Advertisement

Graves’ Disease

  • Josephine H. Li
  • Natasha Kasid
  • James V. HennesseyEmail author
Chapter

Abstract

Thyrotoxicosis refers to the clinical syndrome that results from increased thyroid hormone levels. The diagnosis can be confirmed by a suppressed thyroid-stimulating hormone (TSH) level and increased levels of free thyroxine (T4) and triiodothyronine (T3) on biochemical testing. The differential diagnosis is broad and includes Graves’ disease, which is the most common cause of thyrotoxicosis, followed by toxic nodular goiter and several other less commonly encountered conditions. Graves’ disease is an autoimmune thyroid disease and can present with extrathyroidal manifestations including ophthalmopathy, thyroid dermopathy, and thyroid acropachy. The goals of therapy in Graves’ disease are to restore a euthyroid state with antithyroidal drugs or achieve hypothyroidism with radioactive iodine or thyroidectomy in order to prevent complications of untreated Graves’. Each treatment has its risks and benefits, and therefore the treatment choice should be tailored to the specific clinical features as well as patient preferences. Due to the physiologic changes in pregnancy, special consideration must be given in accurately diagnosing, monitoring, and treating pregnant patients with hyperthyroidism. With proper treatment of Graves’ disease, relapse rates are low with definitive therapies compared to antithyroidal drugs, though all patients will require lifelong monitoring.

Keywords

Graves’ disease Thyrotoxicosis Autoimmune thyroid disease Thionamide Radioactive iodine Thyroidectomy 

References

  1. 1.
    Franklyn JA, Boelaert K. Thyrotoxicosis. Lancet. 2012;379(9821):1155–66.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Boelaert K, Torlinska B, Holder R, Franklyn J. Older subjects with hyperthyroidism present with a paucity of symptoms and signs: a large cross-sectional study. J Clin Endocrinol Metab. 2010;95(6):2715–26.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Burch HB, Cooper DS. Management of Graves disease: a review. JAMA. 2015;314(23):2544–54.CrossRefGoogle Scholar
  4. 4.
    Mooradian AD. Asymptomatic hyperthyroidism in older adults. Drugs Aging. 2008;25(5):371–80.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007;116(15):1725–35.CrossRefGoogle Scholar
  6. 6.
    Brandt F, Green A, Hegedüs L, Brix TH. A critical review and meta-analysis of the association between overt hyperthyroidism and mortality. Eur J Endocrinol. 2011;165(4):491–7.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin N Am. 2006;35(4):663–86.CrossRefGoogle Scholar
  8. 8.
    Swee D, Chng C, Lim A. Clinical characteristics and outcome of thyroid storm: a case series and review of neuropsychiatric derangements in thyrotoxicosis. Endocr Pract. 2014;21(2):182–9.CrossRefGoogle Scholar
  9. 9.
    Akamizu T, Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Monden T, Kouki T, Otani H. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid. 2012;22(7):661–79.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Fadel BM, Ellahham S, Lindsay J, Ringel MD, Wartofsky L, Burman KD. Hyperthyroid heart disease. Clin Cardiol. 2000;23(6):402–8.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593–646.CrossRefGoogle Scholar
  12. 12.
    Bartalena L. Diagnosis and management of Graves disease: a global overview. Nat Rev Endocrinol. 2013;9(12):724–34.CrossRefGoogle Scholar
  13. 13.
    Cappelli C, Pirola I, De Martino E, Agosti B, Delbarba A, Castellano M, Rosei EA. The role of imaging in Graves’ disease: a cost-effectiveness analysis. Eur J Radiol. 2008;65(1):99–103.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Labadzhyan A, Brent GA, Hershman JM, Leung AM. Thyrotoxicosis of pregnancy. J Clin Transl Endocrinol. 2014;1(4):140–4.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Khan FA, Al-Jameil N, Khan MF, Al-Rashid M, Tabassum H. Thyroid dysfunction: an autoimmune aspect. Int J Clin Exp Med. 2015;8(5):6677.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99(1):39–51.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Abraham-Nordling M, Byström K, Törring O, Lantz M, Berg G, Calissendorff J, Nyström HF, Jansson S, Jörneskog G, Karlsson FA. Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011;165(6):899–905.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Davies TF, Ando T, Lin R-Y, Tomer Y, Latif R. Thyrotropin receptor–associated diseases: from adenomata to Graves disease. J Clin Invest. 2005;115(8):1972–83.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Hebrant A, Van Staveren W, Maenhaut C, Dumont JE, Leclère J. Genetic hyperthyroidism: hyperthyroidism due to activating TSHR mutations. Eur J Endocrinol. 2011;164(1):1–9.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Kleinau G, Neumann S, Grüters A, Krude H, Biebermann H. Novel insights on thyroid-stimulating hormone receptor signal transduction. Endocr Rev. 2013;34(5):691–724.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J. 2009;6:5.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Paes JE, Burman KD, Cohen J, Franklyn J, McHenry CR, Shoham S, Kloos RT. Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid. 2010;20(3):247–55.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Barbesino G. Drugs affecting thyroid function. Thyroid. 2010;20(7):763–70.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Bogazzi F, Tomisti L, Bartalena L, Aghini-Lombardi F, Martino E. Amiodarone and the thyroid: a 2012 update. J Endocrinol Investig. 2012;35(3):340–8.Google Scholar
  25. 25.
    Bogazzi F, Bartalena L, Martino E. Approach to the patient with amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab. 2010;95(6):2529–35.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Eskes SA, Wiersinga WM. Amiodarone and thyroid. Best Pract Res Clin Endocrinol Metab. 2009;23(6):735–51.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Walkington L, Webster J, Hancock B, Everard J, Coleman R. Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease. Br J Cancer. 2011;104(11):1665–9.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Kienitz T, Quinkler M, Strasburger CJ, Ventz M. Long-term management in five cases of TSH-secreting pituitary adenomas: a single center study and review of the literature. Eur J Endocrinol. 2007;157(1):39–46.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Losa M, Fortunato M, Molteni L, Peretti E, Mortini P. Thyrotropin-secreting pituitary adenomas: biological and molecular features, diagnosis and therapy. Minerva Endocrinol. 2008;33(4):329–40.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Beck-Peccoz P, Persani L, Mannavola D, Campi I. Pituitary tumours: TSH-secreting adenomas. Best Pract Res Clin Endocrinol Metab. 2009;23(5):597–606.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Leung AM, Braverman LE. Iodine-induced thyroid dysfunction. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):414–9.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Leung AM, Avram AM, Brenner AV, Duntas LH, Ehrenkranz J, Hennessey JV, Lee SL, Pearce EN, Roman SA, Stagnaro-Green A, Sturgis EM, Sundaram K, Thomas MJ, Wexler JA. Potential risks of excess iodine ingestion and exposure: statement by the American Thyroid Association Public Health Committee. Thyroid. 2015;25(2):145–6.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Lee SY, Rhee CM, Leung AM, Braverman LE, Brent GA, Pearce EN. A review: radiographic iodinated contrast media-induced thyroid dysfunction. J Clin Endocrinol Metab. 2014;100(2):376–83.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Kang GY, Parks JR, Fileta B, Chang A, Abdel-Rahim MM, Burch HB, Bernet VJ. Thyroxine and triiodothyronine content in commercially available thyroid health supplements. Thyroid. 2013;23(10):1233–7.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Cooper DS, Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol. 2013;1(3):238–49.PubMedCrossRefGoogle Scholar
  36. 36.
    Krassas G, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31(5):702–55.PubMedCrossRefGoogle Scholar
  37. 37.
    Nyström HF, Jansson S, Berg G. Incidence rate and clinical features of hyperthyroidism in a long-term iodine sufficient area of Sweden (Gothenburg) 2003–2005. Clin Endocrinol. 2013;78(5):768–76.CrossRefGoogle Scholar
  38. 38.
    Abraham P, Acharya S. Current and emerging treatment options for Graves’ hyperthyroidism. Ther Clin Risk Manag. 2010;6:29–40.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Latif R, Morshed SA, Zaidi M, Davies TF. The thyroid-stimulating hormone receptor: impact of thyroid-stimulating hormone and thyroid-stimulating hormone receptor antibodies on multimerization, cleavage, and signaling. Endocrinol Metab Clin N Am. 2009;38(2):319–41.CrossRefGoogle Scholar
  40. 40.
    Bahn RS. Autoimmunity and Graves’ disease. Clin Pharmacol Ther. 2012;91(4):577–9.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Prabhakar BS, Bahn RS, Smith TJ. Current perspective on the pathogenesis of Graves’ disease and ophthalmopathy. Endocr Rev. 2003;24(6):802–35.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Morshed SA, Ando T, Latif R, Davies TF. Neutral antibodies to the TSH receptor are present in Graves’ disease and regulate selective signaling cascades. Endocrinology. 2010;151(11):5537–49.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Lee HJ, Li CW, Hammerstad SS, Stefan M, Tomer Y. Immunogenetics of autoimmune thyroid diseases: a comprehensive review. J Autoimmun. 2015;64:82–90.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Davies TF, Yin X, Latif R. The genetics of the thyroid stimulating hormone receptor: history and relevance. Thyroid. 2010;20(7):727–36.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Tomer Y. Mechanisms of autoimmune thyroid diseases: from genetics to epigenetics. Annu Rev Pathol. 2014;9:147.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Brent GA. Environmental exposures and autoimmune thyroid disease. Thyroid. 2010;20(7):755–61.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Aranha A, Amer S, Reda E, Broadley S, Davoren P. Autoimmune thyroid disease in the use of alemtuzumab for multiple sclerosis: a review. Endocr Pract. 2013;19(5):821–8.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Bohbot NL, Young J, Orgiazzi J, Buffet C, François M, Bernard-Chabert B, Lukas-Croisier C, Delemer B. Interferon-α-induced hyperthyroidism: a three-stage evolution from silent thyroiditis towards Graves’ disease. Eur J Endocrinol. 2006;154(3):367–72.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Holm IA, Manson JE, Michels KB, Alexander EK, Willett WC, Utiger RD. Smoking and other lifestyle factors and the risk of Graves’ hyperthyroidism. Arch Intern Med. 2005;165(14):1606–11.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Bahn RS. Graves’ ophthalmopathy. N Engl J Med. 2010;362(8):726–38.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves’ ophthalmopathy. Thyroid. 2002;12(10):855–60.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Bartalena L, Tanda ML. Graves’ ophthalmopathy. N Engl J Med. 2009;360(10):994–1001.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Daumerie C, Duprez T, Boschi A. Long-term multidisciplinary follow-up of unilateral thyroid-associated orbitopathy. Eur J Intern Med. 2008;19(7):531–6.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Eckstein AK, Loesch C, Glowacka D, Schott M, Mann K, Esser J, Morgenthaler NG. Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetrical Graves ophthalmopathy. Br J Ophthalmol. 2009;93(8):1052–6.CrossRefGoogle Scholar
  55. 55.
    Fatourechi V. Thyroid dermopathy and acropachy. Best Pract Res Clin Endocrinol Metab. 2012;26(4):553–65.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Rice S, Peden N, McGlynn S, Morton C. Atypical presentation of infiltrative thyroid dermopathy. Clin Exp Dermatol. 2010;35(1):56–8.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Fatourechi V. Thyroid dermopathy and acropachy. Expert Rev Dermatol. 2011;6(1):75–90.CrossRefGoogle Scholar
  58. 58.
    Menconi F, Marcocci C, Marinò M. Diagnosis and classification of Graves’ disease. Autoimmun Rev. 2014;13(4):398–402.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Bartalena L, Fatourechi V. Extrathyroidal manifestations of Graves’ disease: a 2014 update. J Endocrinol Investig. 2014;37(8):691–700.CrossRefGoogle Scholar
  60. 60.
    Kotwal N, Singh Y, Menon A, Behera V. Thymic hyperplasia in Graves’ disease. Indian J Endocrinol Metab. 2013;17(3):521.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Popoveniuc G, Sharma M, Devdhar M, Wexler JA, Carroll NM, Wartofsky L, Burman KD. Graves’ disease and thymic hyperplasia: the relationship of thymic volume to thyroid function. Thyroid. 2010;20(9):1015–8.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Williams E, Chillag S, Rizvi A. Thyroid bruit and the underlying ‘inferno’. Am J Med. 2014;127(6):489–90.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Woeber KA. Triiodothyronine production in Graves’ hyperthyroidism. Thyroid. 2006;16(7):687–90.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 64.
    Barbesino G, Tomer Y. Clinical utility of TSH receptor antibodies. J Clin Endocrinol Metab. 2013;98(6):2247–55.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Tozzoli R, Bagnasco M, Giavarina D, Bizzaro N. TSH receptor autoantibody immunoassay in patients with Graves’ disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis. Autoimmun Rev. 2012;12(2):107–13.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Brent GA. Thyroid function tests during pregnancy. In: American Thyroid Association (ATA) satellite symposium, Boston, MA; 2016.Google Scholar
  67. 67.
    Erdogan MF, Anil C, Cesur M, Baskal N, Erdogan G. Color flow Doppler sonography for the etiologic diagnosis of hyperthyroidism. Thyroid. 2007;17(3):223–8.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Abraham-Nordling M, Törring O, Hamberger B, Lundell G, Tallstedt L, Calissendorff J, Wallin G. Graves’ disease: a long-term quality-of-life follow up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery. Thyroid. 2005;15(11):1279–86.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Cooper DS. Antithyroid drugs. N Engl J Med. 2005;352(9):905–17.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Emiliano AB, Governale L, Parks M, Cooper DS. Shifts in propylthiouracil and methimazole prescribing practices: antithyroid drug use in the United States from 1991 to 2008. J Clin Endocrinol Metab. 2010;95(5):2227–33.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Ross DS. Radioiodine therapy for hyperthyroidism. N Engl J Med. 2011;364(6):542–50.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Abraham P, Avenell A, Park CM, Watson WA, Bevan JS. A systematic review of drug therapy for Graves’ hyperthyroidism. Eur J Endocrinol. 2005;153(4):489–98.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Brent GA. Graves’ disease. N Engl J Med. 2008;358(24):2594–605.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Sundaresh V, Brito JP, Wang Z, Prokop LJ, Stan MN, Murad MH, Bahn RS. Comparative effectiveness of therapies for Graves’ hyperthyroidism: a systematic review and network meta-analysis. J Clin Endocrinol Metab. 2013;98(9):3671–7.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Cooper DS, Rivkees SA. Putting propylthiouracil in perspective. J Clin Endocrinol Metab. 2009;94(6):1881.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Bahn RS, Burch HS, Cooper DS, Garber JR, Greenlee CM, Klein IL, Laurberg P, McDougall IR, Rivkees SA, Ross D. The role of propylthiouracil in the management of Graves’ disease in adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid. 2009;19(7):673–4.PubMedCrossRefGoogle Scholar
  77. 77.
    Cooper DS. Antithyroid drugs. In: American Thyroid Association (ATA) satellite symposium, Boston, MA; 2016.Google Scholar
  78. 78.
    Sisson JC, Freitas J, McDougall IR, Dauer LT, Hurley JR, Brierley JD, Edinboro CH, Rosenthal D, Thomas MJ, Wexler JA, Asamoah E, Avram AM, Milas M, Greenlee C. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association. Thyroid. 2011;21(4):335–46.PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Silberstein EB. Reducing the incidence of 131I-Induced sialadenitis: the role of pilocarpine. J Nucl Med. 2008;49(4):546–9.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Acharya SH, Avenell A, Philip S, Burr J, Bevan JS, Abraham P. Radioiodine therapy (RAI) for Graves’ disease (GD) and the effect on ophthalmopathy: a systematic review. Clin Endocrinol. 2008;69(6):943–50.CrossRefGoogle Scholar
  81. 81.
    Lai A, Sassi L, Compri E, Marino F, Sivelli P, Piantanida E, Tanda ML, Bartalena L. Lower dose prednisone prevents radioiodine-associated exacerbation of initially mild or absent Graves’ orbitopathy: a retrospective cohort study. J Clin Endocrinol Metab. 2010;95(3):1333–7.PubMedPubMedCentralCrossRefGoogle Scholar
  82. 82.
    Traisk F, Tallstedt L, Abraham-Nordling M, Andersson T, Berg G, Calissendorff J, Hallengren B, Hedner P, Lantz M, Nystrom E. Thyroid-associated ophthalmopathy after treatment for Graves’ hyperthyroidism with antithyroid drugs or iodine-131. J Clin Endocrinol Metab. 2009;94(10):3700–7.CrossRefGoogle Scholar
  83. 83.
    Sosa JA. Surgery. In: American Thyroid Association (ATA) satellite symposium, Boston, MA; 2016.Google Scholar
  84. 84.
    Erbil Y, Ozluk Y, Giris M, Salmaslıoglu A, Issever H, Barbaros U, Kapran Y, Ozarmagan S, Tezelman S. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves’ disease. J Clin Endocrinol Metabol. 2007;92(6):2182–9.CrossRefGoogle Scholar
  85. 85.
    Sosa JA, Mehta PJ, Wang TS, Boudourakis L, Roman SA. A population-based study of outcomes from thyroidectomy in aging Americans: at what cost? J Am Coll Surg. 2008;206(6):1097–105.PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    Genovese BM, Noureldine SI, Gleeson EM, Tufano RP, Kandil E. What is the best definitive treatment for Graves’ disease? A systematic review of the existing literature. Ann Surg Oncol. 2013;20(2):660–7.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Girgis CM, Champion BL, Wall JR. Current concepts in Graves’ disease. Ther Adv Endocrinol Metab. 2011;2(3):135–44.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Andersen SL, Olsen J, Laurberg P. Antithyroid drug side effects in the population and in pregnancy. J Clin Endocrinol Metab. 2016;101(4):1606–14.PubMedCrossRefGoogle Scholar
  89. 89.
    Laurberg P. Diagnosis & treatment of hyperthyroidism during pregnancy. In: American Thyroid Association (ATA) satellite symposium, Boston, MA; 2016.Google Scholar
  90. 90.
    Kuy S, Roman SA, Desai R, Sosa JA. Outcomes following thyroid and parathyroid surgery in pregnant women. Arch Surg. 2009;144(5):399–406.PubMedCrossRefGoogle Scholar
  91. 91.
    Rotondi M, Cappelli C, Pirali B, Pirola I, Magri F, Fonte R, Castellano M, Rosei EA, Chiovato L. The effect of pregnancy on subsequent relapse from Graves’ disease after a successful course of antithyroid drug therapy. J Clin Endocrinol Metab. 2008;93(10):3985–8.PubMedCrossRefPubMedCentralGoogle Scholar
  92. 92.
    Anagnostis P, Adamidou F, Polyzos SA, Katergari S, Karathanasi E, Zouli C, Panagiotou A, Kita M. Predictors of long-term remission in patients with Graves’ disease: a single center experience. Endocrine. 2013;44(2):448–53.PubMedCrossRefPubMedCentralGoogle Scholar
  93. 93.
    Eckstein AK, Lax H, Lösch C, Glowacka D, Plicht M, Mann K, Esser J, Morgenthaler NG. Patients with severe Graves’ ophthalmopathy have a higher risk of relapsing hyperthyroidism and are unlikely to remain in remission. Clin Endocrinol. 2007;67(4):607–12.Google Scholar
  94. 94.
    Liu L, Lu H, Liu Y, Liu C, Xun C. Predicting relapse of Graves’ disease following treatment with antithyroid drugs. Exp Ther Med. 2016;11(4):1453–8.PubMedPubMedCentralCrossRefGoogle Scholar
  95. 95.
    Quadbeck B, Roggenbuck U, Janssen O, Hahn S, Mann K, Hoermann R. Impact of smoking on the course of Graves’ disease after withdrawal of antithyroid drugs. Exp Clin Endocrinol Diabetes. 2006;114(8):406–11.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Josephine H. Li
    • 1
  • Natasha Kasid
    • 2
  • James V. Hennessey
    • 2
    Email author
  1. 1.Department of MedicineBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Division of Endocrinology, Department of MedicineBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA

Personalised recommendations