Unmasking graves

Salah Raida Ben; Siddiqa Soomauroo; Faten Hadjkacem; Abdelmuhaymen Missaoui; Auckburally Ahmad Ridwaan; Wiem Feki; Mouna Mnif; Sameh Marzouk; Mohamed Abid; Nabila Rekik; Zouheir Bahloul

doi:10.1530/endoabs.99.EP1038

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Endocrine Abstracts (2024) 99 EP1038 | DOI: 10.1530/endoabs.99.EP1038

ECE2024 Eposter Presentations Thyroid (198 abstracts)

Unmasking graves’ disease: navigating the complexities of diagnosis, treatment, and beyond

Raida Ben Salah ¹ , Siddiqa Soomauroo ² , Faten Hadjkacem ² , Abdelmuhaymen Missaoui ² , Ahmad Ridwaan Auckburally ³ , Wiem Feki ³ , Mouna Mnif ² , Sameh Marzouk ¹ , Mohamed Abid ² , Nabila Rekik ² & Zouheir Bahloul ¹

Err

Author affiliations

¹Hedi Chaker University Hospital, Department of Internal Medicine, Sfax, Tunisia; ²Hedi Chaker University Hospital, Department of Endocrinology, Sfax, Tunisia; ³Hedi Chaker University Hospital, Department of Radiology, Sfax, Tunisia

Introduction: Graves’ disease (GD), an autoimmune disorder predominantly impacting the thyroid gland, can extend its effects to various organs, such as the eyes and skin. It stands as the leading cause of hyperthyroidism. It is defined by the pathognomonic combination of thyrotoxicosis, goitre and exophthalmos. The aim of this study was to identify the characteristics of GD.

Patients and Methods: A retrospective study involving 31 patients with primary hyperthyroidism was conducted.

Results: We enrolled 29 patients with overt hyperthyroidism, among which 19 was diagnosed with GD. There were 10 men and 9 women. The mean age at diagnosis was 35.5 years. Weight loss and tremor were the most predominant symptoms noted in 64.5% and 58% of cases respectively. In all patients, we found a goitre, while exophthalmos was found in only 11 patients. The mean TSH level was 0.14 μUI/l. The mean free T4 level was 54.68 pmol/l. The TSH-receptor antibodies were positive in all cases. Dyslipidaemia, poorly controlled diabetes and anaemia were observed in 9 patients each. All patients were treated with a beta-adrenergic blocker. Corticosteroid therapy was initiated in 2 patients who had malignant Graves’ orbitopathy. Eleven patients were treated with only antithyroid drug (ATD) and 17 with radioactive-iodine treatment (RAI). RAI was used after failure of or intolerance to ATD in 9 patients and a second course of RAI was indicated in 2 patients. Only one patient had a total thyroidectomy, indicated because of resistance to ATD, poor socioeconomic conditions, association with type 1 diabetes mellitus and the patient’s young age. Neutropenia secondary to ATD, requiring discontinuation of this treatment and recourse to RAI was observed in one patient. The outcome was considered favourable in 18 patients, with clinical and biological euthyroidism and improvement of the complications caused by the hyperthyroidism itself or by its treatment. One patient died.

Conclusion: GD is a systemic condition that impacts various organs, presenting with diverse symptoms. The optimal management involves a collaborative approach by an interprofessional healthcare team. While antithyroid drugs can control symptoms, they don’t provide a cure, resulting in common relapses. Radioactive iodine is often the preferred approach to address the condition. Hyperthyroidism poses significant short and long-term health risks, emphasizing the importance of early recognition and timely intervention.