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[Update Graves' disease 2019].

Stephanie Allelein1, Matthias Schott1

  • 1Funktionsbereich Spezielle Endokrinologie, Universitätsklinikum Düsseldorf.

Deutsche Medizinische Wochenschrift (1946)
|February 1, 2019
PubMed
Summary
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TSH receptor antibody (TRAb) measurement aids in diagnosing Graves' disease (GD) and distinguishing it from autoimmune thyroiditis (AIT). TRAb levels also help predict treatment outcomes for GD.

Area of Science:

  • Endocrinology
  • Thyroidology

Background:

  • TSH receptor antibody (TRAb) measurement is crucial for diagnosing Graves' disease (GD) and differentiating it from autoimmune thyroiditis (AIT), as per European Thyroid Association Guidelines 2018.
  • Bioassays are essential for distinguishing between stimulating and blocking antibodies for research purposes.

Purpose of the Study:

  • To summarize current guidelines for GD diagnosis and management.
  • To highlight therapeutic options and considerations during pregnancy.
  • To mention emerging treatments for related conditions like Graves' ophthalmopathy.

Main Methods:

  • Review of European and American Thyroid Association guidelines.
  • Discussion of diagnostic methods, including TRAb measurement and bioassays.
  • Overview of therapeutic strategies for hyperthyroidism and Graves' ophthalmopathy.

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Main Results:

  • TRAb measurement is highly sensitive and specific for GD diagnosis.
  • Thiamazole/carbimazole is generally preferred over propylthiouracil (PTU) for GD treatment, except in early pregnancy.
  • PTU is recommended for GD during the first 16 weeks of pregnancy, with careful monitoring thereafter.
  • Teprotumumab shows promise for Graves' ophthalmopathy but lacks approval in Germany.

Conclusions:

  • Accurate diagnosis of GD relies on TRAb measurement.
  • Treatment strategies for GD vary based on patient status, particularly during pregnancy.
  • Ongoing research is exploring new therapeutic avenues for thyroid disorders.