Graves' Disease: Can It Be Cured?

[helvella]

A question asked many times here - including just the other day.

Endocrinol Metab. 2019 Mar;34(1):29-38. English.

Published online Mar 21, 2019. doi.org/10.3803/EnM.2019.34...

Copyright © 2019 Korean Endocrine Society

Graves' Disease: Can It Be Cured?

Wilmar M. Wiersinga

Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Received February 19, 2019; Revised February 28, 2019; Accepted March 05, 2019.

Abstract

Whether or not Graves' hyperthyroidism can be really cured, depends on the definition of “cure.” If eradication of thyroid hormone excess suffices for the label “cure,” then all patients can be cured because total thyroidectomy or high doses of 131I will abolish hyperthyroidism albeit at the expense of creating another disease (hypothyroidism) requiring lifelong medication with levothyroxine. I would not call this a “cure,” which I would like to define as a state with stable thyroid stimulating hormone (TSH), free thyroxine, and triiodothyronine serum concentrations in the normal range in the absence of any thyroid medication. Surgery and radioiodine are unlikely to result in so-defined cures, as their preferable aim as stated in guidelines is to cause permanent hypothyroidism. Discontinuation of antithyroid drugs is followed by 50% recurrences within 4 years; before starting therapy the risk of recurrences can be estimated with the Graves' Recurrent Events After Therapy (GREAT) score. At 20-year follow-up about 62% had developed recurrent hyperthyroidism, 8% had subclinical hypothyroidism, and 3% overt hypothyroidism related to TSH receptor blocking antibodies and thyroid peroxidase antibodies. Only 27% was in remission, and might be considered cured. If the definition of “cure” would also include the disappearance of thyroid antibodies in serum, the proportion of cured patients would become even lower.

Keywords:

Graves hyperthyroidism; Cure; Thyroidectomy; Radioactive iodine; Antithyroid agents; Remission; Long term outcome

Full text freely available:

e-enm.org/DOIx.php?id=10.38...

[Raventhorpe]

Interesting article,thanks for posting, was always told by my endo that graves desease was incurable,wish she had been a bit more honest about how RAI would impact on my life but then maybe she really believed that it was a case of take a little pill and all will be fine and dandy.

[SilverAvocado in reply to Raventhorpe]

I think they really do believe that being hypothyroid is no big deal at all

[leftbehind in reply to Raventhorpe]

I have Graves and had a thyroidectomy. Since then my GP, who stated her brother had Graves and had Rai and now everything was fine, did not recognize any symptoms of hypothyroidism such as dry eyes, sore muscles, poor digestion, she wanted me to go to a specialist for each separate problem. Then she finally stated she was done with me. Inow self-medicate with NP thyroid. My eyes burn and sometimes burn and sometimes outside they will water profusely and run down my face if I can't see anything. I have been told I have dry eyes. Sometimes my eyes ache. I went to an ophthalmologist who said he knew all about Graves eye disease, but then he claimed every symptom on some other cause rather than my level of NP thyroid I am taking. So I quit him and now I just go to a regular GP who will prescribe the level I ask for, which was 60 mg. I self-increased to 75 mg. Now I was feeling good in many ways, but now my eyes feel worse burning and watering again, and sore muscles so bad I can barely walk! In two years I have not been able to sustain any quality of life. It's up and down, on and on. I'm still trying to find a good Endo...they say the treat Graves but then they don't recognize any of the symptoms of hyper or hypo.

Any input on sore muscles, hypo or hyper? I exercise regularly and walk daily...yesterday I could barely move my legs??

[Raventhorpe in reply to leftbehind]

Hi leftbehind, sorry to hear you're not too well. Couple of things you could try for sore muscles magnesium spray or gel seems to relieve the pain for me or warm bath with magnesium flakes. Have you had your vitamin levels checked? B12,folate, ferritin and particularly vit D when you have graves desease you can be low in any or all of these vitamins and they need to be optimal not just in range. When I had joint pain I found I was low in vit D so supplemented and it definitely made a difference so worth checking. It's so hard to find a good endo it took me 8yrs to get t3 prescribed by an endocrinologist and it's made a big difference to my health still not 100% but much better than when I was on levo. Wishing you well.

[Greekchick]

Thanks, helvella, for posting this. The problem with Graves is that none of the choices are really great for treating this disease, and deciding what to do is not easy. We basically end up trading one set of symptoms for another. Wishing you well!

[seeking-answers]

Thanks for posting this. Interesting percentages and it inspires me to be one of the 27%. Been in remission from Graves for 5 months. If anyone has any other success stories of Graves remission, I'd love to hear how they got there AND STAYED THERE!