Endocrine Abstracts

Graves’ disease (GD) is an autoimmune thyroid disorder being the most frequent cause of hyperthyroidism in iodine-sufficient countries. There are three main ways to treat GD: pharmacotherapy, radioiodine treatment (RAI) and thyroidectomy. During the lecture certain advantages and disadvantages of those three methods will be discussed. Advantages of anti-thyroid drugs (ATDs) include their immunosuppressive action and outpatient therapy. Disadvantages are higher relapse rate (about 50%, especially in younger patients, with large goiter, and higher free thyroid hormones), long duration of therapy, side effects (about 13%) and lack of histopathological verification if concomitant focal lesions occur. Benefits of RAI is lower risk of relapse (about 15%), outpatient therapy, no need for hospitalization or anesthesia. It is a good option for older patients, with contraindications for surgery. Weaknesses include the need for following radiation safety procedures, the risk of increase in TRAb level following therapy and thus exacerbation of orbitopathy, lack of histopathological verification if concomitant focal lesions occur, and often is associated with the need for lifelong L-thyroxine substitution. Pros of surgery are histopathological verification of concomitant lesions, lower risk of relapse (about 10%), decrease of TRAb level, lower risk of orbitopathy exacerbation. It is a good option for patients with large or nodular goiter as well as for patients who want to achieve stable euthyroidism quickly. Cons of surgery are the need for hospitalization and anesthesia and longer reconvalescence. Treatment of GD may be associated with side effects or cause permanent damage to the thyroid gland and the need for hormonal treatment for the rest of patients’ life. Thus, at each stage of the therapeutic process, an objective judgment made by the physician, taking into account the needs and preferences of the patient, as well as the available diagnostic and therapeutic methods, is necessary.