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A review of treatment options for Graves ’ disease: why total thyroidectomy is a viable option in selected patients

View Article: PubMed Central - PubMed

ABSTRACT

Graves’ disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I131 iodine ablation are the most commonly prescribed treatment for Graves’ disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves’ disease. She had a history of non-compliance with medications and medical clinic follow-up. The risks and benefits of total thyroidectomy were explained and she consented to surgery. A few months after the procedure, she was biochemically and clinically euthyroid on levothyroxine. She had no further emergency room visits or admissions for uncontrolled thyroid disease. Here we review the advantages and disadvantages of the more typically prescribed treatments, thionamides and I131iodine ablation. We also review the importance of shared decision making and the benefits of total thyroidectomy for the management of Graves' disease. Given the improvement in surgical techniques over the past decade and a significant reduction of complications, we suggest total thyroidectomy be recommended more often for patients with Graves’ disease.

No MeSH data available.


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CT scan of neck significant for tracheal compression and narrowing due to thyroid enlargement.
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Figure 0002: CT scan of neck significant for tracheal compression and narrowing due to thyroid enlargement.

Mentions: Her thyroid function tests revealed thyroid stimulating hormone (TSH) <0.01 mIU/L (reference range 0.27–4.2 mIU/L) and free T4 >7.7 ng/dl (reference range 0.93–1.7 ng/dl). Serum B-hCG was negative. She was treated with hydration, methimazole, and propranolol and her symptoms improved significantly. Ultrasound of the neck was consistent with a diffusely enlarged thyroid gland, each lobe approximately 7 cm in its longest dimension (Fig. 1). Non-contrast computerized tomography (CT) scan revealed subglottic tracheal compression (Fig. 2).


A review of treatment options for Graves ’ disease: why total thyroidectomy is a viable option in selected patients
CT scan of neck significant for tracheal compression and narrowing due to thyroid enlargement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016749&req=5

Figure 0002: CT scan of neck significant for tracheal compression and narrowing due to thyroid enlargement.
Mentions: Her thyroid function tests revealed thyroid stimulating hormone (TSH) <0.01 mIU/L (reference range 0.27–4.2 mIU/L) and free T4 >7.7 ng/dl (reference range 0.93–1.7 ng/dl). Serum B-hCG was negative. She was treated with hydration, methimazole, and propranolol and her symptoms improved significantly. Ultrasound of the neck was consistent with a diffusely enlarged thyroid gland, each lobe approximately 7 cm in its longest dimension (Fig. 1). Non-contrast computerized tomography (CT) scan revealed subglottic tracheal compression (Fig. 2).

View Article: PubMed Central - PubMed

ABSTRACT

Graves&rsquo; disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I131 iodine ablation are the most commonly prescribed treatment for Graves&rsquo; disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves&rsquo; disease. She had a history of non-compliance with medications and medical clinic follow-up. The risks and benefits of total thyroidectomy were explained and she consented to surgery. A few months after the procedure, she was biochemically and clinically euthyroid on levothyroxine. She had no further emergency room visits or admissions for uncontrolled thyroid disease. Here we review the advantages and disadvantages of the more typically prescribed treatments, thionamides and I131iodine ablation. We also review the importance of shared decision making and the benefits of total thyroidectomy for the management of Graves' disease. Given the improvement in surgical techniques over the past decade and a significant reduction of complications, we suggest total thyroidectomy be recommended more often for patients with Graves&rsquo; disease.

No MeSH data available.


Related in: MedlinePlus