Management of Hyperthyroidism in Graves' Disease
Summary
Graves’ disease is an autoimmune disorder characterised by excess thyroid hormone production driven by thyrotropin receptor antibodies, leading to systemic hypermetabolism, atrial arrhythmias and ophthalmopathy. Management aims to restore and maintain a stable euthyroid state while minimising adverse effects. First‐line therapy is often antithyroid drugs (ATDs), principally methimazole or propylthiouracil, which inhibit thyroid peroxidase and reduce hormone synthesis. Beta‐blockers provide symptomatic relief of tremor and tachycardia. Definitive treatments include radioactive iodine (RAI) ablation, which offers a non‐invasive means to destroy thyroid tissue, and total or near‐total thyroidectomy, reserved for large goitres, severe ophthalmopathy or intolerance to ATDs. Patient factors such as age, comorbidities, goitre size, severity of biochemical thyrotoxicosis and presence of eye disease inform individualised strategies. Monitoring of thyroid function tests and thyrotropin receptor antibodies guides duration of therapy, dose adjustments and long‐term surveillance. Emerging emphasis on risk stratification, precision dosimetry and predictive modelling has begun to refine selection of optimal therapy, reduce relapse rates and address refractory cases. The global prevalence of Graves’ disease and its diverse clinical presentations underscore the importance of accessible, evidence‐based management protocols that balance efficacy, safety and patient quality of life.
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Management of Hyperthyroidism in Graves' Disease publication trend
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Technical terms
Thyrotropin Receptor Antibody (TRAb): Autoantibody that binds to the TSH receptor, stimulating excessive thyroid hormone release.
Antithyroid Drugs (ATDs): Medications (eg methimazole) that inhibit thyroid peroxidase and block hormone synthesis.
Radioactive Iodine (RAI): Iodine-131 therapy used to ablate hyperfunctioning thyroid tissue.
Goitre: Enlarged thyroid gland, often palpable or visible in Graves’ disease.
Dosimetric Therapy: Personalised selection of RAI activity based on measured thyroid uptake for optimised dosing.
References
- Enhanced predictive validity of integrative models for refractory hyperthyroidism considering baseline and early therapy characteristics: a prospective cohort study. Journal of Translational Medicine (2024).
- The EANM guideline on radioiodine therapy of benign thyroid disease. European Journal of Nuclear Medicine and Molecular Imaging (2023).
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