How is recurrent Graves' disease treated?

If a patient diagnosed with recurrent Graves’ disease was initially treated with an antithyroid drug, approaches to further treatment may vary based on estimates of the severity of the patient's underlying disorder. If a patient in this situation was initially diagnosed with mild Graves' disease, some doctors may consider recommending a second course of treatment with an antithyroid drug if it appears that there may still be a chance that the patient could spontaneously go into remission. The odds of this occurring may not be very high. For this reason, some doctors may recommend that patients in this situation consider more definitive treatment with radioactive iodine.

If a patient diagnosed with recurrent Graves’ disease was initially treated with radioactive iodine, most doctors would recommend that the patient undergo further treatment with a second dose of 131-Iodine. In the majority of cases a second dose of 131-Iodine will deliver enough beta radiation to destroy an adequate number of overactive follicular cells. Up to 10-20% of all patients with Graves’ disease who were initially treated with radioactive iodine may require further treatment with a second dose of 131-Iodine. In rare cases, some patients with severe Graves’ disease may require treatment with a third dose of 131-Iodine.

If a patient diagnosed with recurrent Graves’ disease was initially treated with thyroid surgery, approaches to further treatment may vary based on the patient’s stated preferences for different forms of therapy. If a patient in this situation is willing to consider treatment with radioactive iodine, many doctors would recommend this approach based on its relative safety and efficacy. If a patient in this situation is not willing to consider treatment with radioactive iodine, repeat thyroid surgery may be an option. In some cases this may be a difficult decision, as initial thyroid surgery may have led to scarring in the region of the neck that may increase the risk of complications. Patients who are not candidates for repeat thyroid surgery may be treated with antithyroid drugs.