TREATMENT
Propranolol
Graves' ophthalmopathy is due to the effects of activated T cells and thyrotropin receptor antiobdies (TRAB) on TSH receptors on retro-orbital fibroblasts and adipocytes. Radioactive iodine (RAI) treatment can raise titers of TRAB and worsen the ophthalmopathy.
High-dose glucocorticoids such as prednisone are used to control severe Graves' ophthalmopathy.
They are helpful in decreasing the severity of inflammation and decreasing extraocular volume.
Conventional antithyroid drugs do not improve ophthalmopathy.
The 3 major treatment options for Graves’ disease are:
Radioactive iodine ablation (preferred in the United States)
Antithyroid drug (ATD) therapy
Thyroidectomy
All 3 modalities are equally effective but surgery and radioactive iodine ablation can permanently treat hyperthyroidism
Anti-thyroid Drugs
Methimazole (MMI) and PTU
Approximately 30%-4Q% of patients treated with ATDs for 1 year go into permanent remission.
The most common side effect of ATDs is allergic reaction (2% of patients).
Both can cause agranulocytosis (most serious side effect), however allergic reaction is the most common
routine CBC is not recommended (because of rarity - 0.3% of patients) but stop the medication and investigate once the patient develop sore throat and fever; if WBC <1.0 => permanent discontinuation; if WBC >1.5 => find other cause