Graves’ Disease Update

• Discuss Rx choices in GD• Review current ATD therapy• Review RAI therapy• Discuss thyroidectomy• Management of Graves’ ophthalmopathy This presentation will discuss new recommendations for treatment of Graves’ Disease (GD) and Graves’ ophthalmopathy (GO). For example, PTU is no longer used routinely for GD, except for early pregnancy or thyroid storm, because of reports are fulminant hepatic failure due to PTU. RAI remains the main treatment choice in the U.S., although ATDs are preferred choices in Europe & Asia. Antithyroid drugs, methimazole (MMI) or neomercazole, are widely used for treatment of GD. MMI in doses of 10-40 mg daily can alleviate symptoms and result in lasting remission in 30-60% of cases. Recent reports suggest that long-term. Low dose MMI is well tolerated and can increase remission to 80%. Other treatment with beta-blockers, selenium, and surgery will be reviewed.Mild GO occurs in 30% of patients with GD but may be symptomatic and severe in some patients. Inactive and/or mild disease may not require additional Rx, but moderate or severe GO warrants careful evaluation and therapy, including steroid pulse therapy. We will discuss new scoring system to evaluate Graves’ eye disease.