Endocrine Abstracts

Graves’ disease is an autoimmune thyroid disease which, untreated, carries a significant morbidity risk. Treatment options for Graves’s disease have changed over the decades.

Aims

To evaluate the outcome and risk factors for relapses of patients with Graves’s disease treated with antithyroid drugs for at least 2 years.

Methods

A retrospective, analytic study on 360 consecutive patients admitted between Jan 2011–Oct 2019 and evaluated at diagnosis, after restoring of euthyroidism and at final visit. Clinical evaluation, thyroid function tests, TRAb (TSH receptor antibodies), goiter volume were obtained.

Results

There were 296F/64M, age at diagnosis: 44.5 ± 13.78 [13–81 years], freeT4 = 41.8 ± 22.68 pmol/l (N = 12–22), 226(62.8%) with ophtalmopathy, 34 (9.4%) with atrial fibrillation, 41 (11.4%) with heart failure. After diagnosis, all received methimazol, 28.15 ± 20. 52 mg/day. Normal free T4 was obtained after 9.37 ± 16.2 months and normal TSH after 12.97 ± 17.8 months. Patients were treated by thyroid surgery (109 pts, after 51 ± 46 months), radioiodine therapy (58 pts, after 58 ± 52 months), radioiodine and surgery (n = 9 pts) and 193 pts received longterm thionamides (55.64 ± 38.5 months). 6/193 patients only medically treated were cured at final visit. 228/360 patients had relapses. Risk factors for relapses were: young age (P = 0.002) and heart failure at diagnosis (P = 0.004). Serum levels of TRAb >10 ng/ml predicted active disease at final evaluation (Sn = 61.3%, Sp = 51%, P = 0.03).

Conclusions

Patients with Graves’s disease have longer duration of antithyroid treatment before ablation, with frequent relapses. Young patients with severe disease at diagnosis (TRAb >10 ng/ml, heart failure) should receive thyroid ablation, because only 5% medically treated became cured.