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TREATMENT OF GRAVES' DISEASE: THE ADVANTAGES OF SURGERY

2000; Elsevier BV; Volume: 29; Issue: 2 Linguagem: Inglês

10.1016/s0889-8529(05)70134-1

1558-4410

Osamah Alsanea, Orlo H. Clark,

Ophthalmology and Eye Disorders

Graves' disease is an autoimmune disorder that has both thyroidal and extrathyroidal manifestations involving extraocular muscles and skin. Most of the manifestations in patients with Graves' disease relate to the hyperthyroid state and cause abnormalities of most organ systems, including the cardiovascular and central nervous systems. Clinically, it is not possible to predict the clinical course and degree of organ involvement in a given patient.15 Graves' disease is an autoimmune disease, and some individuals are genetically predisposed to this condition.85 Usually, the diagnosis of Graves' disease is relatively easy to make, but one must rule out subacute thyroiditis, thyrotoxicosis factitia, and other conditions.48 The treatment remains empiric. Antithyroid medications, radioactive iodine ablation, and surgery (subtotal or near total thyroidectomy) have all been used to treat patients with Graves' disease. Each therapy has its advantages, disadvantages, and complications. An ideal treatment of Graves' disease would include the following: (1) prompt control of the disease manifestations, (2) return to and maintenance of the euthyroid state, (3) minimal morbidity and mortality, and (4) a reasonable cost. Opinions differ dramatically regarding the optimal treatment for a patient with Graves' disease. In response to a questionnaire in the United States, 69% of the respondents from the American Thyroid Association suggested using radioactive iodine ablation for a patient with Graves' disease, whereas 22% of European, 22% of Chinese, 11% of Japanese, and 11% of Korean respondents selected this means of treatment. Most clinicians selected radioactive iodine ablation for patients having recurrent or persistent hyperthyroidism.63, 86, 99 The authors recommend a selective approach in managing patients with Graves' disease and believe that thyroidectomy is an underused mode of therapy in the United States when an experienced thyroid surgeon is available.