Other

See online text for other forms of hyperthyroidism (ficti-tious/iatrogenic thyrotoxicosis).

Two courses of action can be followed for long-term treatment of Graves' disease. The goal is to maintain a euthyroid state. This can be accomplished with continued use of anti-thyroid medication, adjusting dose to maintain sTSH in a normal range. The alternative treatment is ablation of the thyroid gland using 131I, usually requiring postradiation thyroid hormone replacement. Either is appropriate, and usually the patient must take some medication on a permanent basis. Occasionally, a patient will undergo spontaneous remission, so a trial of antithyroid medication for 6 months to 1 year may be worthwhile. This requires close follow-up, however, once the antithyroid medication is discontinued, in case the patient rebounds. The majority of patients elect radioactive ablation and long-term treatment with thyroxine replacement.

Intervention in hyperthyroidism begins with a p-adrenergic receptor blocker as a temporizing agent to control sympathetically mediated symptoms. Specific therapy is deferred pending confirmation of etiology. For Graves' disease, autonomously functioning nodule, or toxic multinodular goiter (TMNG), specific intervention includes propylthiouracil (PTU) or methimazole (MMI) to control thyroxine synthesis and, with PTU, to reduce conversion of T4 to T3 in the peripheral circulation. Once the patient is converted to a euthyroid state, specific treatment based on cause can be instituted.

With treatment of Graves' disease, the goiter found in more than 90% of these patients may shrink. However, large goiters often require surgery for satisfactory cosmetic appearance.

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