Monitoring

After management of hyperthyroidism with surgery or radioactive iodine, monitor replacement thyroxine therapy with serum thyroid-stimulating hormone (TSH) at 6-week intervals until stable, then with serum TSH at least annually. Measurement of free T4 is a much less sensitive parameter of the thyroid metabolic state. However, when pituitary TSH production is suppressed by a previously prolonged state of thyrotoxicity due to presence of high TSH receptor antibody levels, it may take some months for serum TSH levels to recover; during that interval, measurement of serum TSH may be misleading, and free T4 may provide a better indication of thyroid status.

After management of hyperthyroidism with antithyroid drug therapy, similar monitoring is indicated to determine maintenance antithyroid drug dosing and to detect relapse.[48][49]​ The duration of antithyroid drug therapy is around 12-18 months.[48][49]​ Measuring TSH receptor antibody levels prior to stopping antithyroid drug therapy is recommended, as patients with normal TSH receptor antibody levels have higher chance of remission.[48][49]

Patients with moderate-to-severe and sight-threatening orbitopathy need follow-up by a specialist multidisciplinary team consisting of an ophthalmologist and endocrinologist.[118]

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