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Graves’ Disease

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Evidence-Based Endocrine Surgery

Abstract

Graves’ disease (GD) is an autoimmune thyroid disease characterized by signs and symptoms of thyrotoxicosis, coupled with unique extra-thyroidal manifestations such as Graves’ orbitopathy and dermopathy. Central to its pathogenesis is the loss of immunotolerance, which results in the development of thyroid autoantibodies, causing continuous and unregulated thyroid stimulation. Thyroid function testing in GD typically reveals overt hyperthyroidism, with elevated free T4 and/or T3, coupled with suppressed TSH. Measurement of TSH receptor antibodies titer, determination of the radioactive iodine uptake, or measurement of thyroidal blood flow on ultrasound represent the most commonly employed diagnostic tests for this condition. The current treatment modalities for GD are antithyroid drugs, which mainly inhibit thyroid hormone synthesis; radioiodine ablation, which results in ionizing damage to the thyroid follicular cells and gradual destruction of the gland; and thyroidectomy. Antithyroid drug treatment is associated with high disease relapse rate when withdrawn, and both radioiodine ablation and thyroidectomy are associated with permanent hypothyroidism. Thyroidectomy may be preferred in patients who present with large compressive goiters or concomitant thyroid cancers. Patients should be clinically and biochemically euthyroid prior to thyroidectomy or any elective non-thyroid surgeries. Rapid preoperative preparation using several drugs is occasionally needed in thyrotoxic patients requiring urgent surgeries. Preoperative optimization of calcium and vitamin D status with prompt initiation of calcium and calcitriol supplementation is recommended in patients undergoing thyroidectomy. None of the current treatment modalities target the underlying pathogenesis, and ongoing research focusing on the TSH receptor may represent potential treatment modalities.

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  1. Department of Endocrinology, Singapore General Hospital, Singapore, Singapore

    Chiaw-Ling Chng

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  1. Division of Endocrine Surgery, National University Hospital, Singapore, Singapore

    Rajeev Parameswaran

  2. Department of Endocrine Surgery, SGPGI Hospital, Lucknow, India

    Amit Agarwal

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Chng, CL. (2018). Graves’ Disease. In: Parameswaran, R., Agarwal, A. (eds) Evidence-Based Endocrine Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-10-1124-5_2

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  • DOI: https://doi.org/10.1007/978-981-10-1124-5_2

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-1123-8

  • Online ISBN: 978-981-10-1124-5

  • eBook Packages: MedicineMedicine (R0)

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