Personalised immunomodulating treatments forGraves’ disease: fact or fiction?

[holyshedballs]

Swiss Med Wkly. 2017;147:w14476

Full text here smw.ch/article/doi/smw.2017...

Summary

Although Graves’ disease has been recognised for more

than 100 years, its physiopathological mechanisms are incompletely

understood. Treatment strategies today mainly

focus on suppression of thyroid hormone production by

use of antithyroid drugs or radio-iodine, but neglect the

underlying immunological mechanisms. Although Graves’

disease is often seen as a prototype for an autoimmune

mechanism, it is more likely to be a heterogeneous syndrome

showing characteristics of both autoimmunity and

immunodeficiency. The interplay of these two mechanisms

may well characterise the physiopathology of this disease

and its complications. Immunodeficiency may be either

genetically determined or secondarily acquired. Various

triggering events lead to autoimmunity with stimulation of

the thyroid gland resulting in the clinical syndrome of hyperthyroidism.

Also, relapse risk differs from patient to patient

and can be estimated from clinical parameters incorporated

into the Graves’ Recurrent Events After Therapy

(GREAT) score. Accurate risk stratification may help to

distinguish high-risk patients for whom a more definitive

treatment approach should be used from others where

there is a high probability that the disease will recover

with medical treatment alone. Several smaller trials having

found positive effects of immunosuppressive drugs on recurrence

risk in Graves’ disease; therefoore, there is great

potential in the use of novel immunomodulating drugs in

addition to the currently used antithyroid drugs for the successful

treatment of this condition. Further in-depth exploration

of susceptibility, triggering factors and immunological

mechanisms has the potential to improve treatment

of Graves’ disease, with more personalised, risk-adapted

treatment strategies based on the different physiopathological

concepts of this heterogeneous condition.

[nightingale-56]

Thanks for posting holyshedballs . Very interesting, but much too late for me.

[holyshedballs in reply to nightingale-56]

Sorry to hear that but may be for other forum users. And Endocrinologists.

[nightingale-56 in reply to holyshedballs]

Would be really good if Endos read this kind of information. I hope this post helps some Graves patients though.

[holyshedballs in reply to nightingale-56]

it does seem like an interesting development. and more the holistic side of things as well.