Background: Patients suffering from Graves' disease (GD) are quite frequent in endocrine clinical practice. In particular, overt hyperthyroidism may be complicated by serious adverse events and requires careful treatment, but its management has changed over the years in both the USA and European Union (EU). Objectives: To evaluate the current diagnosis and management of patient's with GD in Italy, and compare results with those obtained in previous similar surveys in the USA and EU. Methods: Members of the Italian Association of Clinical Endocrinologists (AME) were asked to participate in a Web-based survey on management of GD. Results: In total, 947 responses were obtained. The preferred diagnostic modality in Italy is TSH receptor antibody determination in conjunction with ultrasound, while radioactive iodine uptake/scan is preferred in the USA. Methimazole (MMI) 20-30 mg/day with a β-blocker is the initial treatment of choice in Italy and the EU, whereas the USA opts more frequently for radioactive therapy. If Graves' orbitopathy occurs, orbit CT/MRI scans are more often obtained in Italy and the EU than in the USA. In case of planned pregnancy in 6-12 months, surgery is more frequently suggested in Italy than in the EU and USA. Propylthiouracil is generally preferred to MMI in the first trimester. Conclusions: Italian endocrinologists have shown significantly different patterns in diagnosis and management of GD compared to both the USA and EU.

1.
Hollowell JG, Staehling NW, Flanders WD, et al: Serum TSH, T(4), and thyroid antibodies in the United States population (1988-1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499.
2.
Burch HB, Burman KD, Cooper DS: A 2011 survey of clinical practice patterns in the management of Graves' disease. J Clin Endocrinol Metab 2012;97:4549-4558.
3.
Bartalena L, Burch HB, Burman KD, Kahaly GJ: A 2013 European survey of clinical practice patterns in the management of Graves' disease. Clin Endocrinol (Oxf) 2016;84:115-120.
4.
Bahn RS, Burch HB, Cooper DS, et al; American Thyroid Association; American Association of Clinical Endocrinologists: Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract 2011;17:456-520.
5.
Barbesino G, Tomer Y: Clinical review: clinical utility of TSH receptor antibodies. J Clin Endocrinol Metab 2013;98:2247-2255.
6.
Tozzoli R, Bagnasco M, Giavarina D, Bizzaro N: TSH receptor autoantibody immunoassay in patients with Graves' disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis. Autoimmun Rev 2012;12:107-113.
7.
McKee A, Peyerl F: TSI assay utilization: impact on costs of Graves' hyperthyroidism diagnosis. Am J Manag Care 2012;18:e1-e14.
8.
Daniels GH: The American Thyroid Association and American Association of Clinical Endocrinologists' guidelines for hyperthyroidism and other causes of thyrotoxicosis: an appraisal. Endocr Pract 2011;17:325-333.
9.
Kahaly GJ, Bartalena L, Hegedus L: The American Thyroid Association/American Association of Clinical Endocrinologists guidelines for hyperthyroidism and other causes of thyrotoxicosis: a European perspective. Thyroid 2011;21:585-591.
10.
Mariotti S, Caturegli P, Piccolo P, et al: Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab 1990;71:661-669.
11.
Morita T, Tamai H, Oshima A, et al: The occurrence of thyrotropin binding-inhibiting immunoglobulins and thyroid-stimulating antibodies in patients with silent thyroiditis. J Clin Endocrinol Metab 1990;71:1051-1055.
12.
Sipos JA, Kahaly GJ: Imaging of thyrotoxicosis. Am J Med 2012;125:S1-S2.
13.
Emiliano AB, Governale L, Parks M, Cooper DS: Shifts in propylthiouracil and methimazole prescribing practices: antithyroid drug use in the United States from 1991 to 2008. J Clin Endocrinol Metab 2010;95:2227-2233.
14.
Cooper DS: Antithyroid drugs. N Engl J Med 2005;352:905-917.
15.
Nakamura H, Miyauchi A, Miyawaki N, Imagawa J: Analysis of 754 cases of antithyroid drug-induced agranulocytosis over 30 years in Japan. J Clin Endocrinol Metab 2013;98:4776-4783.
16.
Biondi B, Bartalena L, Cooper DS, et al: Eur Thyroid J. 2015;4:149-163.
17.
Terris DJ, Inabnet WB 3rd, Kandil E, et al; American Thyroid Association Surgical Affairs Committee Writing Task Force: American Thyroid Association statement on outpatient thyroidectomy. Thyroid 2013;23:1193-1202.
18.
Bartalena L, Baldeschi L, Dickinson AJ, et al; European Group on Gravesʼ Orbitopathy (EUGOGO): Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol 2008;158:273-285.
19.
De Groot L, Abalovich M, Alexander EK, et al: Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012;97:2543-65.
20.
Stagnaro-Green A, Abalovich M, Alexander E, et al: Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011;21:1081-1125.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.