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Treatment Options

Below are links relating to the three common treatments: ADT's, Surgery and RAI.  ADTs are typically the first course in treatment with the goal of remission.  If remission is not likely to happen and the symptoms, such as heart palpitations, could cause serious harm then the next step is usually surgery or radiation.  It's very important to do your own research. For more information relating to treatment see the Treatment tab under Graves 101. 

Comparison of long‐term antithyroid drugs versus radioactive iodine or surgery for Graves' disease: A review of the literature

Conclusions: Long-term ATD is a viable alternative to ablative therapies in the management of GD offering advantages across multiple patient centred outcomes. Decision making must factor differences in this approach compared to ablative therapies and ultimately be tailored to individualized patient situations.



The Treatment of Graves Disease: Different Strokes for Different Folks
Once the diagnosis of hyperthyroidism due to Graves disease is made, the next step is for the patient and the physician to sit down and discuss the most appropriate treatment. The choice of therapy is not an easy one, since all treatments are effective, yet all have certain advantages and disadvantages.

TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study
We describe in detail the course of TSH-receptor autoimmunity after the three common types of therapy for Graves' hyperthyroidism. Medical therapy and subtotal thyroidectomy were followed by a gradual and parallel remission of TSH-receptor autoimmunity, with the disappearance of TRAb from serum in 70 - 80% of the patients after 18 months. After stopping therapy, around 40% of medically treated patients experienced a reactivation of TSH-receptor autoimmunity and became hyperthyroid again. Radioiodine therapy led to a year-long worsening of autoimmunity against the TSH receptor, and the number of patients entering remission of TSH-receptor autoimmunity with disappearance of TRAb from serum during the following years was considerably lower than with the other types of therapy.

2011 - The new ATA and AACE guidelines for hyperthyroidism and other forms of thyrotoxicosis
Surgery recommended for patients with nodular goiters. The new guidelines give more equal and balanced consideration to I-131, anti-thyroid drugs (ATDs), and surgery in the management of Graves disease. plan with proper attention paid to the preferences of each patient.

Thyroid nodules: diagnosis and management

Thyroid nodules are common. Their importance lies in the need to assess thyroid function, degree of and future risk of mass effect, and exclude thyroid cancer, which occurs in 7-15% of thyroid nodules. There are four key components to thyroid nodule assessment: clinical history and examination, serum thyroid stimulating hormone (TSH) measurement, ultrasound and, if indicated, fine-needle aspiration (FNA). Surgery is indicated for FNA findings of malignancy or indeterminate cytology when there is a high risk clinical context. Surgery may also be indicated for suspicion of malignancy; larger nodules, especially with symptoms of mass effect; and in some patients with thyrotoxicosis.

Thyroid nodules

In assessing a lump or nodule in your neck, one of your doctor's main goals is to rule out the possibility of cancer. But your doctor will also want to know if your thyroid is functioning properly.

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