American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment is considered first-line for Graves disease due to its immunomodulatory effects?

1. Radioactive iodine ablation

2. Thionamide drugs

3. Surgery

4. Beta-blockers

The correct answer is: Thionamide drugs

Thionamide drugs are considered first-line treatment for Graves' disease primarily because of their immunomodulatory effects, which address the underlying autoimmune process more effectively than other treatments. These medications, such as methimazole and propylthiouracil, work by inhibiting the enzyme thyroid peroxidase, which plays a critical role in the synthesis of thyroid hormones. By reducing the production of these hormones, thionamides help to alleviate the symptoms of hyperthyroidism and can lead to remission. The immunomodulatory properties of thionamides help in managing the excess thyroid hormone production that characterizes Graves' disease while also addressing some of the autoimmune aspects of the condition. This is particularly important because Graves' disease is an autoimmune disorder, and controlling the underlying autoimmune response can improve the long-term outcomes for patients. Other treatment options, such as radioactive iodine ablation, surgery, and beta-blockers, may play a role in the management of Graves’ disease but do not specifically act on the immune system. Radioactive iodine ablation aims to destroy thyroid tissue, effectively treating hyperthyroidism by reducing hormone production, but it does not modulate the autoimmune response. Surgery can be effective in certain cases where other treatments aren't suitable, but it is