From the Guidelines
Graves' disease should be treated with anti-thyroid medications like methimazole or propylthiouracil, and beta-blockers such as propranolol may be prescribed to manage symptoms like rapid heartbeat and tremors, as recommended by the most recent guidelines 1. The treatment of Graves' disease typically involves a combination of medications to reduce thyroid hormone production and manage symptoms.
- Anti-thyroid medications like methimazole (10-30 mg daily) or propylthiouracil (100-300 mg daily in divided doses) are usually taken for 12-18 months, with regular blood tests to monitor thyroid function 1.
- Beta-blockers such as propranolol (10-40 mg, 3-4 times daily) may be prescribed initially to manage symptoms like rapid heartbeat and tremors, and have been shown to be effective in patients with thyrotoxicosis or symptomatic hyperthyroidism 1. Some key points to consider in the treatment of Graves' disease include:
- Regular monitoring is essential to avoid undertreating or overtreating, as both can lead to complications 1.
- Patients should be aware that stress management and avoiding iodine-rich foods may help manage symptoms alongside medical treatment.
- In pregnant women, Graves' disease should be monitored closely, and treatment with iodine 131 (I-131) is contraindicated due to the risk of neonatal thyroid dysfunction 1.
- Thyroidectomy should be reserved for women who do not respond to thioamide therapy, and hypothyroidism in pregnant women should be treated with levothyroxine to return the TSH level to normal 1.
From the Research
Graves Disease Overview
- Graves disease is an autoimmune disorder that causes hyperthyroidism, characterized by an overproduction of thyroid hormones 2
- The most common causes of hyperthyroidism are Graves disease, toxic multinodular goiter, and toxic adenoma 2
Treatment Options
- Antithyroid medications, such as methimazole and propylthiouracil, can be used to treat hyperthyroidism caused by Graves disease 3, 4, 2
- Radioactive iodine ablation of the thyroid gland and surgical thyroidectomy are also treatment options 2
- The choice of treatment depends on the underlying diagnosis, presence of contraindications, severity of hyperthyroidism, and patient preference 2
Methimazole Treatment
- Methimazole is a commonly used antithyroid medication for treating Graves disease 3, 4, 5, 6
- The initial dose of methimazole can affect the incidence of methimazole-induced agranulocytosis, with lower doses having a lower incidence 5
- A dose of 15 mg/day of methimazole can be effective in rapidly controlling thyroidal overproduction, similar to a dose of 30 mg/day 3
Management and Diagnosis
- Thyrotropin receptor antibodies (TSH-R-Abs) are a specific biomarker for Graves disease and can assist in differential diagnosis 6
- Thyroid ultrasound is a sensitive imaging tool for Graves disease 6
- Patient choice and preference should be emphasized in the management of Graves disease, including the choice of treatment and timing of definitive therapy 6