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This page has moved. Click here to view. Graves' DiseaseGraves' disease is an autoimmune disorder caused by immunoglobulin antibodies that bind to TSH receptors and initiate production and release of thyroid hormone. Graves' disease is the most common cause of hyperthyroidism grave disease, graves disease, Grave's disease. As is true with most autoimmune diseases of the thyroid, Graves' disease is more prevalent in women. In addition to symptoms of hyperthyroidism, 50 percent of patients with Graves' disease also exhibit exophthalmos. Evaluation and Diagnosis. When ophthalmopathy accompanies the cardinal signs of hyperthyroidism, Graves' disease should be suspected. Elderly patients may also present with fatigue, a symptom not seen in younger patients. As Treatment. Three approaches are available for treating Graves' disease (Table 9): surgical excision of the thyroid, thyroid-suppressive drugs, and radioactive ablation of the thyroid gland. In addition, beta blockers can be used to control symptoms of thyrotoxicosis until the cause of hyperthyroidism is established and treated. Surgery is reserved for individuals in whom medication or radioactive iodine ablation are not acceptable options, or when a large goiter is present that compresses nearby structures or is disfiguring. One year after surgery, about Antithyroid drugs are well tolerated and effective in blocking the production and release of thyroid hormone in patients with Graves' disease. These drugs work by blocking the organification of iodine. PTU also prevents peripheral conversion of T4 to the more active T3. PTU must be given in divided doses two or three times per day, whereas methimazole can be administered once per day. The most serious side effect of these drugs is Ablation with radioactive iodine is Treatment of Graves' Disease Treatment Adult dosage Indications Side effects Contraindications Symptomatic relief Propranolol 40 to 160 mg Tachycardia Wheezing, lethargy, Asthma, congestive (Inderal®1 per day depressed cardiac heart failure function Verapamil 240 to 360 mg Tachycardia Constipation, Congestive heart (Calan®, Isoptin®) per day depressed cardiac failure, heart block, function hypotension Thyroid suppression Propylthiouracil (PTU) 100 to 600 mg Graves' disease Rash, itching, None listed per day (especially in arthralgias, hepatic children) dysfunction, PTU preferred agranulocytosis in pregnancy Methimazole I 0 to 40 mg None listed (Tapazole®) per day Thyroid ablation Radioactive iodine Variable Nonpregnant Hypothyroidism Pregnancy, breast- adult feeding Surgery Pregnant woman Hypothyroidism, None listed unable to take hypoparathyroidism, oral therapies, inadvertent injury to Graves' disease recurrent laryngeal with thyroid nerve nodules, long-term therapy in patients unwilling to use radioactive iodine the treatment of choice for Graves' disease in older patients. Radioactive iodine should not be used in children, pregnant women, or nursing mothers. In addition, there is a possibility that using radioactive iodine in patients with active ophthalmopathy may accelerate progression of eye disease. For this reason, some experts initially treat Graves' disease with oral suppressive therapy until ophthalmopathy is Treatment of thyroid storm is important for patients with symptomatic Graves' disease. Administration of high doses of PTU I100 mg every six hours) to quickly block thyroid release and reduce peripheral conversion of T4 to |