Long-term outcomes of treatment of hyperthyroidism in Ireland

Abstract

We investigated the long-term outcome of treatment in 159 patients with hyperthyroidism first seen between 1979 and 1992. Median duration of follow-up was 10 1/2 years. We also inquired into current practice for the follow-up of hyperthyroidism by other endocrinologists in Ireland. Seven cases of unrecognised hyperthyroidism (4 per cent) and one of unrecognised hypothyroidism were identified. Among patients with Graves' disease, of those treated with an antithyroid drug, 28 per cent were in remission, 68 per cent had relapsed and 4 per cent had become hypothyroid. Of those treated by sub-total thyroidectomy, 31 per cent were in remission, 19 per cent had relapsed, 19 per cent were hypothyroid and 31 per cent were sub-clinically hypothyroid. Among patients treated with radioiodine, 19 per cent were euthyroid, 3 per cent were still hyperthyroid and three-quarters had become hypothyroid. In contrast, after radioiodine for toxic nodular goitre, 63 per cent were euthyroid and only 32 per cent had become hypothyroid (Chi Squared v. Graves' disease, P = 0.001). Of 73 patients receiving thyroxine replacement, plasma TSH was normal in only 41 per cent, although 82 per cent of patients had been seen by the family doctor within the previous 12 months. Seven of 17 other endocrinologists undertook long-term follow-up of hyperthyroid patients in their specialist clinics but none was using a computerised system to co-ordinate this. The findings confirm that careful follow-up is required for all hyperthyroid patients. The family doctor is well positioned to undertake this, but education and auditing are required.

Audit of long‐term treatment outcomes of thyrotoxicosis in a single‐centre virtual clinic: The utility of long‐term antithyroid drugs

“…In our study, only a minority of patients with the nodular disease became hypothyroid, but only 2% had persistent thyrotoxicosis, supporting our longstanding recommendation for RAI when such patients relapse after ATD. This majority of patients with toxic multinodular goitre were euthyroid in the long term after RAI in line with some previous reports, 19 but not others 20 . Overall, our results confirm the effectiveness of RAI in control of thyrotoxicosis in a large majority of patients.…”

Comparative Efficacy of Four Treatments in Patients with Graves’ Disease: a Network Meta-analysis

“…In total, 13 studies were included in the narrative review, and the data of 4 studies were included in the meta-analysis; the other 9 studies were not available because of neither RCTs nor relevant outcome measures [7][8][9][10]. Of the 9 excluded studies, 5 were retrospective [11][12][13][14][15], and 4 did not report the related outcomes [16][17][18][19]. Table 1 provides a summary of the studies included in the review.…”

Primary treatment of Graves’ disease: Comparison of radioiodine and antithyroid drugs.

“…In the literature a cure is defined as euthyroidism or hypothyroidism at 12 months post treatment. RI is the more effective treatment with quoted cure rates of between 70-90% for RI and 30-50% for ATD (Leary AC et al 1999;Torring O et al 1996a;Alexander EK and Larsen PR 2002;Cooper 2003;Peters H et al 1997).…”