Management of graves disease a review

Henry B. Burch, David S. Cooper

Research output: Contribution to journalReview articlepeer-review


IMPORTANCE Graves disease is the mostcommoncause of persistent hyperthyroidism in adults. Approximately 3%ofwomen and0.5%ofmenwill develop Graves disease during their lifetime. OBSERVATIONS We searched PubMed and the Cochrane database for English-language studies published from June 2000through October 5, 2015. Thirteen randomized clinical trials, 5 systematic reviews andmeta-Analyses, and 52 observational studieswere included in this review. Patients with Graves diseasemay be treated with antithyroid drugs, radioactive iodine (RAI), or surgery (near-Total thyroidectomy). The optimal approach depends on patient preference, geography, and clinical factors.A12-to 18-month course of antithyroid drugsmay lead to a remission in approximately50%of patients but can cause potentially significant (albeit rare) adverse reactions, including agranulocytosis and hepatotoxicity. Adverse reactions typically occur within the first 90days of therapy. TreatingGraves disease with RAI and surgery result in gland destruction or removal, necessitating life-long levothyroxine replacement. Use of RAI has also been associated with the development orworsening of thyroid eye disease in approximately 15%to 20%of patients. Surgery is favored in patients with concomitant suspicious or malignant thyroid nodules, coexisting hyperparathyroidism, and in patients with large goiters or moderate to severe thyroid eye diseasewhocannot be treated using antithyroid drugs.However, surgery is associated with potential complications such as hypoparathyroidism and vocal cord paralysis in a small proportion of patients. In pregnancy, antithyroid drugs are the primary therapy, but somewomen with Graves disease opt to receive definitive therapy with RAI or surgery prior to becoming pregnant to avoid potential teratogenic effects of antithyroid drugs during pregnancy. CONCLUSIONS AND RELEVANCE Management of Graves disease includes treatment with antithyroid drugs, RAI, or thyroidectomy. The optimal approach depends on patient preference and specific patient clinical features such as age, history of arrhythmia or ischemic heart disease, size of goiter, and severity of thyrotoxicosis. Physicians should be familiar with the advantages and disadvantages of each therapy to best counsel their patients.

Original languageEnglish (US)
Pages (from-to)2544-2554
Number of pages11
JournalJAMA - Journal of the American Medical Association
Issue number23
StatePublished - Dec 15 2015

ASJC Scopus subject areas

  • Medicine(all)


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