Long-term outcomes of Graves’ disease in the Thai population
Keywords:Graves’ disease, hyperthyroidism, anti-thyroid drugs, radio-iodine ablation
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.
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