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  • Q&A with Australian Health Practitioners

    What is the treatment for Graves' disease?

    Related Topics
    Endocrinology Graves' Disease Hyperthyroidism
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  • 15

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    A/Prof Christopher White

    Endocrinologist

    Specialising in the disorders of thyroid, pituitary, adrenal and reproductive endocrinology with a subspecialty interest, training and expertise in metabolic bone disease & calcium homeostasis. … View Profile

    The treatment of graves disease has 2 phases; there is no disagreement about the need for some type of medical therapy to get control of the thyrotoxicosis initially and it comes down to a question of which agent, propylthiouracil or neomercazole. The controversy between doctors is what recommendtion to make thereafter. Some favour early ablation with radioiodine, others favour long term treatment with the abovementioned drugs and treatment for an extended period while still others favour a surgical resolution of the syndrome. What you will need is a clear appreciation of the natural history of the disorder, the potential side-effects of various therapies and a clear appreciation of the consequences of any definitive option that you are being advised to take.

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    Serene Johnson

    Registered Nurse

    Consequences of total thyroidectomy can be intense. Hypocalcemia is not something to play around with (and with this, I speak as a patient!). You need to really thing through treatment options and their consequences before you make a decision. 

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    Dr Kevin Lee

    Endocrinologist, Nuclear Medicine Physician

    Consultant Physician in Endocrinology, Diabetes & Nuclear Medicine. I am on Twitter @dr_kevinlee. I am on Facebook https://www.facebook.com/kevinleefracp/ I help patients with obesity, diabetes, thyroid, … View Profile

    Graves’ disease treatment as already mentioned by Dr. White, there is no best treatment, each has pros & cons and also need to take into account when in the disease course.

    There are basically 3 treatment options:

    1. Anti-thyroid medications

    • Pros- conservative, low risk of permanent hypothyroidism, no radiation exposure
    • Cons- High relapse rate 30-70%, medication side-effects (can be serious),  low adherence, frequent clinic visits and monitoring
    2. Radioiodine
    • Pros- Definitive control, low cost (majority of centres in Australia bulk-bills), No surgery/anaesthetic/hospitalization
    • Cons- Radiation exposure, slow control of hyperthyroidism, risk of worsening or new thyroid eye disease, permanent hypothyroidism
    3. Surgery
    • Pros- Definitive & prompt control, no radiation exposure
    • Cons- Recurrent laryngeal nerve injury, surgical hypoparathyroidism, surgical/anaesthetic/inpatient complications, scar, permanent hypothyroidism
     
    Treatment of thyroid eye disease, depends on which stage of disease. Can include:

    Smoking cessation, selenium, glucocorticoids (also effective in treating eye disease post-radioiodine), surgery.

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    Anonymous

    Surgery is the definitive fix for Grave`s disease , although medical treatment can help some patients to control the symptoms at the initial phase, it does not actually "get rid" of the disease and a variable number of patients will still have relapse after initial succesful medical treatment.

    If you have your operation by an experienced high volume endocrine surgen who does alot of these cases, the risk of complications (low calcium and nerve injury) should be under 1% 

    Hope that helps ...

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