Der Morbus Basedow ist nach der Schilddrüsenautonomie die häufigste Ursache einer Hyperthyreose in Deutschland. Die Inzidenz liegt bei ca. 40/100 000 Einwohner. Am häufigsten ist die Altersgruppe zwischen 20 und 50 Jahren betroffen. Diagnostik- und Therapieempfehlungen in diesem Beitrag basieren u. a. auf europäischen und internationalen Empfehlungen.
Abstract
Diagnosis The diagnosis of Gravesʼ disease is mainly based on ultrasonography and laboratory diagnostics. This includes the determination of the TSH value and the peripheral thyroid hormones. TSH receptor antibody (TRAb) measurement is highly sensitive and specific for the detection of Gravesʼ disease (GD) and helps to distinguish from autoimmune thyroiditis (AIT). However, as recent studies show, some may AIT patients may also reveal TRAb.
Therapy Current guidelines recommend primarily the use of thiamazol/carbimazole in GD. Due to the comparatively higher hepatotoxicity, propylthiouracil is not recommended as first line therapy. In case of relapse during 12 up to 18 months of antithyroid drug therapy or after a frustrating attempt at cessation, definitive therapy should be considered. Alternatively, in accordance with the current recommendations of the European Thyroid Association, drug therapy may be continued for up to 12 months after initial diagnosis.
Pregnancy The treatment of active GD during pregnancy is problematic due to diaplacental crossing of peripheral thyroid hormones, TSH receptor stimulating antibodies and antithyroid drugs. According to current guidelines, PTU is recommended during the first 16 weeks of pregnancy, whereas for the 2nd and 3 rd trimester no special recommendations are given. After that, you can choose which antithyroid drug might be used. The aim of antithyroid drug therapy during pregnancy is to achieve a suppressed TSH value together with normal or slightly increased fT4 while using lowest effective dose of antithyroid drug.
Immune checkpoint inhibitors (ICI) The most common endocrine side effect with this therapy is thyroid dysfunction. Hyperthyroidism; occur most frequently in combination therapy (CTLA-4 / anti-PD-1 therapy) ICI mainly causes destructive thyroiditis with lymphocytic infiltration; GD is absolutely rare in this context and only few cases are described.
Schlüsselwörter
Morbus Basedow - Hyperthyreose - TSH-Rezeptor-Antikörper
Key words
Gravesʼ disease - hyperthyroidism - TSH receptor antibodies
