We searched PubMed and the Cochrane database for English-language studies published from June 2000 through October 5, 2015. Thirteen randomized clinical trials, 5 systematic reviews and meta-analyses, and 52 observational studies were included in this review. Patients with
Graves disease may be treated with
antithyroid drugs, radioactive
iodine (RAI), or surgery (near-total
thyroidectomy). The optimal approach depends on patient preference, geography, and clinical factors. A 12- to 18-month course of
antithyroid drugs may lead to a remission in approximately 50% of patients but can cause potentially significant (albeit rare) adverse reactions, including
agranulocytosis and hepatotoxicity. Adverse reactions typically occur within the first 90 days of
therapy. Treating
Graves 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 or worsening 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 disease who cannot 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 some women 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: