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Management of Graves' hyperthyroidism: present and future.

Luigi Bartalena1, Eliana Piantanida1, Daniela Gallo1

  • 1Department of Medicine and Surgery, University of Insubria, Varese, Italy.

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Summary

Graves' disease management involves antithyroid drugs, radioactive iodine, or thyroidectomy. While effective, these treatments have limitations such as recurrence or hypothyroidism, with new targeted therapies showing promise.

Keywords:
Graves’ diseaseGraves’ orbitopathyK1-70antithyroid drugshyperthyroidismiscalimabmethimazolepropylthiouracilradioactive iodinerituximabthyroidectomythyrotropin receptor

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Area of Science:

  • Endocrinology
  • Immunology
  • Autoimmune diseases

Background:

  • Graves' disease (GD) is an autoimmune disorder targeting the thyrotropin receptor (TSHR), leading to hyperthyroidism.
  • It can manifest with extrathyroidal complications, notably Graves' orbitopathy (GO).
  • Current GD treatments include antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroidectomy.

Purpose of the Study:

  • To review current management strategies for Graves' disease.
  • To discuss the limitations and outcomes associated with existing treatments.
  • To explore emerging targeted therapies for Graves' disease.

Main Methods:

  • Literature search for original articles, clinical trials, systematic reviews, and meta-analyses from 1980-2021.
  • Keywords included: Graves' disease, management, antithyroid drugs, radioactive iodine, thyroidectomy, Graves' orbitopathy, thyroid-eye disease.
  • Synthesis of findings on treatment efficacy, safety, and patient considerations.

Main Results:

  • Antithyroid drugs (ATDs) are first-line, safe, and can reduce relapses with long-term use.
  • Radioactive iodine (RAI) is safe but carries a low risk of GO progression, especially in smokers.
  • Thyroidectomy necessitates experienced surgeons; patient involvement in shared decision-making is crucial.

Conclusions:

  • Established GD treatments have significant drawbacks, including recurrence and hypothyroidism.
  • Emerging targeted therapies acting on TSHR or autoimmune pathways show preliminary promise for future GD management.
  • Personalized treatment choices and ongoing research are key to improving GD outcomes.