Keywords
Abordagem clínica
Tratamento
Hipertireoidismo
How to Cite
Abstract
Graves' disease is a common autoimmune condition that affects the thyroid gland, leading to hyperthyroidism and significant effects on quality of life, such as psychiatric symptoms, incapacity for work, and increased risk of death. This article addresses the epidemiological aspects, clinical presentation, diagnosis, and treatment of Graves' disease (GD), emphasizing the importance of effective management of this condition. The objective is to improve clinical practices and reduce the impact of the disease on the affected population. The methodology used was a systematic review of the literature, examining experimental and non-experimental studies in databases such as PubMed, Medline, SciELO, and Google Scholar. The selection of articles was based on criteria that included direct relevance to the topic and full availability in English. The data found indicate that GD manifests through symptoms such as weight loss, anxiety, and tachycardia, often exacerbated by emotional stress and environmental factors. Differential diagnosis is crucial to exclude other causes of hyperthyroidism, and laboratory tests, such as thyroid hormone levels and anti-thyroid-stimulating hormone receptor antibody (TRAB), are essential in the investigation. Treatment involves the use of antithyroid medications, radioactive iodine therapy and, in some cases, surgery, in addition to continuous monitoring of thyroid function. Evidence-based practices are essential to optimize clinical outcomes and minimize the consequences of this condition in the population
References
ANDERSEN, S. L.; KNØSGAARD, L. Management of thyrotoxicosis during pregnancy. Best Practice & Research Clinical Endocrinology & Metabolism, [s.l.], v. 34, n. 4, p. 101414, 2020.
BAEG, J.; CHOI, H. S.; KIM, C.; KIM, H.; JANG, S. Y. Update on the surgical management of Graves' orbitopathy. Frontiers in Endocrinology (Lausanne), v. 13, p. 1080204, 6 Feb. 2023. DOI: 10.3389/fendo.2022.1080204. PMID: 36824601; PMCID: PMC9941741.
BAHN, R. S. Graves' ophthalmopathy. New England Journal of Medicine, v. 362, n. 8, p. 726-738, 2010. DOI: 10.1056/NEJMra0905750.
BARTALENA, L. Diagnosis and management of Graves disease: a global overview. Nature Reviews Endocrinology, v. 9, n. 12, p. 724-734, 2013. DOI: 10.1038/nrendo.2013.193.
BARTALENA, L.; BURCH, H. B.; BURMAN, K. D.; KAHALY, G. J. A 2013 European survey of clinical practice patterns in the management of Graves' disease. Clinical Endocrinology (Oxford), [s.l.], v. 84, n. 1, p. 115-120, 2016.
BOBANGA, I. D.; McHENRY, C. R. Treatment of patients with Graves' disease and the appropriate extent of thyroidectomy. Best Practice & Research Clinical Endocrinology & Metabolism, [s.l.], v. 33, n. 4, p. 101319, 2019.
BOELAERT, K.; TORLINSKA, B.; HOLDER, R. L.; FRANKLYN, J. A. Older subjects with hyperthyroidism present with a paucity of symptoms and signs: a large cross-sectional study. Journal of Clinical Endocrinology & Metabolism, v. 95, n. 6, p. 2715-2726, 2010. DOI: 10.1210/jc.2009-2495.
BRANDT, F.; THVILUM, M.; ALMIND, D.; CHRISTENSEN, K.; GREEN, A.; HEGEDÜS, L.; BRIX, T. H. Morbidity before and after the diagnosis of hyperthyroidism: a nationwide register-based study. PLoS One, [s.l.], v. 8, n. 6, p. e66711, 2013.
BRANDT, F.; THVILUM, M.; HEGEDÜS, L.; BRIX, T. H. Hyperthyroidism is associated with work disability and loss of labour market income: a Danish register-based study in singletons and disease-discordant twin pairs. European Journal of Endocrinology, v. 173, p. 595-602, 2015.
BURCH, H. B. et al. Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association. European Thyroid Journal, v. 11, n. 6, p. e220189, 8 Dec. 2022. DOI: 10.1530/ETJ-22-0189. PMID: 36479875; PMCID: PMC9727317.
BURCH, H. B.; BURMAN, K. D.; COOPER, D. S. A 2011 survey of clinical practice patterns in the management of Graves' disease. Journal of Clinical Endocrinology and Metabolism, [s.l.], v. 97, n. 12, p. 4549-4558, 2012.
BURCH, H. B.; COOPER, D. S. Management of Graves’ disease: a review. JAMA, v. 315, n. 6, p. 614, 9 fev. 2016] [s.l.], v. 314, n. 23, p. 2544-2554, 2015.
CHNG, C. L.; SEAH, L. L.; KHOO, D. H. Ethnic differences in the clinical presentation of Graves' ophthalmopathy. Best Practice & Research Clinical Endocrinology & Metabolism, v. 26, n. 3, p. 249-258, 2012. DOI: 10.1016/j.beem.2011.10.004.
DOROUDIAN, S.; PEDERSEN, I. B.; KNUDSEN, C. S.; HANDBERG, A.; ANDERSEN, S. L. Comparison of three competitive immunoassays for measurement of TSH receptor antibodies in patients with Graves' disease. Scandinavian Journal of Clinical and Laboratory Investigation, [s.l.], v. 77, n. 7, p. 535-540, 2017.
EFFRAIMIDIS, G.; WIERSINGA, W. M. Mechanisms in endocrinology: autoimmune thyroid disease: old and new players. European Journal of Endocrinology, v. 170, n. 6, p. R241-R252, 2014. DOI: 10.1530/EJE-14-0047.
EUNG, A. K. C.; LEUNG, A. A. C. Evaluation and management of children with thyrotoxicosis. Recent Patents on Endocrine, Metabolic & Immune Drug Discovery, v. 11, n. 1, p. 22-31, 2017.
FEROCI, F.; RETTORI, M.; BORRELLI, A.; et al. A systematic review and meta-analysis of total thyroidectomy versus bilateral subtotal thyroidectomy for Graves' disease. Surgery, [s.l.], v. 155, n. 3, p. 529-540, 2014.
GENCER, B.; CAPPOLA, A. R.; RODONDI, N.; COLLET, T. H. Challenges in the management of atrial fibrillation with subclinical hyperthyroidism. Frontiers in Endocrinology (Lausanne), v. 12, p. 795492, 2022. Published 4 Jan. 2022. DOI: 10.3389/fendo.2021.795492.
GOICHOT, B.; CARON, P.; LANDRON, F.; BOUÉE, S. Clinical presentation of hyperthyroidism in a large representative sample of outpatients in France: relationships with age, aetiology and hormonal parameters. Clinical Endocrinology (Oxf), v. 84, n. 3, p. 445-451, 2016. DOI: 10.1111/cen.12816.
GONTARZ-NOWAK, K.; SZYCHLIŃSKA, M.; MATUSZEWSKI, W.; STEFANOWICZ-RUTKOWSKA, M.; BANDURSKA-STANKIEWICZ, E. Current knowledge on Graves' orbitopathy. Journal of Clinical Medicine, v. 10, n. 1, p. 16, 2020. DOI: 10.3390/jcm10010016.
HAUGEN, B. R.; ALEXANDER, E. K.; BIBLE, K. C.; DOHERTY, G. M.; MANDEL, S. J.; NIKIFOROV, Y. E.; PACINI, F.; RANDOLPH, G. W.; SAWKA, A. M.; SCHLUMBERGER, M.; SCHUFF, K. G.; SHERMAN, S. I.; SOSA, J. A.; STEWARD, D. L.; TUTTLE, R. M.; WARTOFSKY, L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, v. 26, n. 1, p. 1-133, 2016. DOI: 10.1089/thy.2015.0020.
HOANG, T. D.; STOCKER, D. J.; CHOU, E. L.; BURCH, H. B. 2022 Update on Clinical Management of Graves Disease and Thyroid Eye Disease. Endocrinology and Metabolism Clinics of North America, v. 51, n. 2, p. 287-304, Jun. 2022. DOI: 10.1016/j.ecl.2021.12.004. Epub 11 May 2022. PMID: 35662442; PMCID: PMC9174594.
KRAUS, C. N.; SODHA, P.; VAIDYANATHAN, P.; KIRKORIAN, A. Y. Thyroid dermopathy and acropachy in pediatric patients. Pediatric Dermatology, v. 35, n. 6, p. e371-e374, 2018. DOI: 10.1111/pde.13670.
LIU, Z. W.; MASTERSON, L.; FISH, B.; JANI, P.; CHATTERJEE, K. Thyroid surgery for Graves' disease and Graves' ophthalmopathy. Cochrane Database of Systematic Reviews, [s.l.], n. 11, p. CD010576, 2015.
MA, C.; XIE, J.; WANG, H.; LI, J.; CHEN, S. Radioiodine therapy versus antithyroid medications for Graves' disease. Cochrane Database of Systematic Reviews, [s.l.], v. 2, p. CD010094, 2016.
McLEOD, D. S.; COOPER, D. S. The incidence and prevalence of thyroid autoimmunity. Endocrine, v. 42, n. 2, p. 252-265, 2012. DOI: 10.1007/s12020-012-9703-2.
MOLEDINA, M.; DAMATO, E. M.; LEE, V. The changing landscape of thyroid eye disease: current clinical advances and future outlook. Eye (London), v. 38, n. 8, p. 1425-1437, 2024. DOI: 10.1038/s41433-024-02967-9.
NAGA, Nitin L. T.; LAKKUNDI, S.; S L, S. R.; et al. High diagnostic accuracy of thyroid-stimulating hormone (TSH) receptor antibodies in distinguishing Graves' disease and subacute thyrotoxicosis in the Indian population. Cureus, [s.l.], v. 16, n. 2, p. e54303, 2024.
RANDT, F.; ALMIND, D.; CHRISTENSEN, K.; GREEN, A.; BRIX, T. H.; HEGEDÜS, L. Excess mortality in hyperthyroidism: the influence of preexisting comorbidity and genetic confounding: a Danish nationwide register-based cohort study of twins and singletons. Journal of Clinical Endocrinology & Metabolism, [s.l.], v. 97, n. 11, p. 4123-4129, nov. 2012.
RAYMAN, M. P. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proceedings of the Nutrition Society, v. 78, n. 1, p. 34-44, 2019. DOI: 10.1017/S0029665118001192.
REDDY, S. V.; GUPTA, S. K.; JAIN, M. Dermopathy of Graves' disease: clinico-pathological correlation. Indian Journal of Endocrinology and Metabolism, v. 16, n. 3, p. 460-462, May 2012. DOI: 10.4103/2230-8210.95714. PMID: 22629522; PMCID: PMC3354863
REN, Z.; QIN, L.; WANG, J. Q.; LI, Y.; LI, J.; ZHANG, R. G. Comparative efficacy of four treatments in patients with Graves' disease: a network meta-analysis. Experimental and Clinical Endocrinology & Diabetes, [s.l.], v. 123, n. 5, p. 317-322, 2015.
SCHIAVONE, D.; CRIMÌ, F.; CABRELLE, G.; et al. Role of Lugol solution before total thyroidectomy for Graves' disease: randomized clinical trial. British Journal of Surgery, [s.l.], v. 111, n. 8, p. znae196, 2024.
SCHUH, A. et al. Presentation of Graves' orbitopathy within European Group On Graves' Orbitopathy (EUGOGO) centres from 2012 to 2019 (PREGO III). British Journal of Ophthalmology, v. 108, n. 2, p. 294-300, 29 Jan. 2024. DOI: 10.1136/bjo-2022-322442. PMID: 36627174; PMCID: PMC10850632.
SMIT, M. A.; VAN KINSCHOT, C. M. J.; VAN DER LINDEN, J.; VAN NOORD, C.; KOS, S. Measurement of anti-TSH receptor antibodies: what is the correct cut-off value? Netherlands Journal of Medicine, v. 78, n. 2, p. 55-63, 2020.
SMITH, T. J. New advances in understanding thyroid-associated ophthalmopathy and the potential role for insulin-like growth factor-I receptor. F1000Research, v. 7, p. 134, 2018. DOI: 10.12688/f1000research.12787.1.
SMITH, T. J.; HEGEDÜS, L. Graves' disease. New England Journal of Medicine, [s.l.], v. 375, n. 16, p. 1552-1565, 2016.
SUBEKTI, I.; PRAMONO, L. A. Current diagnosis and management of Graves' disease. Acta Medica Indonesiana, [s.l.], v. 50, n. 2, p. 177-182, 2018.
TOMER, Y. Mechanisms of autoimmune thyroid diseases: from genetics to epigenetics. Annual Review of Pathology, v. 9, p. 147-156, 2014.
TORTORA, F. et al. Disease activity in Graves' ophthalmopathy: diagnosis with orbital MR imaging and correlation with clinical score. Neuroradiology Journal, v. 26, n. 5, p. 555-564, Oct. 2013. DOI: 10.1177/197140091302600509. Epub 7 Nov. 2013. PMID: 24199816; PMCID: PMC4202826.
ZIMMERMANN, M. B.; BOELAERT, K. Iodine deficiency and thyroid disorders. The Lancet Diabetes & Endocrinology, v. 3, n. 4, p. 286-295, 2015. DOI: 10.1016/S2213-8587(14)70225-6.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Rodrigo Fernandes Anderson, Valentina Mossini Gratão , João Victor Araújo Sousa Araújo Sousa , Vitória Sousa Magalhães, Marcos Vinícius Fonseca da Silva, Maria Eduarda Arantes Da Cunha, Guilherme Prado Barbosa, Lucas Fernandes Anderson