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Theiler-Schwetz, V; Trummer, C; Pilz, S.
Hyperthyroidism-focus Graves´ disease.
AUST J CLIN ENDOCR M. 2020; Doi: 10.1007/s41969-020-00112-x [OPEN ACCESS]
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Leading authors Med Uni Graz: Pilz Stefan; Theiler-Schwetz Verena
Co-authors Med Uni Graz: Trummer Christian
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Abstract:: The most common causes of hyperthyroidism include Graves' disease and toxic adenoma/toxic multinodular goiter. Apart from thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3), determination of TSH-receptor antibodies (TRAb) for confirming the diagnosis is essential. Calculation of the T3/T4 ratio might be useful in the discrimination of Graves' disease from destructive thyroiditis. Further diagnostic tools include thyroid ultrasound with the typical picture of a hypoechoic thyroid gland with increased vascularization and measurement of peak systolic velocity. Scintigraphy is still useful for the diagnosis of toxic adenoma and toxic multinodular goiter. Graves' hyperthyroidism is treated primarily by antithyroid drugs, usually methimazole, in the form of the titration regimen for a course of 12-18 months. Antithyroid drug treatment can be stopped if TRAb are in the normal range. If not, or in the case of recurrence, definitive therapeutic strategies such as radioiodine therapy or thyroidectomy should be considered. To alleviate symptoms of hyperthyroidism, beta-blockers such as propanol can be added to antithyroid drug treatment. Recent evidence suggests that iodine restriction in Graves' disease should be avoided. As for selenium, positive studies have been published; the largely inconsistent data, however, currently do not allow recommendations for routine clinical use. In the treatment of toxic adenoma/toxic multinodular goiter radioiodine therapy and surgery should be suggested. The diagnosis of thyroid storm is based on clinical criteria using the Burch-Wartofsky score. Management of thyroid storm mostly requires admission to intensive care units.
Find related publications in this database (Keywords): Hyperthyroidism; Toxic adenoma; toxic multi nodular goiter; Methimazole; Antithyroid drugs; Titration regimen