Long-Term Outcome of Hyperthyroidism Treated with Antithyroid Drugs

Hershman, Jerome M.; Givens, James R.; Cassidy, Carl E.; Astwood, E. B.

doi:10.1210/jcem-26-8-803

Cited by 112 publications

(46 citation statements)

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“…Conservative therapy with ATD is the first choice treatment in Europe and it is proven to be effective in achieving euthyroidism in Graves' patients [3], even if long-term remission after therapy withdrawal is unsatisfying with relapse rates of 30-50% [9,[16][17][18][19][20]. However, if the great rate of relapse(s) may be related to TRAb levels and/or other parameters, such as gender, age, fT4 levels or goiter size is still controversial [13,14,[20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Thyrotropin Receptor Antibodies (TRAb) in Graves' Disease: A 120 Months Prospective Study

et al. 2007

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Abstract. In most trials, at least 30-60% of patients with Graves' disease treated with antithyroid drugs relapse within 2 years after therapy withdrawal. At present, there are no prognostic parameters available early in treatment to indicate patients likely to achieve long-term remission. Because thyrotropin receptor autoantibodies (TRAb) are specific for Graves' disease, we evaluated the ability of their levels and of their rate of change to predict long-term prognosis. In our study 216 consecutive patients with newly diagnosed Graves' disease started a therapy with methimazole. Patients were treated until they achieved euthyroidism and TRAb were measured at 6-month intervals throughout a follow up of 120 months. Our study demonstrated that at the onset of hyperthyroidism patients' age, sex, fT4 levels and goiter size had no prognostic value in predicting long-term prognosis (respectively p = 0.79; p = 0.98; p = 0.83; p = 0.89). On the contrary, at the time of diagnosis TRAb titer was a good predictor of the final outcome (p<0.001); a titer equal to (or) more than 46.5 UI/L could identify patients who had never achieved long-term remission with a sensitivity of 52% and a specificity of 78%. Also fall rate of TRAb at 6 months of follow up and after therapy withdrawal were useful to predict the final outcome (p<0.001). At 6 months of follow up the time of therapy withdrawal, a decrease of TRAb lower than 52.3% or even its increase could identify patients who had never achieved permanent remission with a sensitivity of 55% and a specificity of 79.1%. No single parameter among TRAb, satisfactory identified a sub-set of patients who achieved long remission. Accordingly to our data, the best result in predicting long term remission is probably given by the presence of at least one of the two features evaluated at 6 months (TRAb titer and/or percentage of TRAb fall rate), with a sensitivity of 63% and specificity of 88%. TRAb titers evaluated both at the onset of hyperthyroidism that at 6 months of therapy or their rate of fall at 6 months and at ATD withdrawal are predictors of outcome. However, the presence of at least one, between titers of TRAb or their rate of fall at six months, resulted to be the best predictor of remission with the higher sensitivity and specificity.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Thyrotropin Receptor Antibodies (TRAb) in Graves' Disease: A 120 Months Prospective Study

et al. 2007

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“…While such comorbidity is rare [3][4][5][6], a similar case has been reported by Paschke et al, in whom Graves' disease that had been in remission for 5 years suffered a relapse following development of pheochromocytoma [6]. The relapse of Graves' disease occurs at any time in life, but the majority does so within the first two years after discontinuation of antithyroid treatment [7,8]. The incidence of relapse that occurs more than 20 years after withdrawal of antithyroid drugs is quite low.…”

Section: Discussionmentioning

confidence: 73%

“…b-Blocking agents are useful in the management of thyrotoxicosis [7,19]. Several reports showed spontaneous remission of Graves' disease during the treatment with propranolol, a non-selective b-antagonist [24,25].…”

Section: Discussionmentioning

confidence: 99%

Relapse of Graves' Disease in a Patient with Pheochromocytoma

et al. 2003

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Abstract. We describe a patient with right adrenal tumor detected incidentally. The tumor was diagnosed as pheochromocytoma by endocrinological and radiological studies, and was removed surgically. Graves' disease, which had been in remission for more than two decades after discontinuation of antithyroid drug treatment, relapsed during preoperative evaluation of pheochromocytoma when the patient was treated with a-and b 1 -adrenergic antagonists. Administration of methimazole resulted in a rapid improvement of thyroid function and the patient remained euthyroid on small doses of methimazole. This case may suggest possible involvement of excessive catecholamine secretion and b 2 -adrenergic receptor activation by pheochromocytoma in the relapse of Graves' disease.

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“…O volume do bócio pode refletir a resposta funcional da estimulação do receptor do TSH e tem sido referido em vários estudos como sendo preditor da recidiva (11,12,18,19,(21)(22)(23)(24). Vitti e cols.…”

Section: Discussionunclassified

Impacto médico-social do tratamento medicamentoso da moléstia de Graves-Basedow em Hospital Público Universitário: avaliação retrospectiva e projeção prospectiva de conduta terapêutica

Lima

Knobel

Camargo

et al. 2005

Arq Bras Endocrinol Metab

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RESUMOO objetivo do presente estudo foi avaliar esquema terapêutico medicamentoso para aumentar a aderência ao tratamento da moléstia de Graves-Basedow (MGB) em Hospital Público Universitário. Os pacientes foram selecionados segundo critérios rigorosos, que incluíam volume glandular inferior a 60cm 3 , origem da área urbana de São Paulo e não submetidos a terapia prévia da MGB. Receberam gratuitamente a medicação, eram avisados antecipadamente da data da consulta e acompanhados por um único médico durante todo o tratamento. Foram incluídos 229 pacientes, tratados inicialmente com metimazol (MMI -60mg/dia) em dose única diária, seguindo-se com combinação de MMI (20mg) com LT4 (100µg) em dose única diária por 24 meses. Apenas 83 pacientes (36,2%) completaram o protocolo quando foram subdivididos em 2 grupos, após a suspensão do MMI+LT4: Grupo 1 (n= 34), que permaneceram em remissão por 3 anos, e Grupo 2 (n= 49), que apresentaram recidiva da doença entre 2 e 36 meses. Os fatores preditivos associados à remissão foram: decréscimo do volume glandular, tireoglobulina sérica < 40ng/ml e valores séricos normais de anticorpos anti-receptor de TSH. Constatamos que apesar do planejamento cuidadoso, mais de 60% dos portadores de MGB não completaram o protocolo e foram encaminhados a tratamento com radioiodo. Admitimos que esse baixo êxito terapêutico poderia ser melhorado mediante identificação dos fatores capazes de indicar quais pacientes estariam propensos a seguir um tratamento de longa duração. The aim of the present study was to evaluate a new proposal for increasing compliance to the clinical management of patients with Graves' disease (GD) in a large and public University Hospital. The patients were carefully selected (no previous GD treatment, goiter volume less than 6mL must be living in the metro area of São Paulo), received medication at no cost, were contacted frequently by the social worker and alerted for the date of consultation and only referred to a single endocrinologist during all phases of treatment. We recruited 229 patients with GD that were initially treated with methimazole (MMI -60mg q.d) in a single daily dose followed by a combination of MMI (20mg) plus L-T4 (100µg) daily for 24 months. Only 83 patients (36.2%) completed the protocol and were subdivided in: Group 1 (n= 34) that were in remission for 3 years after discontinuation of the MMI and Group 2 (n= 49) that presented recurrence of GD between 2 and 36 months without MMI. Predictive factors associated with remission were: perspectivas

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Long-Term Outcome of Hyperthyroidism Treated with Antithyroid Drugs

Cited by 112 publications

References 0 publications

Prognostic Value of Thyrotropin Receptor Antibodies (TRAb) in Graves' Disease: A 120 Months Prospective Study

Prognostic Value of Thyrotropin Receptor Antibodies (TRAb) in Graves' Disease: A 120 Months Prospective Study

Relapse of Graves' Disease in a Patient with Pheochromocytoma

Impacto médico-social do tratamento medicamentoso da moléstia de Graves-Basedow em Hospital Público Universitário: avaliação retrospectiva e projeção prospectiva de conduta terapêutica

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