Can we predict relapse in Graves’ disease? Results from a systematic review and meta-analysis

Struja, Tristan; Fehlberg, Hannah; Kutz, Alexander; Guebelin, Larissa; Degen, Christian; Müeller, Beat; Schuetz, Philipp

doi:10.1530/eje-16-0725

Cited by 94 publications

(90 citation statements)

References 59 publications

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“…The article presents new information regarding patterns of disappearance of serum TRAb concentrations over time, which appear to have an impact on the probability of remission. Unlike other studies, which found useful predictors of remission in baseline clinical and laboratory tests (e.g.,7,8), the authors of this report found no baseline parameter predicting the likelihood of remission.…”

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confidence: 54%

Long-Term Antithyroid Drug Treatment of Patients With Graves’ Disease

CooperDavid

2019

Clinical Thyroidology

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Background Antithyroid drugs remain an important treatment for hyperthyroidism due to Graves' disease (1). There are two main therapeutic protocols that are used; in the first scenario, antithyroid drugs are given for 12 to 18 months, and, if serum anti-TSH receptor antibody (TRAb) levels have normalized, the drug is discontinued and patients are monitored for recurrence. If antibodies persist, however, definitive treatment with radioiodine or surgery may be recommended (2,3), although continued antithyroid drug therapy is also reasonable in patients with well-controlled mild disease (2,3). In the second scenario, antithyroid drugs are given for as long as necessary, until TRAbs disappear. This could be for years or even for a lifetime (4,5). The aim of the current study was to describe long-term outcomes in 549 adult patients with Graves' disease treated with antithyroid drugs for >8 years and to relate remission and final outcomes to patterns of serum TRAb titers (6). Methods This retrospective study included 549 patients (mean age, 36-41 years) with untreated Graves' disease seen at the

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confidence: 54%

Long-Term Antithyroid Drug Treatment of Patients With Graves’ Disease

CooperDavid

2019

Clinical Thyroidology

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“…Another meta-analysis evaluating 54 trials and 7,595 participants showed several risk factors predicting persistence (49%) in GD [74]. Orbitopathy, smoking, thyroid volume, free T4, total T3, and TSH-R-Ab were significantly associated with relapse.…”

Section: Relapse After a Course Of Atd Treatmentmentioning

confidence: 99%

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

Kahaly¹,

Bartalena²,

Hegedüs³

et al. 2018

Eur Thyroid J

654

650

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Graves’ disease (GD) is a systemic autoimmune disorder characterized by the infiltration of thyroid antigen-specific T cells into thyroid-stimulating hormone receptor (TSH-R)-expressing tissues. Stimulatory autoantibodies (Ab) in GD activate the TSH-R leading to thyroid hyperplasia and unregulated thyroid hormone production and secretion. Diagnosis of GD is straightforward in a patient with biochemically confirmed thyrotoxicosis, positive TSH-R-Ab, a hypervascular and hypoechoic thyroid gland (ultrasound), and associated orbitopathy. In GD, measurement of TSH-R-Ab is recommended for an accurate diagnosis/differential diagnosis, prior to stopping antithyroid drug (ATD) treatment and during pregnancy. Graves’ hyperthyroidism is treated by decreasing thyroid hormone synthesis with the use of ATD, or by reducing the amount of thyroid tissue with radioactive iodine (RAI) treatment or total thyroidectomy. Patients with newly diagnosed Graves’ hyperthyroidism are usually medically treated for 12–18 months with methimazole (MMI) as the preferred drug. In children with GD, a 24- to 36-month course of MMI is recommended. Patients with persistently high TSH-R-Ab at 12–18 months can continue MMI treatment, repeating the TSH-R-Ab measurement after an additional 12 months, or opt for therapy with RAI or thyroidectomy. Women treated with MMI should be switched to propylthiouracil when planning pregnancy and during the first trimester of pregnancy. If a patient relapses after completing a course of ATD, definitive treatment is recommended; however, continued long-term low-dose MMI can be considered. Thyroidectomy should be performed by an experienced high-volume thyroid surgeon. RAI is contraindicated in Graves’ patients with active/severe orbitopathy, and steroid prophylaxis is warranted in Graves’ patients with mild/active orbitopathy receiving RAI.

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“…TSI levels and the age or sex did not show significant associations with recurrence. 7) In another studies showed average age at diagnosis was significantly younger at non-remission group compared with remission group after antithyroid drug therapy for GD. 8,9) But, our data showed opposite result.…”

Section: Resultsmentioning

confidence: 93%

The Recurrence Rate of Graves' Disease among Patients with Subclinical Thyrotoxicosis after Initial Remission with Antithyroid Agents

et al. 2017

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Background and Objectives:The recurrence rate of patients with Graves' disease (GD) is estimated to be 50-55% after withdrawal of antithyroid drug therapy, and relapse is frequent in the first year after discontinuing the medication. Follow-up examination of these patients frequently reveals laboratory findings consistent with subclinical thyrotoxicosis in the first year after stopping the antithyroid agents. We investigated the risk of recurrence of GD among patients with resurfacing subclinical thyrotoxicosis state after remission of initial GD with antithyroid treatments. Materials and Methods: We reviewed the patients diagnosed with GD who visited the Department of Endocrinology at two tertiary medical centers: Wonju Severance Christian Hospital and Gangneung Asan Hospital. We enrolled patients whose GD was completely treated after initial treatment with antithyroid agents who then developed subclinical thyrotoxicosis after discontinuation of antithyroid agents. Results: We reviewed a total of 44 patients (29 females, 15 males; age, 48.93±18.04; range, 17-85 years). The recurrence rate was 27.3% (12/44 patients), and recurrence occurred 3 months to 12 months later resurfacing of subclinical thyrotoxicosis. Patients with recurred GD was significantly older than non-recurred patients (44.63±17.75 years vs. 58.58±15.48 years, p=0.02). Other clinical parameters measured at the time of initial diagnosis were not different between the two groups. Conclusion: The recurrence rate of GD in patients with resurfacing subclinical thyrotoxicosis after initial remission of the disease was less than 30%. A close monitoring is recommended in these subgroup patients, especially in older patients.

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Can we predict relapse in Graves’ disease? Results from a systematic review and meta-analysis

Abstract: This analysis found several risk factors to predict relapse in Graves' disease, which can be combined in a risk score. Prospective studies should evaluate the prognostic accuracy of such a score to guide treatment decisions.

Cited by 94 publications

References 59 publications

Long-Term Antithyroid Drug Treatment of Patients With Graves’ Disease

Long-Term Antithyroid Drug Treatment of Patients With Graves’ Disease

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

The Recurrence Rate of Graves' Disease among Patients with Subclinical Thyrotoxicosis after Initial Remission with Antithyroid Agents

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