[Update Graves' disease 2019].

DIAGNOSIS: Also accordingly to the recent European Thyroid Association Guidelines 2018, TSH receptor antibody (TRAb) measurement is highly sensitive and specific for the detection of Graves' disease (GD) and to distinguish from autoimmune thyroiditis (AIT). Bioassays are used for distinguishing stimulating from blocking antibodies and are used for scientific questions.

THERAPY: According to the current guidelines - and with exception for pregnant women - the use of thiamazol/carbimazole is generally favored from propylthiouracil (PTU). In case of relapse or missing remission after 12 up to 18 months antithyroid drug therapy, thyroid ablative therapy including radioiodine therapy or thyroidectomy, respectively, should be performed.

PROGNOSIS: TRAb measurement can also be used for outcome prediction.

PREGNANCY: Recently the American Thyroid Association published a new guideline for the management of thyroid disease during pregnancy. According to this, during the first 16 weeks of pregnancy PTU is preferred for the treatment of GD with hyperthyroidism. After the 16th week of pregnancy, there is no clear recommandation which antithyroid drug should be used. The general aim is to reach a maternal serum T4 at the upper serum range or moderately above the reference range with the lowest effective dose of an antithyroid drug.

ENDOCRINE OPHTHALMOPATHY: As recently shown, Graves' ophthalmopathy improves significantly following the treatment with the monoclonal antibody teprotumumab which inhibits the IGF 1 receptor. This therapy is, however, not been approved in Germany.