Graves' disease: review of disease characteristics, burden, and treatments.

Graves' disease, the most common cause of hyperthyroidism, is a chronic autoimmune disorder that can lead to serious health problems. Treatment options for Graves' hyperthyroidism have not changed in several decades and include antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroidectomy. Few literature reviews comprehensively evaluating the burden of Graves' disease, including epidemiological, clinical, humanistic, and economic outcomes, have been published since the American Thyroid Association and European Thyroid Association treatment guidelines for Graves' disease were developed in 2016 and 2018, respectively. In this review, we evaluate the disease burden, treatment landscape, unmet needs, and research gaps among adult patients with Graves' disease. Significant clinical and humanistic burden is observed in patients with Graves' disease, including treated patients, compared to control populations. Across global survey studies, over 90% of clinicians preferred ATDs compared to RAI and thyroidectomy as the first-line treatment of Graves' disease; however, a reported 37% to 76% of patients who achieve euthyroidism with a first-line course of ATDs will subsequently relapse. Although long-term use (>2 years) of low-dose ATDs can improve relapse rates compared with conventional ATD treatment (12-18 months), a subset of patients will not achieve sufficient control of their hyperthyroidism with an initial course of ATDs and approximately one-fifth of patients will experience adverse effects with long-term ATDs. Limited evidence on the economic burden of Graves' disease was identified. Results suggest ATDs or thyroidectomy are both more cost-effective than RAI. In conclusion, patients with Graves' disease experience substantial clinical and humanistic disease burden that current treatment options do not adequately address. While this targeted literature review was guided by a protocol, qualitative evidence synthesis is limited due to its nonsystematic nature. Further evaluation based on robust, real-world evidence studies is needed to understand the long-term impact of Graves' disease and care needs throughout a patient's lifetime.