![]() If TRAb levels remain elevated, the chances of remission are much lower and prolonging treatment with antithyroid drugs is safe and may increase chances of remission. If methimazole is chosen, it can be continued for 12-18 months and then discontinued if TSH and TRAb levels are normal at that time. These medications do not cure Graves’ hyperthyroidism, but when given in adequate doses are effective in controlling the hyperthyroidism. ![]() Treatment options to control Graves’ disease hyperthyroidism include antithyroid drugs (generally methimazole, although propylthiouracil may be used in rare instances such as the first trimester of pregnancy), radioactive iodine and surgery.Īntithyroid medications are typically preferred in patients who have a high likelihood of remission (women, mild disease, small goiters, negative or low titer of antibodies). All hyperthyroid patients should be initially treated with beta-blockers. The treatment of hyperthyroidism is described in detail in the Hyperthyroidism brochure. If this test is negative (which can also occur in some patients with Graves’ disease), or if this test is not available, then your doctor should refer you to have a radioactive iodine uptake test (RAIU) to confirm the diagnosis.Īlso, in some patients, measurement of thyroidal blood flow with ultrasonography may be useful to establish the diagnosis if the above tests are not readily available. Measurement of antibodies, such as TRAb or TSI, is cost effective and if positive, confirms the diagnosis of Graves’ disease without further testing needed. ![]() The choice of initial diagnostic testing depends on cost, availability and local expertise. Clues that your hyperthyroidism is caused by Graves’ disease are the presence of Graves’ eye disease and/or dermopathy (see above), a symmetrically enlarged thyroid gland and a history of other family members with thyroid or other autoimmune problems, including type 1 diabetes, rheumatoid arthritis, pernicious anemia (due to lack of vitamin B12) or painless white patches on the skin known as vitiligo. The diagnosis of hyperthyroidism is made on the basis of your symptoms and findings during a physical exam and it is confirmed by laboratory tests that measure the amount of thyroid hormones (thyroxine, or T4, and triiodothyronine, or T3) and thyroid-stimulating hormone (TSH) in your blood (see the Hyperthyroidism brochure). Its severity is not related to the level of thyroid hormone. Like the eye trouble of Graves’ disease, the skin problem does not necessarily begin precisely when the hyperthyroidism starts. This skin condition is usually painless and relatively mild, but it can be painful for some. Rarely, patients with Graves’ disease develop a lumpy reddish thickening of the skin in front of the shins known as pretibial myxedema (called Graves’ dermopathy). We do not know why, but problems with the eyes occur much more often and are more severe in people with Graves’ disease who smoke cigarettes. Diminished vision or double vision are rare problems that usually occur later, if at all. ![]() ![]() The severity of the eye symptoms is not related to the severity of the hyperthyroidism.Įarly signs of trouble might be red or inflamed eyes, a bulging of the eyes due to inflammation of the tissues behind the eyeball or double vision. In some patients with eye symptoms, hyperthyroidism never develops and, rarely, patients may be hypothyroid. Seldom do eye problems occur long after the disease has been treated. Patients who have any suggestion of eye symptoms should seek an evaluation with an eye doctor (an ophthalmologist) as well as their endocrinologist.Įye symptoms most often begin about six months before or after the diagnosis of Graves’ disease has been made. Overall, a third of patients with Graves’ disease develop some signs and symptoms of Graves’ eye disease but only 5% have moderate-to-severe inflammation of the eye tissues to cause serious or permanent vision trouble. Graves’ disease is the only kind of hyperthyroidism that can be associated with inflammation of the eyes, swelling of the tissues around the eyes and bulging of the eyes (called Graves’ ophthalmopathy or orbitopathy). These may include, but are not limited to, racing heartbeat, hand tremors, trouble sleeping, weight loss, muscle weakness, neuropsychiatric symptoms and heat intolerance. The majority of symptoms of Graves’ disease are caused by the excessive production of thyroid hormones by the thyroid gland (see Hyperthyroidism brochure). ![]()
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