgery, which is performed only in special circumstances due to the risks associated with it 5
- β-adrenergic antagonists, which are used to decrease the symptoms of hyperthyroidism 5
- Inorganic iodide, which is primarily used to prepare patients for thyroid surgery 5