USMLE Internal Medicine Review 12 02 Treatment of Graves’ Disease

USMLE Internal Medicine Review 12 02 Treatment of Graves’ Disease

On these “Gold Standard Internal Medicine Facts” pages you will find Free:

  • USMLE Audio Review files from our “Gold Standard USMLE Reviews”
  • Transcriptions of those files
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Let’s start our USMLE Review with Hypothyroidism and Hyperthyroidism from the Gold Standard USMLE Foundations of Medicine Audio Review program.

 

Play USMLE Audio MP3 12 02 Treatment of Graves’ Disease Below

 

Begin 12 02 Treatment of Graves’ Disease Transcription

Alright, we move now to the treatment of Graves’ disease, the most prevalent form of thyrotoxicosis. Although autoimmune mechanisms are responsible for the syndrome of Graves’ disease, treatment is directed largely toward controlling the hyperthyroidism.

What are 3 good treatment options? Just name them please.

  • Three good methods of treatment for Graves’ disease are antithyroid drug therapy, surgery and radioactive iodine therapy.

Generally speaking for which Graves’ disease population is antithyroid drug therapy the most useful?

  • For young patients with small glands and mild disease.

What are the 2 main antithyroid drugs in use?

  • Propylthiouracil and Methimazole, given until the disease undergoes spontaneous remission.

Remission occurs in 20-40% of patients treated from anywhere from 6 months to 15 years. While antithyroid drug therapy is the only treatment measure for Graves’ disease, which leaves the thyroid gland intact, it requires a long period of observation and relapse rate it high.

At about what percentage? 

  • Relapse rate is as high as 60-80%. This rate can be reduced with the use of total thyroid block which we’ll discuss shortly.

An advantage of Propylthiouracil over Methimazole as antithyroid drug therapy is that it partially inhibits conversion of T4 to T3 with which beneficial result?

  • Limited conversion of T4 to T3 helps more quickly bring down the levels of activated thyroid hormone.

And conversely what is an advantage of Methimazole?

  • Methimazole has a longer duration of action and so is probably the better choice if only a single daily dose is desirable.

What would be a common regimen for use of Propylthiouracil in the treatment of Graves’ disease? Go ahead and tape the tape for this.

  • Propylthiouracil 100-150mg Q6h initially then in 4-8 weeks reducing to 50-200mg once or twice daily.

And what would be a typical regimen on Methimazole?

  • A typical program would start with Methimazole 40 mg each morning for 1-2 months then reduced to 5-20mg each morning for maintenance therapy.

What are the 2 most useful lab serum tests for monitoring the course of antithyroid drug therapy for Graves’ disease? 

  • Serum FT4 and TSH.

Student doctor please pause the tape and summarize antithyroid drug therapy in the treatment of Graves’ disease. Please include the patient population for which it is most beneficial and the benefits and advantages of Propylthiouracil and Methimazole use, along with dosing regimens. Also please give the 2 lab tests most effective in monitoring antithyroid drug therapy.

  • Generally speaking, antithyroid drug therapy is most useful for younger Graves’ disease patients with small glands and mild disease. The 2 main antithyroid drugs in use, Propylthiouracil and Methimazole, are given until the disease undergoes spontaneous remission. Remission occurs in 20-40% of patients treated from anywhere from 6 months to 15 years. While antithyroid drug therapy is the only treatment measure for Graves’ disease, which leaves the thyroid gland intact, it requires a long period of observation and relapse rate it high, as high as 60-80%. An advantage of Propylthiouracil over Methimazole as antithyroid drug therapy is that it partially inhibits conversion of T4 to T3, more quickly bringing down the levels of activated thyroid hormone. Conversely, Methimazole has a longer duration of action and so is probably the better choice if only a single daily dose is desirable. A typical dose regimen for Propylthiouracil in the treatment of Graves’ disease is 100-150mg Q6h initially then in 4-8 weeks reducing to 50-200mg once or twice daily. For Methimazole, a typical program would start with 40 mg each morning for 1-2 months then reducing to 5-20mg each morning for maintenance therapy. Serum FT4 and TSH are the 2 most useful lab serum tests for monitoring the course of antithyroid drug therapy for Graves’ disease.

****END OF TRANSCRIPTION****

 

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