Treatment of Graves' Disease in Israel

Professor Naftali Stern

Endocrinologist

Graves' disease is one of the most common autoimmune diseases of the thyroid gland, requiring precise diagnosis and appropriate therapy selection. Treatment of Graves' disease in Israel is organized in such a way that the patient can undergo examination, receive consultations from specialized professionals, and start individually tailored therapy as quickly as possible. Israeli clinics offer modern methods for controlling thyrotoxicosis – from precision medication therapy to radioactive iodine treatment and gentle surgical interventions. This comprehensive approach allows for effective stabilization of hormonal levels, prevention of complications, and achieving sustained remission even in complex cases.

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of patients choose an online consultation with an Israeli expert even before arriving at the clinic

>30%

of patients received innovative treatments unavailable in local clinics

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- hour support in Russian

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Table of Contents

Treatment Methods

Diagnosis

Prices

Endocrinologists have extensive experience in treating thyroid diseases, enhancing their qualifications by regularly undergoing internships at the largest endocrinological centers in the world. Reviews highlight the comfortable treatment process in Israel, patient support at all stages, and detailed recommendations for further monitoring. Additionally, the cost of medical services is lower compared to other countries with high levels of healthcare, making Israel one of the preferred destinations for treating endocrine disorders.

About the Disease

Graves' disease, or diffuse toxic goiter, is a chronic autoimmune disease that leads to excessive production of thyroid hormones. The disease develops with the production of a specific autoimmune antibody that attaches to healthy thyroid cells, resulting in excessive hormone production.

Risk factors include:

• having Graves' disease in close relatives;
• other autoimmune diseases (type 1 diabetes, pernicious anemia);
• estrogen as the primary sex hormone;
• selenium and vitamin D deficiency;
• smoking.

The clinical signs of Graves' disease typically develop gradually. The main symptoms of the disease include:

• rapid heartbeat (tachycardia);
• tremor;
• shortness of breath;
• heat intolerance and excessive sweating;
• irritability, aggressiveness;
• insomnia;
• exophthalmos (bulging eyes);
• enlargement of the thyroid gland (goiter);
• weight loss;
• diarrhea;
• exophthalmos (bulging eyes);
• thin, warm, and moist skin;
• hair loss.

With timely diagnosis and proper treatment, the prognosis is generally favorable.

Treatment Methods for the Disease

At the Ichilov Clinic, the choice of treatment method for Graves' disease (conservative treatment with thionamides, radioiodine therapy, or surgical intervention) is made individually, based on the results of comprehensive diagnostics, the severity and course of the disease, as well as the presence of concomitant factors.

Medication Therapy

Medication treatment is a key method for controlling Graves' disease, especially in the early stages and in cases of moderate thyrotoxicosis. The basis of therapy is thionamides (for example, methimazole), which suppress the synthesis of thyroid hormones – triiodothyronine (T3) and thyroxine (T4). Treatment begins with high doses and, after achieving stable normal levels, transitions to a maintenance regimen. The entire course usually takes 1-1.5 years and requires regular monitoring of hormone levels and thyroid ultrasound. Additionally, beta-blockers are prescribed to alleviate symptoms of thyrotoxicosis, such as tachycardia and tremor, often used before the onset of thionamide action. In cases of acute inflammation or ophthalmopathy, short courses of glucocorticoids may be prescribed, and calcium and vitamin D levels are adjusted as necessary. Medication treatment is considered the first stage, which can lead to sustained remission or serve as preparation for radical methods (e.g., radioiodine therapy).

Radioiodine Therapy

In cases where it is necessary to eliminate thyroid hyperfunction without open surgery, radioactive iodine therapy remains one of the main radical methods for adult patients. At the Ichilov Clinic, the technique is applied considering concomitant factors: the size and structure of the gland, the state of ophthalmopathy, and the expected post-therapeutic effect (hypothyroidism is often diagnosed after radioiodine therapy, which is corrected with replacement hormone therapy). Before the procedure, thorough visualization and preparation are conducted, and after the administration of radioactive iodine, patients are monitored for an extended period. The appointment of radioiodine therapy is discussed separately in the presence of pronounced ophthalmopathy, as this treatment may lead to a temporary exacerbation of eye pathology.

Surgical Treatment

In cases of significant goiter size, ineffectiveness of conservative therapy, or suspicion of malignant degeneration, the question of surgical removal of part or all of the thyroid gland (thyroidectomy) is considered. At the Ichilov Clinic, surgeries are performed by experienced endocrine surgeons using methods that minimize the risk of complications. These methods include neuromonitoring of the recurrent laryngeal nerve, precise hemostasis, and the use of gentle surgical techniques that help reduce the risk of hypoparathyroidism. After surgery, levothyroxine replacement therapy and monitoring of calcium metabolism are prescribed. In some cases, one-stage reconstruction is performed. The surgery provides a rapid effect; however, the decision to perform it is made after a collegial discussion of the risks and expectations.

Treatment of Ophthalmopathy

Ophthalmopathy occurring with Graves' disease requires separate treatment. In the early stage, conservative immunomodulation is performed – intravenous administration of high doses of corticosteroids, as well as local support. For patients with moderate to severe ophthalmopathy, targeted therapy is effective. In cases of progressive pathology or ineffectiveness of medication therapy, orbital radiation and/or reconstructive surgeries (including orbital decompression) are performed in multidisciplinary departments. At the Ichilov Clinic, endocrinologists work together with ophthalmologists to develop a treatment plan focused on preserving vision and reducing progression.

Symptomatic Therapy

At the Ichilov Clinic, significant attention is paid to symptomatic treatment. For rapid control of tachycardia and tremor, β-blockers are used, and the comprehensive therapy includes correction of mineral and vitamin deficiencies, proper dietary nutrition, and treatment of concomitant diseases. In severe cases, palliative care is aimed at alleviating painful symptoms, stabilizing the condition, and maintaining vital functions.

Follow-up Monitoring and Multidisciplinary Support

After treatment, patients require long-term monitoring. Regular control of thyroid function, adjustment of replacement therapy, and monitoring the risk of recurrence are necessary. Israeli clinics practice coordinated monitoring with a pre-established schedule of visits to the endocrinologist and tests, which is important for the early diagnosis of complications and adjustment of ongoing treatment.

Diagnostic Methods for the Disease

At the Ichilov Clinic, the high qualifications of specialists and modern diagnostic equipment and techniques allow for an accurate diagnosis and development of a treatment plan, on average, within three days.

First Day

Upon arrival at the clinic, the patient undergoes a primary consultation with the attending endocrinologist. During the appointment, the doctor listens to complaints, conducts a superficial examination, and prescribes necessary tests.

Second Day

Undergoing examinations:

• determination of thyroid hormone and thyroid-stimulating hormone (TSH) levels in the patient's blood;
• immunoassay to detect autoimmune antibodies to thyroid cells in the blood;
• thyroid ultrasound;
• thyroid scintigraphy (if necessary – differentiation from thyroiditis);
• thyroid Doppler ultrasound;
• ECG;
• Complete blood count and biochemical blood tests.

Third Day

The obtained examination results are forwarded to the medical council. After evaluating the data, the doctors make a final diagnosis and develop a treatment program.

Diagnostic Procedures

How Much Does Treatment Cost

Advantages of Treatment in Israel

• High qualifications of doctors.
• Clinics equipped with modern medical equipment.
• Use of advanced treatment methods.
• Individual approach.
• Affordable prices.

By contacting the clinic consultant, you can order an online consultation with an Israeli doctor from home. The specialist will answer all your questions, evaluate the provided documentation in advance, and recommend further therapy.