Graves’ Disease: New Management Protocol
A mini review
JCEM 2020 105 (12)3704-20.
- Low TSH
- Free T4, TSH-R-Ab, Thyroid Ultrasound
- Positive TSH-R-Ab
- Dx of GD.
- Methimazole MMI Treatment of choice for 18 months for adults and 36 months for children.
- Serious adverse effects poor compliance, or patient choice. Surgery for big glands or nodules included or graves’ eye disease GO.
- Radioiodine RAI, no GO no nodules volume <50 ml.
- Relapse or recurrence.
- Long term low dose MMI is a safe and valuable alternative to destructive surgery or RAI.
- GO therapy with anti-insulin like growth factor 1 monoclonal antibody for severe active eye disease is FDA approved.
- COVID 19 infection is a risk factor for poor controlled hyperthyroidism.This contributes to infection related mortality.
- If GO is not severe postpone steroids with Covid19 infection. Use only local treatment and preventive measures.
- Call me for evaluation before having surgery or RAI.
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