Management of Graves’ hyperthyroidism

The treatment strategy for the hyperthyroidism of Graves’ disease remains a matter of controversy for several reasons. Treatment modalities available so far are symptomatic rather than pathophysiological, patients are heterogeneous in the severity and prognosis of the disease, and, in many patients, the disease is lifelong. Even symptomatic treatment should be adapted to the severity of the disease, both in terms of intensity of hyperthyroidism and degree of immunological derangement, an elusive goal so far. Current treatment modalities are medical/conservative with antithyroid drugs, often marred by relapse, and radical/destructive with radio-iodine or surgery with subsequent hypothyroidism. Being controversial, the selection of the treatment strategy also requires the patient’s informed cooperation. Finally, another peculiarity of the management of Graves’ disease is the frequent requirement of a multidisciplinary approach. This chapter will discuss general and specific therapeutic approaches of hyperthyroid Graves’ disease.