Endocrine Abstracts

Aims: A study looking at the incidence, presentation, diagnosis, management strategies and outcomes following anti-thyroid drug treatment and radio-iodine therapy in a cohort of patients presenting with hyperthyroidism.

Methods: Retrospective longitudinal study of all patients (n=442) who received treatment for a new diagnosis of hyperthyroidism (Grave’s disease (GD), multinodular goitre (MNG), Toxic nodule) in a secondary care outpatient setting over a 15 year period (2002-17). All patients are initially treated with thionamides for at least a 6 month period, and up to 2 years until a biochemical remission (TSH level within the normal range) is observed for at least 6 months after cessation of drug treatment. A second course of treatment is offered to patients in cases of relapse, but treatment is individualised depending on personal circumstance, aetiology and patient preference.

Results: 442 patients were treated with thionamides between 2002 and 2017. Mean duration of treatment was 295 days (range min-max). The age of diagnosis ranges between 17 and 91 years (mean 52.6±17.1 years) with female (74.4%) to male (25.6%) ratio of 3:1. 78.5% (n=347) of subjects had Graves disease, 8.4% (n=37) had multinodular goitre (MNG), 6.6% (n=29) had amiodarone induced thyrotoxicosis and n=16 (6%) had toxic nodule. A biochemical cure on drug treatment was achieved in 161 patients (37%), and of these 93% (n=150) had Graves, 4.4% (N=7) had multinodular goitre 2.5% (n=4) had thyroid nodule. In 122 patients who received radioiodine, 70% (n=85) had Graves disease, 15% (n=18) had multinodular goitre, 13% (n=16) had toxic nodule, 2% (n=3) were of indeterminate aetiology. In 18 patients who received a 2nd dose of radioiodine, 67% (n=12) had Graves disease, 11% (n=2) had multinodular goitre, and 22% (n=4) had toxic nodule. 50% (n=61) patients developed permanent hypothyroidism within 6 months of radioiodine therapy. Of these 65% (n=56) had Graves disease, 22% (n=4) patients had MNG and 25% (n=1) had toxic nodule. In 8 patients who underwent a thyroidectomy, 6 had Graves’ disease and 2 had amiodarone induced thyrotoxicosis.

Conclusions: This is the first study to report characteristics of patients with hyperthyroidism in a UK population managed in the outpatient setting. Although the data may be limited by some incomplete records commonly encountered in retrospective series, we present some interesting findings showing the likely clinical response rates to various established treatment modalities used.