Indications are given in box 5. The aims of treatment are to relieve the symptoms, to suppress the process of the disease, to restore muscle motility, and to improve cosmetic appearance. Fortunately, most cases are mild and require simple measures, but in some, the disease may be severe and require the collaboration of an ophthalmologist. The different aspects of the management are summarised in box 6. Patients tend to be older than those with Graves' disease, however, and because of this, cardiovascular features such as atrial fibrillation or cardiac failure tend to predominate.
Treatment is usually with radioiodine treatment or thyroid surgery.
Most patients are female and aged over 40 years. The diagnosis is confirmed by its characteristic findings on thyroid isotope scanning as described earlier. Both radioiodine or surgical lobectomy are effective treatments. It is an inflammation of the thyroid gland induced by viruses such as Coxsackie or enteroviruses. The diagnosis is confirmed by a raised white cell count and erythrocyte sedimentation rate, and low radioisotope uptake by the gland.