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.
Treatment Options
- Antithyroid medications: methimazole (10-30 mg daily) or propylthiouracil (100-300 mg daily divided into multiple doses)
- Nonreversible thyroid ablation therapy: radioactive iodine or surgery
- Beta-blockers: propranolol (20-40 mg 3-4 times daily) to control symptoms such as rapid heart rate and tremors
Treatment Duration and Monitoring
- Treatment usually continues for 12-18 months, after which some patients achieve remission
- Regular monitoring of thyroid function tests is essential throughout treatment to adjust medication dosages appropriately
Definitive Options
- Radioactive iodine therapy: gradually destroys thyroid cells
- Thyroid surgery (thyroidectomy): immediately removes most or all of the gland
- Both treatments typically result in hypothyroidism, requiring lifelong levothyroxine replacement therapy
Important Considerations
- Graves' disease occurs when antibodies mistakenly attack the thyroid's TSH receptors, stimulating excessive hormone production
- The condition affects women more frequently than men and often presents with symptoms including weight loss, anxiety, heat intolerance, bulging eyes (Graves' ophthalmopathy), and an enlarged thyroid gland (goiter) 1.
From the FDA Drug Label
In patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter for whom surgery or radioactive iodine therapy is not an appropriate treatment option. Methimazole is indicated for use in patients with Graves’ disease who have hyperthyroidism. The main uses are:
- To treat hyperthyroidism when surgery or radioactive iodine therapy is not suitable
- To manage symptoms of hyperthyroidism before thyroidectomy or radioactive iodine therapy 2
From the Research
Overview of Graves' Disease
- Graves' disease is an autoimmune disorder that causes hyperthyroidism, characterized by an overproduction of thyroid hormones 3.
- The most common causes of hyperthyroidism are Graves' disease, toxic multinodular goiter, and toxic adenoma 3.
Treatment of Graves' Disease
- Antithyroid medications, such as methimazole and propylthiouracil, can be used to treat hyperthyroidism caused by Graves' disease 3.
- Radioactive iodine ablation of the thyroid gland and surgical thyroidectomy are also treatment options 3.
- The choice of treatment depends on the underlying diagnosis, presence of contraindications, severity of hyperthyroidism, and patient preference 3.
Methimazole Treatment
- Methimazole dose, pretreatment serum T3 levels, and goitre size are the main determinants of the therapeutic response to methimazole in Graves' disease 4.
- A higher dose of methimazole (40 mg/day) is more effective than a lower dose (10 mg/day) in achieving euthyroidism 4.
- However, a higher dose of methimazole (30 mg/day) is associated with a higher risk of agranulocytosis compared to a lower dose (15 mg/day) 5.
Prediction of Remission
- A practical treatment with a minimum maintenance dose of anti-thyroid drugs can predict remission in Graves' disease 6.
- Measurement of TSH-binding inhibitory immunoglobulin (TBII) and thyroid-stimulating antibodies (TSAb) can provide some information on the likelihood of remission, but is not a reliable predictor 6.