Table6.50 recommendations that form these guidelines Number Recommendation CefAbsaenneandpetolcrapd2ndoantdigaobandafadignotof 1,0000 2,0000 Scintigraphy of the thyroid is sugested when thyroid nodularity coeistswith hyperthyroidism,and prior to radioactive iodine 2. herap ahpmeeCapphrotnmtoadaeteandw地ADRhnpyortodtoyye 1,0000 1,0000 MMIis administered for 12-18 months then discontinued if the TSH and TSH-R-Ab levels are normal 1.0000 Tlaa8mmsaaanpmdatghhpaawane上ooo 1.0000 1.0000 1.0000 ended in al suitable patientswith Graveshyperthyroidism 1.0000 prefer thisapp Treatment of SHis recommended n Graves'patients5 years with seru TSH levels that are persistentlymIU/L 1.0g00 ATD should be the hoie oftreatment of GraveSH 1,0000 monitoring in an intensive care unit 1,0000 Verbal as well as witte aspects of efficacy and potential RAI therapy should be provided 1,0000 ed before RAI therapy they should be paused around I week before and after therapy in order not to decrease the 1.0000 No dose calculation can secure long-term euthyroidism and it is fully acceptable to ofera fixed dose of RAl 1.0000 Pregnancy and breast fecding con 1,0000 Conception should be postponed until at least 6 months after RAI in both males and females 1,0000 1.0000 procedure of hoice,and shoud be perormed 1,0000 1,0000 Vitamin D deficiency should be correted toreduce the postoperative risk of hypocalcemia 1,0000 bamgr-1M Kahaly/Bartalena/Hegeduis/Leenhardt/ Poppe/Pearce 医通 http://guide.medlive.cn/ Kahaly/Bartalena/Hegedüs/Leenhardt/ Poppe/Pearce 180 Eur Thyroid J 2018;7:167–186 DOI: 10.1159/000490384 Table 6. 50 recommendations that form these guidelines Number Recommendation Strength and level of evidence 1 The measurement of TSH-R-Ab is a sensitive and specific tool for rapid and accurate diagnosis and differential diagnosis of Graves’ hyperthyroidism 1, ØØØØ 2 When technically available, differentiation of TSH-R-Ab functionality is helpful and predictive in Graves’ patients during pregnancy/post-partum, as well as for extra-thyroidal manifestations 2, ØØØO 3 US examination, comprising conventional grey scale analysis and color-flow or power Doppler examination is recommended as the imaging procedure to support the diagnosis of Graves’ hyperthyroidism 1, ØØØØ 4 Scintigraphy of the thyroid is suggested when thyroid nodularity coexists with hyperthyroidism, and prior to radioactive iodine therapy 2, ØØØO 5 Patients with newly diagnosed Graves’ hyperthyroidism should be treated with ATD. RAI therapy or thyroidectomy may be considered in patients who prefer this approach 1, ØØØØ 6 MMI (CBZ) should be used in every non-pregnant patient who chooses ATD therapy for Graves’ hyperthyroidism 1, ØØØØ 7 MMI is administered for 12–18 months then discontinued if the TSH and TSH-R-Ab levels are normal 1, ØØØØ 8 Measurement of TSH-R-Ab levels prior to stopping ATD therapy is recommended, as it aids in predicting which patients can be weaned from the medication, with normal levels indicating a greater chance of remission 1, ØØØØ 9 Patients with persistently high TSH-R-Ab at 12–18 months can continue MMI therapy, repeating the TSH-R-Ab measurement an after additional 12 months, or opt for RAI or thyroidectomy 1, ØØØO 10 Patients should be informed of potential side effects of ATD and the necessity of informing the physician promptly if they should develop jaundice, light-colored stools, dark urine, fever, pharyngitis, or cystitis 1, ØØOO 11 In patients taking ATD, a differential white blood cell count should be obtained during febrile illness and/or pharyngitis, and liver function should be assessed in those who experience jaundice, light-colored stools, or dark urine 1, ØØOO 12 Beta-adrenergic blockade is recommended in all suitable patients with Graves’ hyperthyroidism 1, ØØØØ 13 If a patient with GD becomes hyperthyroid after completing a first course of ATD, definitive treatment with RAI or thyroidectomy is recommended. Continued long-term low-dose MMI can be considered in patients not in remission who prefer this approach 1, ØØØO 14 Treatment of SH is recommended in Graves’ patients >65 years with serum TSH levels that are persistently <0.1 mIU/L 1, ØØOO 15 ATD should be the first choice of treatment of Graves’ SH 1, ØØOO 16 A multimodality treatment approach to GD patients with thyroid storm should be used, including ATD therapy, glucocorticoid administration, beta-adrenergic blockade, cooling blankets, volume resuscitation, nutritional support, respiratory care, and monitoring in an intensive care unit 1, ØØOO 17 There are no absolute indications for RAI therapy, but it is often recommended for patients with side-effects to, or recurrence after a course of ATD 1, ØØOO 18 Verbal as well as written information on all aspects of efficacy and potential side-effects of RAI therapy should be provided 1, ØØOO 19 If ATD are used before RAI therapy they should be paused around 1 week before and after therapy in order not to decrease the efficacy of RAI 1, ØØØØ 20 No dose calculation can secure long-term euthyroidism and it is fully acceptable to offer a fixed dose of RAI 1, ØØØO 21 Pregnancy and breast feeding constitute absolute contraindications to RAI therapy 1, ØØØO 22 Conception should be postponed until at least 6 months after RAI in both males and females 1, ØØØO 23 If used in children, ablative doses aiming at rapid hypothyroidism should be administered 1, ØØOO 24 If surgery is selected, total thyroidectomy is the procedure of choice, and should be performed by a skilled surgeon with high annual volumes of thyroidectomies 1, ØØØØ 25 Euthyroidism should be restored by ATD prior to surgery to avoid peri- or postoperative exacerbation of thyrotoxicosis 1, ØØØØ 26 Vitamin D deficiency should be corrected to reduce the postoperative risk of hypocalcemia 1, ØØØØ http://guide.medlive.cn/