From the Research
The initial treatment for Graves' disease typically involves antithyroid medications, with methimazole being the first choice for most patients at doses of 10-30 mg daily. This approach is supported by the most recent and highest quality study available, which suggests that antithyroid drugs (ATDs) are the most common therapeutic approach for Graves' disease, with methimazole being a good option for remission 1.
Key Considerations
- Methimazole is preferred over propylthiouracil (PTU) due to its lower risk of side effects, except during the first trimester of pregnancy, where PTU is preferred due to a lower risk of birth defects.
- The treatment period with ATDs is usually 12-18 months, with the dosage adjusted based on thyroid function tests performed every 4-6 weeks initially.
- Beta-blockers, such as propranolol, may be added temporarily to control symptoms like rapid heart rate, tremors, and anxiety until the antithyroid medications take effect.
- Patients should be monitored for potential side effects, including rash, joint pain, and rarely, agranulocytosis (severe white blood cell reduction).
Alternative Treatments
- If remission is not achieved after an adequate trial of medication, or if there are contraindications, radioactive iodine therapy or thyroid surgery may be considered as definitive treatments.
- The choice of initial therapy depends on factors including the patient's age, disease severity, pregnancy status, and personal preferences, as outlined in studies such as 2 and 3.
Quality of Life
- It is also important to pay attention to the quality of life of the patients, as mentioned in 1, and to consider the long-term management of recurrent Graves' disease, including the evaluation of the patient's drug response and the potential need to switch to surgery or radioactive iodine therapy.
Monitoring and Follow-Up
- Regular monitoring of thyroid function tests and adjustment of medication as needed is crucial for effective management of Graves' disease.
- The measurement of TSH receptor antibodies and thyroid-stimulating antibodies may provide additional information for predicting remission, as discussed in 4 and 3.