ग्रेव्स रोग में हाइपरथायरॉइडिज्म का उपचार

References

1. Graves disease, the most common cause of hyperthyroidism in the United States, is an autoimmune disorder in which thyroid-stimulating antibodies activate thyroid-stimulating hormone (TSH) receptors, triggering thyroid hormone synthesis.
2. Graves disease requires one of the three treatment options: an antithyroid medication (methimazole [Tapazole] or propylthiouracil), radioactive iodine (I-131) ablation of the thyroid gland, or surgical thyroidectomy.
3. Because Graves disease remits in up to 30% of patients treated with thionamides, these medications can be used as the initial treatment, with ablation or thyroidectomy performed if remission does not occur.
4. Because use of propylthiouracil has a higher risk of causing severe liver injury, as highlighted in the U.S. Food and Drug Administration's boxed warning, methimazole is preferred except during the first trimester of pregnancy (can cause birth defects) and in patients with an adverse reaction to methimazole.
5. An antithyroid medication should be continued for 12 to 18 months, then tapered or discontinued if the TSH level is normal at the time.
6. Free T4 and total T3 should be obtained four weeks after starting a thionamide and every four to eight weeks thereafter with the dosage adjusted based on results.
7. Once free T4 and total T3 levels normalize, they should be monitored every three months.