Endocrine Abstracts

Background: Graves’ disease is the commonest cause of hyperthyroidism. Although first line and definitive treatment options are clearly defined, management practices and the natural history in terms of outcomes of treatment in a large consecutive cohort of Graves’ disease has not been well characterised.

Aims: To describe incidence, presentation, diagnosis, management strategies and medium term outcomes following anti-thyroid drug treatment, radio-iodine ablation and surgery in a consecutive cohort of patients presenting with Graves’ disease.

Methods: Retrospective cohort study of all patients (n=659) who received treatment for a new diagnosis of Graves’ disease in secondary care over a five year period. Median (IQR) follow up was 42.9 (29.0–57.5) months.

Results: Incidence of adult onset Graves’ disease was 24.8 per 100,000 per year (11.0 and 37.9 for males and females respectively). TRAb was positive in 91.7% (n=341) and TPO in 73.1% (n=236). 93.1% (n=581) achieved initial control with thionamide medication and 73.1% (n=428) achieved remission. At last follow up, 36.7% (n=157) relapsed. The risk of relapse was higher in patients who received block and replace therapy (P=0.013) versus titration, TRAb positive patients (P=0.035) and those with higher pre-treatment FT₃ (P<0.001) and FT₄ (P<0.001) levels.

Of 144 patients who had RIA treatment, 5.6% (n=8) relapsed. Of 119 patients having surgery, 5.2% (n=6) had long term hypoparathyroidism and no one had documented long term RLN palsy. Surgery was performed more often in younger, female patients with more severe disease.

Conclusions: This is the first study to report incidence of Graves’ disease in a UK population. In the short to medium term, 39.9% (n=263) of patients required surgery or RIA; both of which have little morbidity. Up to two-thirds of patients who achieved remission did not relapse. This information on effectiveness of various treatments for Graves’ disease will help clinicians and patients in decision making.