Highlights & Basics
- Graves disease is the most common cause of hyperthyroidism in countries with sufficient iodine intake.
- Caused by TSH receptor antibodies.
- Extrathyroidal manifestations include orbitopathy, pretibial myxedema (thyroid dermopathy), or acropachy, which do not occur with other causes of hyperthyroidism.
- Diagnostic tests are suppressed serum TSH, elevated levels of circulating thyroid hormones, detectable TSH receptor antibodies, and high thyroid uptake of radioactive iodine (or technetium 99).
- Treatment options are antithyroid drugs, radioactive iodine therapy, and thyroid surgery.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Lid retraction, mild proptosis, and mild chemosis
Pretibial myxedema (nonpitting edema)
Orbitopathy and elephantiasis
Iodine uptake scans. Typical appearances of absent uptake in thyroiditis (top panel). Diffuse increased uptake in Graves disease (lower left panel). Areas of increased and decreased uptake in toxic multinodular goiter (lower middle panel). Single area of increased uptake in a toxic adenoma (lower right panel)
Axial CT scan through the orbits of a patient with Graves orbitopathy showing increased thickness of medial recti
Elephantiasis
Citations
Smith TJ, Hegedüs L. Graves' disease. N Engl J Med. 2016 Oct 20;375(16):1552-65.[Abstract]
Kahaly GJ, Bartalena L, Hegedüs L, et al. 2018 European Thyroid Association Guideline for the management of Graves' hyperthyroidism. Eur Thyroid J. 2018 Jul 25;7(4):167-86.[Abstract][Full Text]
Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-421.[Abstract][Full Text]
Mooij CF, Cheetham TD, Verburg FA, et al. 2022 European Thyroid Association guideline for the management of pediatric Graves' disease. Eur Thyroid J. 2022 Jan 1;11(1):e210073.[Abstract][Full Text]
1. Tanda ML, Piantanida E, Liparulo L, et al. Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed graves' hyperthyroidism seen at a single center. J Clin Endocrinol Metab. 2013 Apr;98(4):1443-9.[Abstract][Full Text]
2. Smith TJ, Hegedüs L. Graves' disease. N Engl J Med. 2016 Oct 20;375(16):1552-65.[Abstract]
3. Davies TF, Andersen S, Latif R, et al. Graves' disease. Nat Rev Dis Primers. 2020 Jul 2;6(1):52.[Abstract][Full Text]
4. Boelaert K, Torlinska B, Holder RL, et al. Older subjects with hyperthyroidism present with a paucity of symptoms and signs - a large cross-sectional study. J Clin Endocrinol Metab. 2010 Jun;95(6):2715-26.[Abstract]
5. Krassas GE. Thyroid disease and female reproduction. Fertil Steril. 2000 Dec;74(6):1063-70.[Abstract]
6. Goswami R, Guleria R, Gupta AK, et al. Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves' disease and their reversibility with carbimazole therapy. Eur J Endocrinol. 2002 Sep;147(3):299-303.[Abstract]
7. Mitchell AL, Pearce SH. How should we treat patients with low serum thyrotropin concentrations? Clin Endocrinol (Oxf). 2010 Mar;72(3):292-6.[Abstract]
8. Col NF, Surks MI, Daniels GH. Subclinical thyroid disease: clinical applications. JAMA. 2004 Jan 14;291(2):239-43.[Abstract]
9. Biondi B, Palmieri EA, Klain M, et al. Subclinical hyperthyroidism: clinical features and treatment options. Eur J Endocrinol. 2005 Jan;152(1):1-9.[Abstract]
10. Bartley GB, Fatourechi V, Kadrmas EF, et al. Clinical features of Graves' ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996 Mar;121(3):284-90.[Abstract]
11. Taylor PN, Albrecht D, Scholz A, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018 Mar 23;14(5):301-16.[Abstract]
12. Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves' ophthalmopathy. Thyroid. 2002 Oct;12(10):855-60.[Abstract]
13. Laurberg P, Jorgensen T, Perrild H, et al. The Danish investigation on iodine intake and thyroid disease, DanThyr: status and perspectives. Eur J Endocrinol. 2006 Aug;155(2):219-28.[Abstract]
14. Bartley GB, Fatourechi V, Kadrmas EF, et al. Chronology of Graves' ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996 Apr;121(4):426-34.[Abstract]
15. 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 (Oxf). 2013 May;78(5):768-76.[Abstract]
16. McLeod DS, Caturegli P, Cooper DS, et al. Variation in rates of autoimmune thyroid disease by race/ethnicity in US military personnel. JAMA. 2014 Apr 16;311(15):1563-5.[Abstract][Full Text]
17. Zhyzhneuskaya S, Addison C, Tsatlidis V, et al. The natural history of subclinical hyperthyroidism in Graves' disease: the rule of thirds. Thyroid. 2016 Jun;26(6):765-9.[Abstract]
18. Fatourechi V. Pretibial myxedema: pathophysiology and treatment options. Am J Clin Dermatol. 2005;6(5):295-309.[Abstract]
19. Fatourechi V, Pajouhi M, Fransway AF. Dermopathy of Graves disease (pretibial myxedema): review of 150 cases. Medicine. 1994 Jan;73(1):1-7.[Abstract]
20. Abraham-Nordling M, Byström K, Törring O, et al. Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011 Dec;165(6):899-905.[Abstract][Full Text]
21. Perros P, Žarković M, Azzolini C, et al. PREGO (presentation of Graves' orbitopathy) study: changes in referral patterns to European Group On Graves' Orbitopathy (EUGOGO) centres over the period from 2000 to 2012. Br J Ophthalmol. 2015 Nov;99(11):1531-5.[Abstract]
22. Eckstein AK, Johnson KT, Thanos M, et al. Current insights into the pathogenesis of Graves' orbitopathy. Horm Metab Res. 2009 Jun;41(6):456-64. [Abstract]
23. Ajjan RA, Weetman AP. Techniques to quantify TSH receptor antibodies. Nat Clin Pract Endocrinol Metab. 2008 Aug;4(8):461-8.[Abstract]
24. Ando T, Latif R, Davies TF. Thyrotropin receptor antibodies: new insights into their actions and clinical relevance. Baillieres Best Pract Res Clin Endocrinol Metab. 2005 Mar;19(1):33-52.[Abstract]
25. Franklyn JA, Boelaert K. Thyrotoxicosis. Lancet. 2012 Mar 24;379(9821):1155-66.[Abstract]
26. Chen Y, Li S, Huang R, et al. Comprehensive meta-analysis reveals an association of the HLA-DRB1*1602 allele with autoimmune diseases mediated predominantly by autoantibodies. Autoimmun Rev. 2020 Jun;19(6):102532.[Abstract][Full Text]
27. Carlé A, Bülow Pedersen I, Knudsen N, et al. Graves' hyperthyroidism and moderate alcohol consumption: evidence for disease prevention. Clin Endocrinol (Oxf). 2013 Jul;79(1):111-9.[Abstract]
28. Wiersinga WM. Smoking and thyroid. Clin Endocrinol (Oxf). 2013 Aug;79(2):145-51.[Abstract][Full Text]
29. Scappaticcio L, Castellana M, Virili C, et al. Alemtuzumab-induced thyroid events in multiple sclerosis: a systematic review and meta-analysis. J Endocrinol Invest. 2020 Feb;43(2):219-29.[Abstract][Full Text]
30. Fatourechi V, Garrity JA, Bartley GB, et al. Orbital decompression in Graves' ophthalmopathy associated with pretibial myxedema. J Endocrinol Invest. 1993 Jun;16(6):433-7.[Abstract]
31. Łacheta D, Miśkiewicz P, Głuszko A, et al. Immunological Aspects of Graves' Ophthalmopathy. Biomed Res Int. 2019;2019:7453260.[Abstract][Full Text]
32. Perros P, Neoh C, Dickinson J. Thyroid eye disease. BMJ. 2009 Mar 6;338:b560.[Abstract]
33. Cawood TJ, Moriarty P, O'Farrelly C, et al. Smoking and thyroid-associated ophthalmopathy: A novel explanation of the biological link. J Clin Endocrinol Metab. 2007 Jan;92(1):59-64.[Abstract]
34. Lazarus JH. Lithium and thyroid. Best Pract Res Clin Endocrinol Metab. 2009 Dec;23(6):723-33.[Abstract]
35. Torino F, Barnabei A, Paragliola R, et al. Thyroid dysfunction as an unintended side effect of anticancer drugs. Thyroid. 2013 Nov;23(11):1345-66.[Abstract]
36. Decallonne B, Bartholomé E, Delvaux V, et al. Thyroid disorders in alemtuzumab-treated multiple sclerosis patients: a Belgian consensus on diagnosis and management. Acta Neurol Belg. 2018 Jan 25;118(2):153-9.[Abstract][Full Text]
37. Illés A, Bíró E, Miltényi Z, et al. Hypothyroidism and thyroiditis after therapy for Hodgkin's disease. Acta Haematol. 2003;109(1):11-7.[Abstract]
38. Roque C, Vasconcelos CA. <sup>131</sup>I-Induced Graves' disease in patients treated for toxic multinodular goitre: systematic review and descriptive analysis. J Endocrinol Invest. 2018 Sep;41(9):1019-1028.[Abstract][Full Text]
39. Mizokami T, Wu Li A, El-Kaissi S, Wall JR. Stress and thyroid autoimmunity. Thyroid. 2004 Dec;14(12):1047-55.[Abstract]
40. Pearce EN. Diagnosis and management of thyrotoxicosis. BMJ. 2006 Jun 10;332(7554):1369-73.[Abstract]
41. Kakuno Y, Amino N, Kanoh M, et al. Menstrual disturbances in various thyroid diseases. Endocr J. 2010;57(12):1017-22.[Abstract][Full Text]
42. Gabrielson AT, Sartor RA, Hellstrom WJG. The impact of thyroid disease on sexual dysfunction in men and women. Sex Med Rev. 2019 Jan;7(1):57-70.[Abstract][Full Text]
43. Kahaly GJ, Bartalena L, Hegedüs L, et al. 2018 European Thyroid Association Guideline for the management of Graves' hyperthyroidism. Eur Thyroid J. 2018 Jul 25;7(4):167-86.[Abstract][Full Text]
44. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-421.[Abstract][Full Text]
45. Bano A, Gan E, Addison C, et al. Age may influence the impact of TRAbs on thyroid function and relapse-risk in patients with Graves disease. J Clin Endocrinol Metab. 2019 May 1;104(5):1378-85.[Abstract]
46. Amino N, Yabu Y, Miki T, et al. Serum ratio of triiodothyronine to thyroxine, and thyroxine-binding globulin and calcitonin concentration in Graves' disease and destruction-induced thyrotoxicosis. J Clin Endocrinol Metab. 1981 Jul;53(1):113-6.[Abstract]
47. Yoshimura Noh J, Momotani N, Fukada S, et al. Ratio of serum free triiodothyronine to free thyroxine in Graves' hyperthyroidism and thyrotoxicosis caused by painless thyroiditis. Endocr J. 2005 Oct;52(5):537-42.[Abstract][Full Text]
48. Sriphrapradang C, Bhasipol A. Differentiating Graves' disease from subacute thyroiditis using ratio of serum free triiodothyronine to free thyroxine. Ann Med Surg (Lond). 2016 Aug 8;10:69-72.[Abstract][Full Text]
49. Bogazzi F, Vitti P. Could improved ultrasound and power Doppler replace thyroidal radioiodine uptake to assess thyroid disease? Nat Clin Pract Endocrinol Metab. 2008 Feb;4(2):70-1.[Abstract]
50. Bartalena L, Kahaly GJ, Baldeschi L, et al. The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy. Eur J Endocrinol. 2021 Aug 27;185(4):G43-G67.[Abstract][Full Text]
51. Schwartz KM, Fatourechi V, Ahmed DD, et al. Dermopathy of Graves' disease (pretibial myxedema): long-term outcome. J Clin Endocrinol Metab. 2002 Feb;87(2):438-46.[Abstract]
52. Fatourechi V, Ahmed DDF, Schwartz KM. Thyroid acropachy: report of 40 patients treated at a single institution in a 26-year period. J Clin Endocrinol Metab. 2002 Dec;87(12):5435-41.[Abstract]
53. Anagnostis P, Boboridis K, Adamidou F, et al. Natural course of mild Graves' orbitopathy: is it a chronic remitting or a transient disease? J Endocrinol Invest. 2017 Mar;40(3):257-61.[Abstract]
54. Mitchell AL, Goss L, Mathiopoulou L, et al. Diagnosis of Graves' orbitopathy (DiaGO): results of a pilot study to assess the utility of an office tool for practicing endocrinologists. J Clin Endocrinol Metab. 2015 Mar;100(3):E458-62.[Abstract]
55. Bartalena L. Graves' disease: complications. Thyroid Disease Manager. February 2018 [internet publication].[Full Text]
56. Jabbour SA. Cutaneous manifestations of endocrine disorders: a guide for dermatologists. Am J Clin Dermatol. 2003;4(5):315-31.[Abstract]
57. Baskin HJ, Cobin RH, Duick DS, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002 Nov-Dec;8(6):457-69.[Abstract]
58. Refetoff S, Dumitrescu AM. Syndromes of reduced sensitivity to thyroid hormone: genetic defects in hormone receptors, cell transporters and deiodination. Best Pract Res Clin Endocrinol Metab. 2007 Jun;21(2):277-305.[Abstract]
59. British Thyroid Association. UK guidelines for the use of thyroid function tests. June 2006 [internet publication].[Full Text]
60. Lazarus JH. Thyroid disorders associated with pregnancy: etiology, diagnosis, and management. Treatment Endocrinol. 2005;4(1):31-41.[Abstract]
61. Hershman JM. The role of human chorionic gonadotropin as a thyroid stimulator in normal pregnancy. J Clin Endocrinol Metab. 2008 Sep;93(9):3305-6.[Abstract]
62. Izumi Y, Hidaka Y, Tada H, et al. Simple and practical parameters for differentiation between destruction-induced thyrotoxicosis and Graves' thyrotoxicosis. Clin Endocrinol (Oxf). 2002 Jul;57(1):51-8.[Abstract]
63. Losa M, Giovanelli M, Persani L, et al. Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas. J Clin Endocrinol Metab. 1996 Aug;81(8):3084-90.[Abstract]
64. Beck-Peccoz P, Persani L, Mantovani S, et al. Thyrotropin-secreting pituitary adenomas. Metab Clin Exp. 1996 Aug;45(8 Suppl 1):75-9.[Abstract]
65. Sanno N, Teramoto A, Osamura RY. Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma. J Neurosurg. 2000 Aug;93(2):194-200.[Abstract]
66. Elston MS, Sehgal S, Du Toit S, et al. Factitious Graves' disease due to biotin immunoassay interference - a case and review of the literature. J Clin Endocrinol Metab. 2016 Sep;101(9):3251-5.[Abstract][Full Text]
67. Mariotti S, Martino E, Cupini C, et al. Low serum thyroglobulin as a clue to the diagnosis of thyrotoxicosis factitia. N Engl J Med. 1982 Aug 12;307(7):410-2.[Abstract]
68. U.S. Preventive Services Task Force. Final recommendation statement: thyroid dysfunction - screening. March 2015 [internet publication].[Full Text]
69. Birtwhistle R, Morissette K, Dickinson JA, et al. Recommendation on screening adults for asymptomatic thyroid dysfunction in primary care. CMAJ. 2019 Nov 18;191(46):E1274-80.[Abstract][Full Text]
70. Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017 Mar;27(3):315-89.[Abstract][Full Text]
71. The American College of Obstetricians and Gynecologists. Thyroid disease in pregnancy: ACOG practice bulletin, number 223. Obstet Gynecol. 2020 Jun;135(6):e261-74.[Abstract]
72. Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology and Associazione Medici Endocrinologi. Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. Endocr Pract. 2016 May;22(5):622-39.[Abstract][Full Text]
73. Cooper DS. Antithyroid drugs in the management of patients with Graves' disease: an evidence-based approach to therapeutic controversies. J Clin Endocrinol Metab. 2003 Aug;88(8):3474-81.[Abstract]
74. Kahaly GJ. Management of Graves thyroidal and extrathyroidal disease: an update. J Clin Endocrinol Metab. 2020 Dec 1;105(12):3704-20[Abstract][Full Text]
75. Weber KJ, Solorzano CC, Lee JK, et al. Thyroidectomy remains an effective treatment option for Graves' disease. Am J Surg. 2006 Mar;191(3):400-5.[Abstract]
76. Hegedüs L. Treatment of Graves' hyperthyroidism: evidence-based and emerging modalities. Endocrinol Metab Clin North Am. 2009 Jun;38(2):355-71.[Abstract]
77. Sherman SI, Simonson L, Ladenson PW. Clinical and socioeconomic predispositions to complicated thyrotoxicosis: a predictable and preventable syndrome? Am J Med. 1996 Aug;101(2):192-8.[Abstract]
78. Vennard K, Gilbert MP. Thyroid Storm and Complete Heart Block after Treatment with Radioactive Iodine. Case Rep Endocrinol. 2018;2018:8214169.[Abstract][Full Text]
79. Chiha M, Samarasinghe S, Kabaker AS. Thyroid storm: an updated review. J Intensive Care Med. 2015 Mar;30(3):131-40.[Abstract]
80. Turner BC. Thyroid emergencies part 1: Thyroid storm. CPD J Acute Med. 2004;3:93-5.
81. Vijayakumar V, Nusynowitz ML, Ali S. Is it safe to treat hyperthyroid patients with I-131 without fear of thyroid storm? Ann Nucl Med. 2006 Jul;20(6):383-5.[Abstract]
82. Cooper DS. Approach to the patient with subclinical hyperthyroidism. J Clin Endocrinol Metab. 2007 Jan;92(1):3-9.[Abstract]
83. Burch HB, Burman KD, Cooper DS. A 2011 survey of clinical practice patterns in the management of Graves' disease. J Clin Endocrinol Metab. 2012 Dec;97(12):4549-58.[Abstract][Full Text]
84. Committee on Pharmaceutical Affairs, Japanese Society for Pediatric Endocrinology, and the Pediatric Thyroid Disease Committee, Japan Thyroid Association (Taskforce for the Revision of the Guidelines for the Treatment of Childhood-Onset Graves' Disease)., Minamitani K, Sato H, et al. Guidelines for the treatment of childhood-onset Graves' disease in Japan, 2016. Clin Pediatr Endocrinol. 2017;26(2):29-62.[Abstract][Full Text]
85. Abraham-Nordling M, Torring O, Hamberger B, et al. Graves' disease: a long-term quality-of-life follow up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery. Thyroid. 2005 Nov;15(11):1279-86.[Abstract]
86. Abraham P, Avenell A, McGeoch SC, et al. Antithyroid drug regimen for treating Graves' hyperthyroidism. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003420.[Abstract][Full Text]
87. Razvi S, Vaidya B, Perros P, et al. What is the evidence behind the evidence-base? The premature death of block-replace antithyroid drug regimens for Graves' disease. Eur J Endocrinol. 2006 Jun;154(6):783-6.[Abstract][Full Text]
88. US Food and Drug Administration. Drug safety communication: New Boxed Warning on severe liver injury with propylthiouracil. April 2010 [internet publication]. [Full Text]
89. Abraham P, Avenel A, Park CM, et al. A systematic review of drug therapy for Graves' hyperthyroidism. Eur J Endocrinol. 2005 Oct;153(4):489-98.[Abstract]
90. Azizi F. The safety and efficacy of antithyroid drugs. Expert Opin Drug Saf. 2006 Jan;5(1):107-16.[Abstract]
91. Glaser NS, Styne DM; Organization of Pediatric Endocrinologists of Northern California Collaborative Graves' Disease Study Group. Predicting the likelihood of remission in children with Graves' disease: a prospective, multicenter study. Pediatrics. 2008 Mar;121(3):e481-8.[Abstract]
92. Leger J, Gelwane G, Kaguelidou F, et al; French Childhood Graves' Disease Study Group. Positive impact of long-term antithyroid drug treatment on the outcome of children with Graves' disease: national long-term cohort study. J Clin Endocrinol Metab. 2012 Jan;97(1):110-9.[Abstract]
93. Kaguelidou F, Carel JC, Léger J. Graves' disease in childhood: advances in management with antithyroid drug therapy. Horm Res. 2009;71(6):310-7.[Abstract]
94. Otsuka F, Noh JY, Chino T, et al. Hepatotoxicity and cutaneous reactions after antithyroid drug administration. Clin Endocrinol (Oxf). 2012 Aug;77(2):310-5.[Abstract]
95. Nakamura H, Miyauchi A, Miyawaki N, et al. Analysis of 754 cases of antithyroid drug-induced agranulocytosis over 30 years in Japan. J Clin Endocrinol Metab. 2013 Dec;98(12):4776-83.[Abstract]
96. Robinson J, Richardson M, Hickey J, et al. Patient knowledge of antithyroid drug-induced agranulocytosis. Eur Thyroid J. 2014 Dec;3(4):245-51.[Abstract][Full Text]
97. Balavoine AS, Glinoer D, Dubucquoi S, et al. Antineutrophil cytoplasmic antibody-positive small-vessel vasculitis associated with antithyroid drug therapy: how significant is the clinical problem? Thyroid. 2015 Dec;25(12):1273-81.[Abstract]
98. Ma C, Xie J, Wang H, et al. Radioiodine therapy versus antithyroid medications for Graves' disease. Cochrane Database Syst Rev. 2016 Feb 18;(2):CD010094.[Abstract][Full Text]
99. Fatourechi V. Medical treatment of Graves' ophthalmopathy. Ophthalmol Clin North Am. 2000;13:683-91.
100. Tallstedt L, Lundell G, Blomgren H, et al. Does early administration of thyroxine reduce the development of Graves' ophthalmopathy after radioiodine treatment? Eur J Endocrinol. 1994 May;130(5):494-7.[Abstract]
101. Tallstedt L, Lundell G, Torring O, et al. Occurance of ophthalmopathy after treatment for Graves' hyperthyroidism: the Thyroid Study Group. N Engl J Med. 1992 Jun 25;326(26):1733-8.[Abstract][Full Text]
102. Bartalena L, Tanda ML, Piantanida E, et al. Relationship between management of hyperthyroidism and course of the ophthalmopathy. J Endocrinol Invest. 2004 Mar;27(3):288-94.[Abstract]
103. Li HX, Xiang N, Hu WK, et al. Relation between therapy options for Graves' disease and the course of Graves' ophthalmopathy: a systematic review and meta-analysis. J Endocrinol Invest. 2016 Nov;39(11):1225-33.[Abstract]
104. Bartalena L. The dilemma of how to manage Graves' hyperthyroidism in patients with associated orbitopathy. J Clin Endocrinol Metab. 2011 Mar;96(3):592-9.[Abstract]
105. Perros P, Kendall-Taylor P, Neoh C, et al. A prospective study of the effects of radioiodine therapy for hyperthyroidism in patients with minimally active graves' ophthalmopathy. J Clin Endocrinol Metab. 2005 Sep;90(9):5321-3.[Abstract][Full Text]
106. Sisson JC, Freitas J, McDougall IR, et al; American Thyroid Association Taskforce on Radioiodine Safety. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I: practice recommendations of the American Thyroid Association. Thyroid. 2011 Apr;21(4):335-46.[Abstract][Full Text]
107. Whalen G, Sullivan M, Maranda L, et al. Randomized trial of a short course of preoperative potassium iodide in patients undergoing thyroidectomy for Graves' disease. Am J Surg. 2017 Apr;213(4):805-9.[Abstract]
108. Roher HD, Goretzki PE, Hellmann P, et al. Complications in thyroid surgery: incidence and therapy [in German]. Chirurg. 1999 Sep;70(9):999-1010.[Abstract]
109. Barczynski M, Konturek A, Stopa M, et al. Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy. World J Surg. 2012 Jun;36(6):1340-7.[Abstract][Full Text]
110. Cavicchi O, Caliceti U, Fernandez IJ, et al. Laryngeal neuromonitoring and neurostimulation versus neurostimulation alone in thyroid surgery: a randomized clinical trial. Head Neck. 2012 Feb;34(2):141-5.[Abstract]
111. Zhang Y, Dong Z, Li J, et al. Comparison of endoscopic and conventional open thyroidectomy for Graves' disease: a meta-analysis. Int J Surg. 2017 Apr;40:52-9.[Abstract]
112. Miccoli P, Fregoli L, Rossi L, et al. Minimally invasive video-assisted thyroidectomy (MIVAT). Gland Surg. 2020 Jan;9(suppl 1):S1-S5.[Abstract][Full Text]
113. Stålberg P, Svensson A, Hessman O, et al. Surgical treatment of Graves' disease: evidence-based approach. World J Surg. 2008 Jul;32(7):1269-77.[Abstract]
114. Barczynski M, Konturek A, Hubalewska-Dydejczyk A, et al. Randomized clinical trial of bilateral subtotal thyroidectomy versus total thyroidectomy for Graves' disease with a 5-year follow-up. Br J Surg. 2012 Apr;99(4):515-22.[Abstract]
115. Wiersinga WM, Perros P, Kahaly GJ, et al; European Group on Graves' Orbitopathy (EUGOGO). Clinical assessment of patients with Graves' orbitopathy: the European Group on Graves' Orbitopathy recommendations to generalists, specialists and clinical researchers. Eur J Endocrinol. 2006 Sep;155(3):387-9.[Abstract]
116. Perros P, Dayan CM, Dickinson AJ, et al. Management of patients with Graves' orbitopathy: initial assessment, management outside specialised centres and referral pathways. Clin Med (Lond). 2015 Apr;15(2):173-8.[Abstract][Full Text]
117. Burch HB, Perros P, Bednarczuk T, et al. Management of thyroid eye disease: a consensus statement by the American Thyroid Association and the European Thyroid Association. Thyroid. 2022 Dec;32(12):1439-70.[Abstract][Full Text]
118. Marcocci C, Kahaly GJ, Krassas GE, et al. Selenium and the course of mild Graves' orbitopathy. N Engl J Med. 2011 May 19;364(20):1920-31.[Abstract][Full Text]
119. Bednarczuk T, Schomburg L. Challenges and perspectives of selenium supplementation in Graves' disease and orbitopathy. Hormones (Athens). 2020 Mar;19(1):31-9.[Abstract][Full Text]
120. Zang S, Ponto KA, Kahaly GJ. Clinical review: intravenous glucocorticoids for Graves' orbitopathy: efficacy and morbidity. J Clin Endocrinol Metab. 2011 Feb;96(2):320-32.[Abstract]
121. Bartalena L, Krassas GE, Wiersinga W, et al. Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves' orbitopathy. J Clin Endocrinol Metab. 2012 Dec;97(12):4454-63.[Abstract][Full Text]
122. American Academy of Ophthalmology. Thyroid Eye Disease. July 2021 [internet publication]. [Full Text]
123. Men CJ, Kossler AL, Wester ST. Updates on the understanding and management of thyroid eye disease. Ther Adv Ophthalmol. 2021 Jan-Dec;13:25158414211027760.[Abstract][Full Text]
124. Chundury RV, Weber AC, Perry JD. Orbital radiation therapy in thyroid eye disease. Ophthal Plast Reconstr Surg. 2016 Mar-Apr;32(2):83-9.[Abstract]
125. Rajendram R, Bunce C, Lee RW, et al. Orbital radiotherapy for adult thyroid eye disease. Cochrane Database Syst Rev. 2012 Jul 11;(7):CD007114.[Abstract][Full Text]
126. Tanda ML, Bartalena L. Efficacy and safety of orbital radiotherapy for Graves' orbitopathy. J Clin Endocrinol Metab. 2012 Nov;97(11):3857-65.[Abstract]
127. Boboridis KG, Bunce C. Surgical orbital decompression for thyroid eye disease. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD007630.[Abstract][Full Text]
128. Szczapa-Jagustyn J, Gotz-Więckowska A, Kocięcki J. An update on thyroid-associated ophthalmopathy in children and adolescents. J Pediatr Endocrinol Metab. 2016 Oct 1;29(10):1115-22.[Abstract][Full Text]
129. Vannucchi G, Campi I, Covelli D, et al. Treatment of pretibial myxedema with dexamethazone injected subcutaneously by mesotherapy needles. Thyroid. 2013 May;23(5):626-32.[Abstract]
130. Azizi F, Amouzegar A. Management of hyperthyroidism during pregnancy and lactation. Eur J Endocrinol. 2011 Jun;164(6):871-6.[Abstract]
131. Korevaar TI, Muetzel R, Medici M, et al. Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population-based prospective cohort study. Lancet Diabetes Endocrinol. 2016 Jan;4(1):35-43.[Abstract]
132. Andersen SL, Olsen J, Wu CS, et al. Birth defects after early pregnancy use of antithyroid drugs: a Danish nationwide study. J Clin Endocrinol Metab. 2013 Nov;98(11):4373-81.[Abstract]
133. Andersen SL, Olsen J, Wu CS, et al. Severity of birth defects after propylthiouracil exposure in early pregnancy. Thyroid. 2014 Oct;24(10):1533-40.[Abstract][Full Text]
134. Morales DR, Fonkwen L, Nordeng HME. Antithyroid drug use during pregnancy and the risk of birth defects in offspring: systematic review and meta-analysis of observational studies with methodological considerations. Br J Clin Pharmacol. 2021 Oct;87(10):3890-900.[Abstract][Full Text]
135. Mooij CF, Cheetham TD, Verburg FA, et al. 2022 European Thyroid Association guideline for the management of pediatric Graves' disease. Eur Thyroid J. 2022 Jan 1;11(1):e210073.[Abstract][Full Text]
136. Reinhardt MJ, Brink I, Joe AY, et al. Radioiodine therapy in Graves' disease based on tissue-absorbed dose calculations: effect of pre-treatment thyroid volume on clinical outcome. Eur J Nucl Med Mol Imaging. 2002 Sep;29(9):1118-24.[Abstract]
137. Sosa JA, Tuggle CT, Wang TS, et al. Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metab. 2008 Aug;93(8):3058-65.[Abstract][Full Text]
138. De Napoli L, Spinelli C, Ambrosini CE, et al. Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy in pediatric patients. Eur J Pediatr Surg. 2014 Oct;24(5):398-402.[Abstract][Full Text]
139. Thompson GB. Surgical management in Graves' disease. Panminerva Med. 2002 Dec;44(4):287-93.
140. Barakate MS, Agarwal G, Reeve TS, et al. Total thyroidectomy is now the preferred option for the surgical management of Graves' disease. ANZ J Surg. 2002 May;72(5):321-4.[Abstract]
141. Haase A, Bahre M, Lauer I, et al. Radioiodine therapy in Graves' hyperthyroidism: determination of individual optimum target dose. Exp Clin Endocrinol Diabetes. 2000;108(2):133-7.[Abstract]
142. Stensvold AD, Jorde R, Sundsfjord J. Late and transient increases in free T4 after radioiodine treatment for Graves' disease. J Endocrinol Invest. 1997 Nov;20(10):580-4.[Abstract]
143. Chiovato L, Fiore E, Vitti P, et al. Outcome of thyroid function in Graves' patients treated with radioiodine: role of thyroid-stimulating and thyrotropin-blocking antibodies and of radioiodine-induced thyroid damage. J Clin Endocrinol Metab. 1998 Jan;83(1):40-6.[Abstract]
144. Ross DS. Radioiodine therapy for hyperthyroidism. N Engl J Med. 2011 Feb 10;364(6):542-50.[Abstract]
145. Redmond GP. Propranolol and fetal growth retardation. Semin Perinatol. 1982 Apr;6(2):142-7.[Abstract]
146. Bartalena L, Fatourechi V. Extrathyroidal manifestations of Graves' disease: a 2014 update. J Endocrinol Invest. 2014 Aug;37(8):691-700.[Abstract][Full Text]
147. Salvi M, Vannucchi G, Currò N, et al. Efficacy of B-cell targeted therapy with rituximab in patients with active moderate to severe Graves' orbitopathy: a randomized controlled study. J Clin Endocrinol Metab. 2015 Feb;100(2):422-31.[Abstract][Full Text]
148. Stan MN, Garrity JA, Carranza Leon BG, et al. Randomized controlled trial of rituximab in patients with Graves' orbitopathy. J Clin Endocrinol Metab. 2015 Feb;100(2):432-41.[Abstract][Full Text]
149. Smith TJ, Hegedüs L, Douglas RS. Role of insulin-like growth factor-1 (IGF-1) pathway in the pathogenesis of Graves' orbitopathy. Best Pract Res Clin Endocrinol Metab. 2012 Jun;26(3):291-302.[Abstract][Full Text]
150. Smith TJ, Kahaly GJ, Ezra DG, et al. Teprotumumab for thyroid-associated ophthalmopathy. N Engl J Med. 2017 May 4;376(18):1748-1761. [Abstract][Full Text]
151. Douglas RS, Kahaly GJ, Patel A, et al. Teprotumumab for the treatment of active thyroid eye disease. N Engl J Med. 2020 Jan 23;382(4):341-352.[Abstract][Full Text]
152. Kahaly GJ, Douglas RS, Holt RJ, et al. Teprotumumab for patients with active thyroid eye disease: a pooled data analysis, subgroup analyses, and off-treatment follow-up results from two randomised, double-masked, placebo-controlled, multicentre trials. Lancet Diabetes Endocrinol. 2021 Jun;9(6):360-72.[Abstract][Full Text]
153. Bednarczuk T, Pearce SH. The knowns and unknowns of teprotumumab for thyroid eye disease. Lancet Diabetes Endocrinol. 2021 Jun;9(6):323-5.[Abstract][Full Text]
154. Kahaly GJ, Riedl M, König J, et al; European Group on Graves' Orbitopathy (EUGOGO). Mycophenolate plus methylprednisolone versus methylprednisolone alone in active, moderate-to-severe Graves' orbitopathy (MINGO): a randomised, observer-masked, multicentre trial. Lancet Diabetes Endocrinol. 2018 Apr;6(4):287-98.[Abstract]
155. American College of Radiology, American College of Nuclear Medicine, American Society for Radiation Oncology, Society of Nuclear Medicine and Molecular Imaging, Society for Pediatric Radiology. Practice parameter for treatment of benign and malignant thyroid disease with I-131 sodium iodide. 2019 [internet publication].[Full Text]
156. Boelaert K, Maisonneuve P, Torlinska B, et al. Comparison of mortality in hyperthyroidism during periods of treatment with thionamides and after radioiodine. J Clin Endocrinol Metab. 2013 May;98(5):1869-82.[Abstract]
157. Okosieme OE, Taylor PN, Evans C, et al. Primary therapy of Graves' disease and cardiovascular morbidity and mortality: a linked-record cohort study. Lancet Diabetes Endocrinol. 2019 Feb 28;7(4):278-87.[Abstract]
158. Struja T, Fehlberg H, Kutz A, et al. Can we predict relapse in Graves' disease? Results from a systematic review and meta-analysis. Eur J Endocrinol. 2017 Jan;176(1):87-97.[Abstract][Full Text]
159. Shi H, Sheng R, Hu Y, et al. Risk factors for the relapse of Graves' disease treated with antithyroid drugs: a systematic review and meta-analysis. Clin Ther. 2020 Apr;42(4):662-75.e4.[Abstract][Full Text]
160. Flynn RW, Bonellie SR, Jung RT, et al. Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab. 2010 Jan;95(1):186-93.[Abstract]
161. Soares-Welch CV, Fatourechi V, Bartley GB, et al. Optic neuropathy of Graves disease: results of transantral orbital decompression and long-term follow-up in 215 patients. Am J Ophthalmol. 2003 Sep;136(3):433-41.[Abstract]
162. Rose Jr JG, Burkat CN, Boxrud CA. Diagnosis and management of thyroid orbitopathy. Otolaryngol Clin North Am. 2005 Oct;38(5):1043-74.[Abstract]
