Graves’ disease is an autoimmune disorder characterized by a hyperthyroid state and the accompanying signs and symptoms caused by excess thyroid hormone. The mechanism of disease involves an antibody mistakenly directed towards the thyroid-stimulating hormone (TSH) receptor, which controls thyroid hormone production. The result is an overactive thyroid gland that produces too much hormone; it may also grow significantly, forming a goiter. In connection with Thyroid Awareness Month, below we examine the current state of research concerning Graves’ disease, and what that might mean for doctors and patients alike (previously we reviewed the latest research for Hashimoto’s) .
Are there any research studies or clinical trials seeking better therapies for Graves’ disease?
Yes there are, and they appear to be ongoing. In fact, the Mayo Clinic has a team dedicated solely to thyroid research, including Graves’ disease, and the University of Michigan’s Kellogg Eye Center is actively engaged in studying the ocular aspects of the disease.
Past and current studies appear to focus on learning more about the pathology and genetics of the disease, as well as finding novel therapies, or novel uses for existing therapies. However, much of the research also includes reviews of standard treatments, in the hopes of developing new and better therapeutic avenues.
One continuing area of investigation involves whether to use oral anti-thyroid drugs versus radioiodine therapy, and the benefits and disadvantages of each. For example, one study examined whether the latter was better able to manage the oxidation/anti-oxidant balance that is often upset during standard treatment. Using specific markers, the researchers found that radioiodine was indeed better at managing the oxidative stress that accompanies thyroid imbalance. Other earlier studies have looked at whether radioiodine treatment alone would suffice, in terms of eliminating hyperthyroidism while preventing subsequent hypothyroidism.
Because eye involvement (Graves’ ophthalmopathy) is very common, and untreated Grave’s can result in serious ocular problems, there is also interest in finding ways to avoid this. A recently published study demonstrated beta cell depletion, via rituximab, resulted in lower TSH antibodies, and therefore yielded a safe and effective method of treating these complications before they begin to jeopardize sight. Additional recent work in this area has lead to the recommendation that all cases of Graves’ ophthalmopathy be evaluated by MRI to determine management options, preferably at a specialized clinic or hospital.
There are also studies that have examined alternative treatments for Graves’ disease, such as using royal jelly cream, derived from worker bees, which is said to possess anti-inflammatory and immunomodulatory properties. Initial results suggest that such application might be helpful in these pursuits, although further research is necessary. Investigating the possible use of antioxidants in the treatment of Graves’ disease has also received attention from the research community, and may be a viable future option.
Up-to-date information on clinical trials may be found by visiting ClinicalTrials.gov or CenterWatch.com, both of which provide extensive listings of research studies currently being conducted, or planned for the future and recruiting participants. Other good sources for research information are your closest major academic medical center, and/or your endocrinologist.
If doctors think current treatments are effective for Graves’ disease, what criteria is used to determine that?
The major initial criteria used to determine whether Graves’ disease treatments are effective are a review of the patient’s signs and symptoms, along with any pertinent labs. Examining the patient’s symptom profile and lab results, and comparing these indicators to previous visits, will allow the physician to determine if and how well current therapies are working. Depending on the individual situation, radiographic studies may also be ordered to better visualize the thyroid gland. Based on this assessment, and in consideration of all risks and benefits, the doctor then decides what adjustments, if any, should be made to the current regimen. In the event that traditional therapies are failing, the doctor may then decide to explore alternative options, such as those listed above, among others.
Clinical treatment guidelines, typically provided by national governing bodies or medical associations, help your doctor to decide on the right course of therapy for your disease. For instance, the decision about whether to employ oral medications or radioiodine initially is an important one, and each doctor has his or her reasons for this preference, and he or she will make this choice within the accepted guideline parameters. There are certain considerations when making this decision, and your endocrinologist will take these into account when listing your options. There are also specific clinical scenarios that require special intervention, which are evaluated individually, within the context of the overall clinical picture. Sometimes, when making treatment decisions, doctors may also use treatment algorithms or protocols, which involve following decision trees to determine the best course of action. Such tools can be particularly useful and effective when the path ahead is not straightforward, or there are special circumstances involved.
Questions for your doctor:
- Are you involved in any research for Graves’ disease? Are any of your colleagues?
- Where can I find the latest information on research progress involving Graves’ disease?
- What do you think about alternative treatments, such as the royal jelly cream and others? Are there some I should stay away from?
- Do you recommend signing up for any clinical trials? What are the pros and cons?
- Is there any reason to seek out other therapies, or is my disease well controlled and best treated using the current regimen?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].