[The treatment of Graves' disease: current views and controversies]. / Traitement de la maladie de Basedow : problématiques actuelles.

ABSTRACT

One of the more prevalent among the organ-specific autoimmune diseases, Graves' disease share their chronic evolution and lack of immunomodulatory treatment. Treatment strategy has to consider as opposite options as medical conservatory or ablative approach which requires much expertise and attention to patients' wish. Whatever treatment option, it is mandatory to prevent any risk of iatrogenic hypothyroidism, especially a rise of TSH above normal limit. The long-lasting benefit-risk ratio of treatment options is of primordial importance in this usually benign but enduring disease. Occurrence of Graves' orbitopathy, a significant complication, requires a special multidisciplinary management; the same is true in the case of a current or planned pregnancy. Overall quality-of-life is often markedly affected by Graves' disease; this should not be overlooked. Smoking increases relapse risk after a course of antithyroid drug; it also increases the risk and severity of Graves' orbitopathy. Patients must be made aware of these deleterious effects and encouraged to quit smoking.