Graves' disease in adults Antithyroid drugs, radioactive iodine, or sometimes thyroidectomy

What is the best treatment for adults with Graves' disease in 2016? To answer this question, we reviewed the literature using the standard Prescrire methodology. When the symptoms of hyperthyroidism are poorly tolerated, a beta-blocker relieves tachy- cardia, anxiety and tremor. Three treatments have been shown to be effec- tive in controlling hyperthyroidism: antithyroid drugs, radioiodine, and thyroidectomy. Carbimazole and its metabolite thiamazole are the antithyroid drugs with the best harm-benefit balance, except during the first trimester of preg- nancy. About 50% of patients are cured after 12 to 18 months of treatment. Antithyroid drugs carry a risk of rare but serious adverse effects, including agranulocytosis. Hepa- titis is more frequent with propylthiouracil. Radioiodine is administered as a single oral dose, in order to destroy the thyroid gland. Perma- nent cure is achieved in about 80% of cases, usu- ally after 1 or 2 months. Permanent hypothyroid- ism is frequent, occurring at various intervals after treatment. Radioiodine may exacerbate pre-existing oph- thalmopathy or provoke its onset, especially among smokers. Corticosteroid therapy reduces this risk. Protective measures are used for a few days or weeks in order to avoid radiation exposure among close contacts. Radioiodine is contraindi- cated during pregnancy. Surgical thyroidectomy may be total with little risk of recurrence, or subtotal with about an 8% risk of recurrence. The complications of surgery mainly consist of. hypoparathyroidism and permanent paralysis of the recurrent laryngeal nerve, which occur after 1% to 5% of procedures. In practice, the choice of treatment depends on the patient's preferences and situation, including a woman's desire to conceive, size of the goitre, the degree of hyperthyroidism, and the presence of ophthalmopathy.