Journal of Yeungnam Medical Science

Review article

Long-term management of Graves disease: a narrative review: Hyo-Jeong Kim; J Yeungnam Med Sci. 2023;40(1):12-22. Published online November 4, 2022; DOI: https://doi.org/10.12701/jyms.2022.00444

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Graves disease (GD) is the most common cause of hyperthyroidism, accounting for more than 90% of cases in Korea. Patients with GD are treated with any of the following: antithyroid drugs (ATDs), radioactive iodine (RAI) therapy, or thyroidectomy. Most patients begin treatment with ATDs, and clinical guidelines suggest that the appropriate treatment period is 12 to 18 months. While RAI treatment and surgery manage thyrotoxicosis by destroying or removing thyroid tissue, ATDs control thyrotoxicosis by inhibiting thyroid hormone synthesis and preserving the thyroid gland. Although ATDs efficiently control thyrotoxicosis symptoms, they do not correct the main etiology of GD; therefore, frequent relapses can follow. Recently, a large amount of data has been collected on long-term ATDs for GD, and low-dose methimazole (MMZ) is expected to be a good option for remission. For the long-term management of recurrent GD, it is important to induce remission by evaluating the patient’s drug response, stopping ATDs at an appropriate time, and actively switching to surgery or RAI therapy, if indicated. Continuing drug treatment for an extended time is now encouraged in patients with a high possibility of remission with low-dose MMZ. It is also important to pay attention to the quality of life of the patients. This review aimed to summarize the appropriate treatment methods and timing of treatment transition in patients who relapsed several times while receiving treatment for GD.

Citations

Citations to this article as recorded by

Commentary: Azathioprine as an adjuvant therapy in severe Graves’ disease: a randomized controlled open-label clinical trial
Madhukar Mittal, Azher Rizvi
Frontiers in Endocrinology.2024;[Epub] CrossRef
Total Thyroidectomy – A Cost-effective Alternative to Anti-Thyroid Drugs in the Management of Grave's Disease
Erivelto Volpi, Leonardo M. Volpi
Clinical Thyroidology.2023; 35(5): 183. CrossRef
Evaluation of the Abbott Alinity i Thyroid-Stimulating Hormone Receptor Antibody (TRAb) Chemiluminescent Microparticle Immunoassay (CMIA)
Deborah J. W. Lee, Soon Kieng Phua, Yali Liang, Claire Chen, Tar-Choon Aw
Diagnostics.2023; 13(16): 2707. CrossRef
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Robert M Branstetter, Rahib K Islam, Collin A Toups, Amanda N Parra, Zachary Lee, Shahab Ahmadzadeh, Giustino Varrassi, Sahar Shekoohi, Alan D Kaye
Cureus.2023;[Epub] CrossRef

Case report

Massive cerebral venous sinus thrombosis secondary to Graves' disease: Hye-Min Son; Yeungnam Univ J Med. 2019;36(3):273-280. Published online September 18, 2019; DOI: https://doi.org/10.12701/yujm.2019.00339

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Abstract PDF

Cerebral venous sinus thrombosis (CVT) is a rare cerebrovascular condition accounting for 0.5–1% of all types of strokes in the general population. Hyperthyroidism is associated with procoagulant and antifibrinolytic activity, thereby precipitating a hypercoagulable state that predisposes to CVT. We report the case of a 31-year-old Korean man with massive CVT and diagnosis of concomitant Graves’ disease at admission. Early diagnosis and prompt treatment of CVT are important to improve prognosis; therefore, CVT should be considered in the differential diagnosis in all patients with hyperthyroidism presenting with neurological symptoms.

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Hyperthyroidism-induced Cerebral Venous Thrombosis Presenting as Chronic Isolated Intracranial Hypertension
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Internal Medicine.2023; 62(20): 3021. CrossRef
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Tiziana Ciarambino, Pietro Crispino, Giovanni Minervini, Mauro Giordano
Biomedicines.2023; 11(5): 1280. CrossRef
Insights Into a Hypercoagulable Case of Thyrocardiac Disease and Literature Overview
Pin-Yi Wu, Ruchika Meel
Annals of Internal Medicine: Clinical Cases.2023;[Epub] CrossRef
Cerebral Venous Thrombosis during Thyrotoxicosis: Case Report and Literature Update
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Cureus.2022;[Epub] CrossRef
Cerebral venous sinus thrombosis caused by traumatic brain injury complicating thyroid storm: a case report and discussion
Shurong Gong, Wenyao Hong, Jiafang Wu, Jinqing Xu, Jianxiang Zhao, Xiaoguang Zhang, Yuqing Liu, Rong-Guo Yu
BMC Neurology.2022;[Epub] CrossRef
Severe headache as a monosymptom of cerebral venous sinus thrombosis: a case report with effective utilization of the SNNOOP10 approach
Garik Yeganyan, Hasmik Sargsyan, Mariam Manukyan, Henrik Schytz, Samson Khachatryan
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Hyperthyroidism as a Precipitant Factor for Cerebral Venous Thrombosis: A Case Report
Ahmed Elkhalifa Elawad Elhassan, Mohammed Omer Khalil Ali, Amina Bougaila, Mohammed Abdelhady, Hassan Abuzaid
Journal of Investigative Medicine High Impact Case Reports.2020; 8: 232470962094930. CrossRef

Case Reports

Severe chest pain with mid-ventricular obstruction in a patient with hyperthyroidism: Jong Ho Nam, Jang Won Son, Geu Ru Hong; Yeungnam Univ J Med. 2017;34(1):128-131. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.128

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Abstract PDF: Mid-ventricular obstruction (MVO) rarely occurs in patients without hypertrophic cardiomyopathy. Increased cardiac contractility may play an important role in causing MVO. We experienced a case of severe chest pain and MVO in a 50-year-old female patient. She had hypertension, diabetes, stroke and peripheral artery disease. Her blood pressure was very high (222/122 mmHg) with severe fluctuation. The transthoracic echocardiography revealed MVO accompanied by hyper-dynamic left ventricular systolic function. We regarded her chest pain and MVO as secondary findings related to other diseases. Coronary angiography and several tests for uncontrolled hypertension were performed, and those evaluations revealed that she had coronary artery disease and hyperthyroidism. We considered that the increase in the myocardial oxygen demand in response to the increase in cardiac contractility and workload associated with hyperthyroidism aggravated her symptoms and MVO. She was treated with methimazole and beta blockers and her symptoms dramatically improved.

A Case of Pancytopenia with Hyperthyroidism.: Tae Hoon Kim, Ji Sung Yoon, Byung Sam Park, Dong Won Lee, Jae Ho Cho, Jun Sung Moon, Eui Hyun Kim, Kyu Chang Won, Hyoung Woo Lee; Yeungnam Univ J Med. 2013;30(1):47-50. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.47

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Abstract PDF

There has been an increase in the number of reports of atypical manifestations of Graves' disease (GD), such as jaundice, anemia, thrombocytopenia and leukopenia. Pancytopenia also rarely occurs in GD. In this paper, a case of pancytopenia with GD that was successfully treated with an anti-thyroid drug is reported. In this case, a 69-year-old woman showed pancytopenia with a normal peripheral blood smear, bone marrow aspiration smear and bone marrow biopsy. Her thyroid function test and thyroid scintigraphy confirmed her hyperthyroid status. Her laboratory abnormality and clinical condition improved after she was treated with an anti-thyroid drug. This is a rare case of pancytopenia associated with GD.

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Therapeutic plasma exchange for Graves’ disease in pregnancy
Matthew Lumchee, Mimi Yue, Josephine Laurie, Adam Morton
Obstetric Medicine.2023; 16(2): 126. CrossRef
Non-myeloproliferative Pancytopenia: A Rare Presentation of Thyrotoxicosis
Izzathunnisa Rahmathullah, Maheswaran Umakanth, Suranga Singhapathirane
Cureus.2023;[Epub] CrossRef
Atypical Complications of Graves’ Disease: A Case Report and Literature Review
Khaled Ahmed Baagar, Mashhood Ahmed Siddique, Shaimaa Ahmed Arroub, Ahmed Hamdi Ebrahim, Amin Ahmed Jayyousi
Case Reports in Endocrinology.2017; 2017: 1. CrossRef

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