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Endocrine Abstracts (2023) 92 PS2-15-09 | DOI: 10.1530/endoabs.92.PS2-15-09

ETA2023 Poster Presentations Hyperthyroidism (9 abstracts)

Long-term follow-up after antithyroid drug treatment withdrawal in patients with the first episode of graves` disease: a retrospective cohort study in spain

Diego Meneses , Begoña Sánchez Lechuga , María Vélez Romero , Roberto Sierra Poyatos , Clotilde Vázquez Martínez & Jersy Cárdenas Salas


Hospital Universitario Fundación Jiménez Díaz, Endocrinology, Madrid, Spain


Background: Despite a high relapse rate, antithyroid drugs (ATDs) remain the first-line therapy of Graves’ disease (GD). Long-term follow-up studies of GD in Spain are scarce. Our aims were to identify clinical differences between patients who relapsed vs those who attained remission and to describe the relapse rate of GD after ATD withdrawal.

Methods: We analyzed patients with the first episode of GD who were treated with ATDs during 2010 - 2020, in a third-level hospital in Madrid, Spain. Relapse was defined as overt clinical and biochemical hyperthyroidism after the withdrawal of ATDs. Categorical and continuous variables were analyzed by chi-squared test and independent samples t-test. ROC analyses were used to determine relapse cutoff values for each of the quantitative variables. The cumulative risk of relapse during follow-up was estimated using the Kaplan–Meier approach.

RemissionRelapse
Numbers168 105
Male sex, n (%)32 (11.7)25 (14.5)7 (6.7)0.040*
Age at diagnosis, years46.1 (36.4 – 53.9)45.6 (36.4 – 51.9)46.8 (36.9 – 56.4)0.379
Thyroid volume, mL13.6 (8.8 – 19.5)13.6 (8.8 – 19.7)13.2 (8.8 – 18.9)0.709
fT4, ng/dL2.47 (1.83 – 3.46)2.45 (1.72 – 3.64)2.5 (1.9 – 3.2)0.501
fT3, pg/mL6.75 (4.77 – 10.57)6.76 (4.54 – 10.52)6.48 (5.1 – 10.7)0.707
TRAb, U/l5.60 (3.16 – 11.3)4.97 (3.08 – 10.21)6.6 (3.61 – 12.9)0.393
Graves’ orbitopathy, No. (%)37 (13.7)16 (9.7)21 (20)0.016*
Smoking, No. (%)44 (18.7)26 (17.8)18 (20.7)0.035*
Treatment duration, months18.4 (14.6 – 22.9)17.9 (13 – 21.8)19.4 (16.8 – 23.5)0.043*

Results: During a median follow-up time of 4.2 years (1.2 – 6.8), 105 (38.5%) patients experienced a relapse. Fifty-four (51.4%) relapses occurred during the 1st year, 20 (19%) during the 2nd, 11 (10.5%) during the 3rd, 9 (8.6%) during the 4th and the remaining 11 (10.5%) during the following 6 years. The majority of relapses occurred during the first and second year, 0.0172 relapses per patient-month and 0.0074 relapses per patient-month, respectively. Cutoff values to predict relapse were fT4 ≥2.5 ng/dl, fT3 ≥5.07 pg/ml, TRAb ≥ 6.33 U/l, age ≥ 50.1 years and a thyroid volume of ≥ 27.7ml for males and ≥ 12.2 for females.

Conclusions: In our population, female sex, Graves` orbitopathy and smoking were associated with relapse of GD. The majority of relapses occurred during the first 2 years but maintained a considerable rate until the 4th year after ATD withdrawal.

Volume 92

45th Annual Meeting of the European Thyroid Association (ETA) 2023

European Thyroid Association 

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