Resumo
A Doença de Graves é uma condição autoimune comum que afeta a glândula tireoide, levando ao hipertireoidismo e a importantes efeitos na qualidade de vida, como sintomas psiquiátricos, incapacidade para o trabalho e aumento do risco de morte. Este artigo aborda os aspectos epidemiológicos, a apresentação clínica, o diagnóstico e o tratamento da Doença de Graves (DG), enfatizando a importância do manejo eficaz dessa condição. O objetivo é aprimorar as práticas clínicas e reduzir o impacto da doença na população afetada. A metodologia empregada foi uma revisão sistemática da literatura, examinando estudos experimentais e não experimentais em bases de dados como PubMed, Medline, SciELO e Google Acadêmico. A seleção dos artigos foi baseada em critérios que incluíam relevância direta ao tema e disponibilidade completa em inglês. Os dados encontrados indicam que a DG se manifesta por meio de sintomas como perda de peso, ansiedade e taquicardia, frequentemente exacerbados por estresse emocional e fatores ambientais. O diagnóstico diferencial é crucial para excluir outras causas de hipertireoidismo, e exames laboratoriais, como dosagem de hormônios tireoidianos e anticorpo anti-receptor do hormônio estimulador da tireoide (TRAB), são fundamentais na investigação. O tratamento envolve o uso de medicamentos antitireoidianos, terapia com iodo radioativo e, em alguns casos, cirurgia, além de monitoramento contínuo da função tireoidiana. Práticas baseadas em evidências são essenciais para otimizar os resultados clínicos e minimizar as consequências dessa condição na população.
Referências
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.
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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