Choosing a Treatment Method for Graves' Disease

Graves' disease, also known as diffuse toxic goiter, is characterized by pathological activation of thyroid function.

The disease is autoimmune. Autoantibodies are produced against one of the structural components of the thyroid gland (thyroid-stimulating hormone receptors), which causes the gland to become abnormally activated and produce excess hormones.

The leading manifestations of Graves' disease are:

Hyperthyroidism
Diffuse gout (The thyroid gland is enlarged in size)
Graves' orbitopathy (characteristic changes in the eyes) – which are not always apparent

Treatment options

After confirming the diagnosis, a treatment method must be chosen.

According to the American Thyroid Association guidelines, a choice should be made between three currently available methods for managing Graves' disease. These are:

Radioiodine therapy
Use of antithyroid medications
Thyroidectomy – surgical removal of the thyroid gland

The choice of treatment is decided jointly by the doctor and the informed patient. The following should be considered:

The issue of local availability of the method
The length of time required to achieve the desired treatment effect
Estimated recovery period after treatment
Advantages of the method
Potential side effects
Cost

According to studies, the quality of life in the future is equal when all three of these treatment methods are used.

Radioiodine therapy

The essence of the method is as follows: the patient receives a selected dose of radioactive iodine, which, after entering the body, is absorbed by the cells of the thyroid gland. The iodine that enters here, due to its radioactivity, begins to destroy the cells, and as a result, the thyroid gland stops functioning/producing hormones.

Although the word "radioactive" may sound alarming, this method has been successfully used in medicine for several decades and is considered a safe and effective way to treat Graves' disease and malignant thyroid tumors.

Clinical situations that justify choosing this method of therapy and patients who are good candidates for radioiodine therapy:

A woman who wants to become pregnant in the near future (must be at least 6 months post-radioiodine therapy)
Patients with comorbidities that increase the risks of surgical intervention
Patients who have had previous surgery or radiation to the neck area
Lack of access to a surgeon with adequate experience in thyroid surgery
Patients in whom antithyroid medications are contraindicated or in whom the desired results have not been achieved with these medications
Patients with periodic thyrotoxic hypokalemic paralysis

Radioiodine therapy is contraindicated in patients, Who are:

Pregnant women
Breastfeeding mothers
Women planning a pregnancy within the next 4-6 months
Individuals who are unable to follow safety recommendations following radioiodine therapy
In the presence of confirmed or suspected thyroid malignancy in conjunction with Graves' disease

When choosing this treatment method, the patient has a high priority:

Effective complete control of hyperthyroidism
Avoiding surgical intervention
Avoiding the side effects of antithyroid drugs

Disadvantages:

The need to take thyroid hormone medication for the rest of your life
Relatively slow resolution of thyrotoxicosis
Potential for the development or exacerbation of Graves' orbitopathy

Treatment with antithyroid medications

This type of medication blocks the process of hormone synthesis in the thyroid gland and ensures the normalization of laboratory parameters and the elimination of symptoms of hyperthyroidism when taken in appropriate doses.

Treatment continues for at least 12-18 months. After this period, if laboratory data allow, the medication can be discontinued.

In some cases, stopping treatment may result in remission – the disease going into remission. This period can last from a few months to a few years. Years later, there is still a chance that the symptoms of the disease will return.

Suitable candidates for this treatment option are::

Patients who have a high probability of remission (temporary cessation of the disease). These are: patients, especially women, with a mild course of the disease, small goiter size, slightly elevated or negative levels of antibodies against thyroid receptors
Pregnant women
Elderly or younger patients who have high surgical risks or a reduced life expectancy due to comorbidities
Individuals who are unable to follow safety recommendations following radioiodine therapy
Patients who have previously undergone thyroid surgery
Patients who do not have access to an experienced thyroid surgeon
Patients with moderate to severe Graves' orbitopathy
Patients who require rapid relief of symptoms of thyrotoxicosis.

Contraindications to the method:

The main contraindication to the use of antithyroid medications is a history of their side effects.

Advantages of the method:

The probability of achieving disease remission
Avoiding the need to take thyroid hormones for the rest of your life
Avoiding surgical intervention
Avoiding radioactive iodine exposure

Disadvantages:

Side effects typical of medications
Possibility of disease recurrence after treatment discontinuation

Surgical removal of the thyroid gland

Surgical intervention for Graves' disease involves the complete removal of the glandular tissue.

Surgical method The candidates eligible for election are::

Women who are planning a pregnancy in less than 6 months (this includes the period needed for hormonal levels to adjust)
Patients with large goiters presenting with compression symptoms
Low radioactive iodine uptake rate
When thyroid cancer is confirmed or suspected
In the case of non-functional or low-functioning nodules, especially if their size is greater than 4 cm
If there is concomitant hyperparathyroidism (parathyroid disease) that requires surgical intervention
If the level of antibodies against thyroid-stimulating hormone receptors is very high
If treatment with antithyroid drugs does not produce remission
Patients with moderate to severe Graves' orbitopathy.

Contraindications to surgical intervention:

Severe concomitant diseases
Lack of access to a surgeon experienced in thyroid surgery
Pregnancy is only a partial contraindication. Surgical intervention is performed only when rapid relief of thyrotoxicosis is required and medication is not possible. The second trimester is a relatively safe period for surgical intervention.

Advantages of the method: