Graves' Disease: A Comprehensive Guide for Clinicians

347 Pages·2015·8.008 MB·English

by  Rebecca S. Bahn (eds.)

Rebecca S. Bahn
Editor
Graves’ Disease
A Comprehensive
Guide for Clinicians
123
Graves’ Disease

Rebecca S. Bahn
Editor
Graves’ Disease
A Comprehensive Guide for Clinicians
Editor
Rebecca S. Bahn
Professor of Medicine
Mayo Clinic College of Medicine
Division of Endocrinology and Metabolism
Mayo Clinic
Rochester , MN , USA
ISBN 978-1-4939-2533-9 ISBN 978-1-4939-2534-6 (eBook)
DOI 10.1007/978-1-4939-2534-6
Library of Congress Control Number: 2015935197
Springer New York Heidelberg Dordrecht London
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Pref ace
Graves’ disease combines the clinical symptoms and signs of hyperthyroidism, dif-
fuse goiter, characteristic ocular fi ndings, and less frequently unique dermatologic
changes. The earliest descriptions of the triad in modern medical context can be
found in writings by Caleb Perry [1], Robert Graves [2], and Carl von Basedow [3].
The eye disease is variously termed Graves’ ophthalmopathy or orbitopathy (GO),
or simply thyroid eye disease (TED).
Graves’ hyperthyroidism is mediated by autoantibody stimulation of the thyro-
tropin receptor on thyrocytes resulting in excess thyroid hormone production. The
fundamental immunologic abnormalities leading to the production of these antibod-
ies is complex and as yet incompletely understood, as is their relationship to the
development of GO. Precise targeted therapy of the Graves’ disease syndrome will
likely become available once pathogenic mechanisms are better understood. Until
then treatment options for hyperthyroidism are limited to functional ablation of the
thyroid gland using radioactive iodine or surgery, or to pharmacologic inhibition of
thyroid hormonogenesis. Therapeutic options for GO are similarly limited to the
targeting of disease manifestations, rather than basic mechanisms.
Nevertheless, there have been a number of important refi nements in the treat-
ment of Graves’ disease in recent years. These include new indications and contra-
indications for antithyroid drugs, improved approaches to radioactive iodine therapy,
the development of novel surgical techniques, and better understanding of the com-
bined use of these modalities. Advances in the treatment of GO include the use of
disease activity and severity assessments to inform management decisions and the
completion of the fi rst randomized controlled therapeutic trials. The choice of opti-
mal treatment for an individual patient should take into account the preferences of
adequately informed patients. This volume was designed to facilitate these physi-
cian–patient discussions by providing up-to-date evidence-based information pre-
sented in a clinically useful and patient-centric manner. It is my hope that a
recognition of the limitations of the currently available therapies will stimulate the
development and testing of new disease hypotheses that will translate into novel
therapies or preventive strategies for Graves’ disease and GO.
v
vi Preface
W e are especially fortunate to have contained in this volume the combined
expertise of a group of internationally respected authorities. I am indebted to each
author for his or her enthusiastic agreement to participate in this project and for
contributing a most scholarly and well-written manuscript. In addition, I wish to
thank Michele Aiello from Springer, without whose expert editorial assistance the
publication of this volume could not have been accomplished.
Rochester, MN, USA Rebecca S. Bahn, M.D.
References
1. Parry CH. Collections from unpublished medical writings of the late Caleb Parr.
London:Underwoods; 1825. 2. p. 110.
2 . G raves RJ. Clinical lectures delivered at the Meath Hospital during the session of 1834-5.
Lecture XII. London Med Surg J. 1835;7:513.
3 . B asedow CA. Exophthalmos durch hyperthrophie des zellgewebes in der augenhohle.
Worchenschr Ges Heilk. 1840;6:197–204, 220–8.
Contents
1 Professionalism and the Art of Patient-Centric Thyroidology ........... 1
Michael Brennan
2 Immunopathogenesis of Graves’ Disease .............................................. 5
Basil Rapoport and Sandra M. McLachlan
3 Epidemiology and Genetic Factors in Graves’ Disease
and Graves’ Ophthalmopathy ............................................................... 21
Sara Salehi Hammerstad and Yaron Tomer
4 Laboratory and Clinical Assessment of Hyperthyroidism .................. 39
M. Regina Castro
5 Evidence-Based Discussion of Treatment Options
for Graves’ Disease .................................................................................. 53
Juan P. Brito and Victor M. Montori
6 Antithyroid Drug Therapy in Patients with Graves’ Disease ............. 65
Peter Laurberg and David S. Cooper
7 Radioiodine Treatment in Patients with Graves’ Disease.................... 83
Douglas S. Ross
8 Thyroidectomy in Patients with Graves’ Disease ................................. 99
Adwoa Opoku-Boateng , Tracy S. Wang , and Julie Ann Sosa
9 Diagnosis and Management of Thyroid Storm .................................... 115
Alicia L. Warnock and Henry B. Burch
10 Impact of Hyperthyroidism on the Cardiovascular
and Musculoskeletal Systems and Management
of Patients with Subclinical Graves’ Disease ........................................ 133
Bernadette Biondi
11 Graves’ Disease in Childhood ................................................................ 147
Scott A. Rivkees
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viii Contents
12 Graves’ Disease and Pregnancy ............................................................. 167
Alex Stagnaro-Green
13 Pathogenesis of Graves’ Orbitopathy .................................................... 179
Rebecca S. Bahn
14 Combined Thyroid–Eye Clinics in the Management
of Graves’ Ophthalmopathy ................................................................... 187
Wilmar M. Wiersinga
15 Thyroid Dermopathy and Acropachy ................................................... 195
Vahab Fatourechi
16 Treatment of Hyperthyroidism in Patients
with Graves’ Orbitopathy ...................................................................... 213
Luigi Bartalena
17 Assessment and Management Plan for Graves’ Orbitopathy ............. 223
Peter J. Dolman
18 Natural History, Risk Factors, and Management
of Patients with Mild GO ....................................................................... 241
Marius N. Stan
19 Medical Treatment of Moderately Severe
and Vision-Threatening Graves’ Orbitopathy ..................................... 257
Maarten P. Mourits
20 Preoperative Assessment and Orbital Decompression Surgery
in Patients with Graves’ Ophthalmopathy ........................................... 277
James A. Garrity
21 Surgical Management of Extraocular Muscle Dysfunction
in Patients with GO ................................................................................. 287
Anja Eckstein and Joachim Esser
22 Quality of Life in Graves’ Ophthalmopathy ........................................ 301
Elizabeth A. Bradley and Molly L. Fuller
23 Future Therapy for Graves’ Disease and Ophthalmopathy ............... 317
Mario Salvi and Guia Vannucchi
Index ................................................................................................................. 337
Contributors
Rebecca S. Bahn , M.D. Mayo Clinic College of Medicine, Division of
Endocrinology and Metabolism , Mayo Clinic , Rochester , MN , USA
Luigi Bartalena , M.D. E ndocrine Unit, Ospedale di Circolo, U niversity of
Insubria , Viale Borri, Varese , Italy
Bernadette Biondi , M.D. D epartment of Clinical Medicine and Surgery,
University of Naples Federico II , Naples , Italy
Elizabeth A. Bradley , M.D. D epartment of Ophthalmology, Mayo Clinic College
of Medicine , Mayo Clinic , Rochester , MN , USA
Michael Brennan , M.D., F.R.C.P.I. Division of Endocrinology and Metabolism ,
Mayo Clinic , Rochester , MN , USA
Juan P. Brito , M.D. D ivision of Endocrinology, Diabetes, Metabolism and
Nutrition , Mayo Clinic , Rochester , MN , USA
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester,
MN, USA
Henry B. Burch , M.D. Endocrinology Service, Department of Medicine , Walter
Reed National Military Medical Center , Bethesda , MD , USA
Department of Medicine, Uniformed Services University of Health Sciences,
Bethesda, MD, USA
M. Regina Castro , M.D. Division of Endocrinology and Metabolism , Mayo
Clinic , Rochester , MN , USA
David S. Cooper , M.D. Division of Endocrinology, Diabetes, and Metabolism ,
The Johns Hopkins University School of Medicine , Baltimore , MD , USA
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