Long-term outcomes of Graves’ disease in the Thai population

Authors

  • Atchara Charoenpiriya Department of Endocrine and Metabolism Unit, Maharaj Nakhon Si Thammarat Hospital

Keywords:

Graves’ disease, hyperthyroidism, anti-thyroid drugs, radio-iodine ablation

Abstract

Abstract
Graves’ disease (GD) is the most common cause of hyperthyroidism. The approach to the investigation and treatment of GD varies widely in clinical practice. This study describes the clinical manifestations and modes of treatment of GD in Thailand. A retrospective study of all cases of GD diagnosed at the Maharaj Nakhon Si Thammarat hospital in the period between January 2011 and December 2020. A total of 646 patients were diagnosed with GD (mean age of 46 years, 67.8% female, mean age of 42 years at diagnosis, BMI 23.3 kg/m2). The mean follow-up duration was 39.9 months, 83.3% were treated with methimazole and mean maintenance period, with an antithyroid drug (ATD) was 34.6 months. The major side effects were found in 0.62% of the subjects. The remission rate at 12 months was 56.7% and had a tendency to decline to 19.3% at 108 months after ATD withdrawal. The factors related to the rate of relapse was age at diagnosis < 40 years (OR = 1.71, 95%CI = 1.06-2.76; p=0.027). The GD patients with failed initial remission after ATD were treated with a second course of ATD at 51.9%, radio-iodine ablation (RIA) at 43.3% and thyroidectomy at 4.8%. The clinical features of GD patients treated with a thyroidectomy were more severe than those treated with RIA and ATD, respectively. However, the relapse rate was lowest among patients who underwent a thyroidectomy (27.3%) and the patients who underwent RIA (29%), respectively. The approach and modality of treatment affected the remission rate and complications, so treating physicians and patients should discuss each of the treatment options and had lifelong follow-up on the disease.

Downloads

Download data is not yet available.

References

Weetman A P. Graves’ disease. N Engl J Med 2000;343:1236-48.

Brent GA. Clinical practice. Graves’ disease. N Engl J Med 2008;358:2594-605.

Benker G, Reinwein D, Kahaly G, et al. Is there a methimazole dose effect on remission rate in Graves’ disease? Results from a long-term prospective study. The European Multicentre Trial Group of the Treatment of Hyperthyroidism with Antithyroid Drugs. Clin Endocrinol (Oxf)

;49:451-7.

Hedley A J, Younget E R, Jonesal J S, et al. Antithyroid drugs in the treatment of hyperthyroidism of Graves’ disease: longterm follow-up of 434 patients. Scottish Automated Follow-Up Register Group. Clin Endocrinol (Oxf) 1989;31:209-18.

Yang J, Zhu Y J, Zhong J J, et al. Characteristics of antithyroid drug-induced agranulocytosis in patients with Hyperthyroidism: A Retrospective Analysis of 114 Cases in a Single Institution in China Involving 9690 patients referred for radioiodine treatment over 15 years.

Thyroid 2016;26:627-33.

Nakamura H, Miyauchiet A, Miyawaki N, at al. Analysis of 754 cases of antithyroid drug-induced agranulocytosis over 30 years in Japan. J Clin Endocrinol Metab 2013;98:4776-83.

Sundaresh V, Brito J P, Wang Z, et al. Comparative effectiveness of therapies for Graves’ hyperthyroidism: a systematic review and network meta-analysis. J Clin Endocrinol Metab 2013;98:3671-7.

Bergenfelz A, Brito J P, Wanget Z, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008;393:667-73.

Torring O, Watt T, Sjölinet G, et al. impaired quality of life after radioiodine therapy compared to antithyroid Drugs or Surgical Treatment for Graves’ hyperthyroidism: A long-term follow-up with the thyroidrelated patient-reported outcome questionnaire and 36-Item Short Form

Health Status Survey. Thyroid 2019;29: 322-31.

Tominaga T, Yokoyama N, Nagataki S, et al. International differences in approaches to 131I therapy for Graves’ disease: case selection and restrictions recommended to patients in Japan, Korea, and China. Thyroid 1997;7:217-20.

Mohlin E H, Nyström H F, Eliasson M. longterm prognosis after medical treatment of Graves’ disease in a northern Swedish population 2000-2010. Eur J Endocrinol 2014;170:419-27.

Diker-Cohen T, Duskin-Bitan H, Shimon I, et al. Disease Presentation and remission rate in graves disease treated with antithyroid drugs: Is gender really a factor? Endocr pract 2019;25:43-50.

Hussain Y S, Hookham J C, Allahabadiaet A, at al. Epidemiology, management and outcomes of Graves’ disease-real life data. Endocrine 2017;56:568-78.

Nystrom HF, Jansson S, Berg G. Incidence rate and clinical features of hyperthyroidism in a long-term iodine sufficient area of Sweden (Gothenburg) 2003-2005. Clin Endocrinol (Oxf) 2013;78:768-76.

Moon J H, Hee K. The diagnosis and management of hyperthyroidism in Korea: consensus report of the korean thyroid association. Endocrinol Metab (Seoul) 2013;28:275-9.

Sriphrapradang C. Diagnosis and management of Graves’ disease in Thailand: A survey of current practice. J Thyroid Res 2020;11:81.

Bartalena L, Burch H B, Burmanet K D, at el. A 2013 European survey of clinical practice patterns in the management of Graves’ disease. Clin Endocrinol (Oxf) 2016;84:115-20.

Burch H B, Burman K D, Cooper D S. A 2011 survey of clinical practice patterns in the management of Graves’ disease. J Clin Endocrinol Metab 2012;97:4549-58.

Shiroozu A, Okamura K, Ikenoue H, et al. Treatment of hyperthyroidism with a small single daily dose of methimazole. J Clin Endocrinol Metab 1986;63:125-8.

Sriussadaporn S, Pumchumpol W, Lertwattanarak R, et al. Efficacy of once daily versus divided daily administration of low daily dosage (15 mg/Day) of methimazole in the Induction of euthyroidism in Graves’ hyperthyroidism: A randomized controlled study. Int J Endocrinol 2017;2017:2619695.

Ross D S, Burch H B, Cooper D S, et al. 2016 American Thyroid Association Guidelines for Diagnosis and management of hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016;26:1343-421.

Watanabe N, Narimatsu H, Noh J Y, et al. Antithyroid drug-induced hematopoietic damage: a retrospective cohort study of agranulocytosis and pancytopenia involving 50,385 patients with Graves’ disease. J Clin Endocrinol Metab 2012;97:E49-53.

Zimmermann MB, Boelaert K. Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol 2015;3:286-95.

Klein I, Becker D V, Levey G S. Treatment of hyperthyroid disease. Ann Intern Med 1994;121:281-8.

Konishi T, Okamoto Y, Ueda M, et al. Drug discontinuation after treatment with minimum maintenance dose of an antithyroid drug in Graves’ disease: a retrospective study on effects of treatment duration with minimum maintenance dose on lasting remission. Endocr J

;58:95-100.

Shi H, Sheng R, Hu Y, et al. Risk factors for the relapse of Graves’ disease treated with antithyroid drugs: A systematic review and meta-analysis. Clin Ther 2020;42:662-75.

Anagnostis P, Adamidou F, Polyzoset S A, et al. Predictors of long-term remission in patients with Graves’ disease: a single center experience. Endocrine 2013;44: 448-53.

Park S, Song E, Ohet H S, et al. When should antithyroid drug therapy to reduce the relapse rate of hyperthyroidism in Graves’ disease be discontinued? Endocrine 2019;65:348-56.

Slingerland D W, Burrows B A. Long-term antithyroid treatment in hyperthyroidism. JAMA 1979;242:2408-10.

Azizi F, Ataie L, Hedayatiet M, et al. Effect of long-term continuous methimazole treatment of hyperthyroidism: comparison with radioiodine. Eur J Endocrinol 2005;152:695-701.

Villagelin D, Romaldini J H, Santoset R B, et al. Outcomes in relapsed Graves’ disease patients following radioiodine or rolonged low dose of methimazole treatment. Thyroid 2015;25:1282-90.

Downloads

Published

2022-08-31

Issue

Section

Original Article (บทความวิจัย)