Diagnosis and Management of Graves’ Disease in Thailand: A Survey of Current Practice

Abstract

Background. The data on clinical practice patterns in the evaluation and management of Graves’ disease (GD) are limited in Asia. The aims of this survey were to report the current practices in the management of GD in Thailand and to examine any international differences in the management of GD. Methods. Members of the Endocrine Society of Thailand who were board certified in endocrinology (N = 392) were invited to participate in an electronic survey on the management of GD using the same index case and questionnaire as in previous North American and European surveys. Results. One hundred and twenty responses (30.6%) from members were included. TSH receptor antibody measurement (29.2%), thyroid ultrasound (6.7%), and isotopic studies (5.9%) were used less frequently to confirm the etiology compared with those in North American and European surveys. Treatment with an antithyroid drug (ATD) was the preferred first choice of therapy (90.8%). Methimazole at 10–15 mg/day with a beta-blocker was the initial treatment of choice. The preferred ATD in pregnancy was propylthiouracil in the first trimester and methimazole in the second and third trimesters, which was similar to the North American and European surveys. Conclusion. Ultrasound and isotopic studies will be requested only by a small proportion of Thai endocrinologists. Higher physician preference for ATD is similar to Europe, Latin America, and other Asian countries. Geographical differences in the use of ATD, radioactive iodine, and thyroidectomy exist.

Analysis of the Application Value of Ultrasound Three-Dimensional Speckle Tracking Technology Combined with Thyroid Autoantibodies and Hormones in the Diagnosis and Treatment of Graves’ Disease

“…Studies in recent decades have confirmed the close relation of the occurrence of hyperthyroidism to thyroid autoantibody stimulation of the thyroid [23][24][25][26]. TPOAb and TGAb are both destructive antibodies with their target antigens of thyroid peroxidase and thyroglobulin, respectively.…”

Incidence, treatments, and outcomes of Graves’ disease in Thailand: a single-center study

“…The rst-line treatment was an ATD of 99.7%, higher than the recent survey study of 90.8% [14] and retrospective review of 70.8% in Thailand [15]. The RAI treatment of 0.3% was lesser than 21% of the previous study.…”

“…The bene t and risk of each modality may affect each individual's life differently, therefore the shared decision between doctors and patients is likely to t the patients' preference [12,13]. A trend toward ATD in Thailand was seen in the questionnaire survey [14] and a low remission rate was seen in the retrospective review in the private hospital [15]. This study aimed to explore the treatment choices and outcomes of GD in the hospital center in the suburban area.…”

Impact of first-line treatment choice on long-term outcomes of hyperthyroid Graves’ disease patients with thyrotoxic periodic paralysis

“…Surgery is preferred in the treatment of Graves’ disease in the cases with large goiter, moderate to severe GO, inability to tolerate RAI or ATD, or Graves’ disease with suspicious nodule. In our present study, surgical treatment had been underused as a definitive treatment for hyperthyroidism from local practice preference among thyroidiologists [31] . However, this treatment option is still a viable option for patients who need to control their hyperthyroidism rapidly, patients who have huge goiters, or patients with suspected co-existing thyroid cancer [32] .…”