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Treatment Of Graves

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The treatment of Graves’ disease: What we do and the evidence behind it. Bijay Vaidya Ali Chakera
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 1 ,[object Object],[object Object],[object Object],[object Object]
What would you do? ,[object Object],[object Object],[object Object],[object Object]
What your colleagues do? ,[object Object],[object Object]
Preferred treatment options for initial treatment of Graves’ Vaidya et al . Clinical Endocrinology (2008) 68 , 814
What are the questions? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What should we use as initial treatment?
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Efficacy
Cost-effectiveness ,[object Object],[object Object],[object Object],[object Object],[object Object],Thionamide £3763 RAI £1375 Surgery £6551 Thionamide £21800 RAI £275 Surgery £6500
Side-Effects/Problems ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is the best drug therapy?
Medical Treatment ,[object Object],[object Object],[object Object]
Which drug? ,[object Object],[object Object],[object Object]
Which drug? ,[object Object],[object Object],[object Object],[object Object]
Normalisation of FT4 with MMI and PTU
Which drug? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],The problems of PTU
Which drug? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Which regime? ,[object Object],[object Object],[object Object],[object Object]
Relapse rates: B&R vs Titration
Side effects: B&R vs titration
B&R versus Dose Titration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Duration of treatment
Duration of Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Radioactive iodine and surgery
Radioactive Iodine ,[object Object],[object Object],[object Object],[object Object]
Radioactive Iodine ,[object Object],[object Object]
Surgery ,[object Object],[object Object]
Heged ü s. Endo & Metab Clinic. 2009
Summary ,[object Object],[object Object],[object Object],[object Object]
Any thoughts?

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Treatment Of Graves

Hinweis der Redaktion

  1. Things to consider: Would you change treatment if the patient was male? What if they had a large goitre? They were a smoker? What if the patient was older?
  2. 26. Cooper DS. The side effects of antithyroid drugs. Endocrinologist 1999;9:457–76. 27. Pearce SH. Spontaneous reporting of adverse reactions to carbimazole and propylthiouracil in the UK. Clin Endocrinol (Oxf) 2004;61(5):589–94.
  3. 26. Cooper DS. The side effects of antithyroid drugs. Endocrinologist 1999;9:457–76. 27. Pearce SH. Spontaneous reporting of adverse reactions to carbimazole and propylthiouracil in the UK. Clin Endocrinol (Oxf) 2004;61(5):589–94.