Long-term prognosis after medical treatment of Graves' disease in a northern Swedish population 2000–2010

Abstract

Objective: To investigate the long-term prognosis of patients with Graves' disease (GD) after antithyroid drug (ATD) treatment and follow-up outside of highly specialised care. Design and methods: Medical records of all patients diagnosed with first-time GD in 2000-2010 with at least 6 months ATD treatment at a central hospital and follow-up in primary health care in the county of Norrbotten in northern Sweden were retrospectively reviewed. Patients were followed for relapse until 31st December 2012. We included 219 patients (mean age 46 years, 82.5% women) with follow-up of maximum 10 years and 829 observed patient years. Data were analysed using Kaplan-Meier estimates and log-rank test. Results: During the observation period, 43.5% of the patients had relapsed into active GD. The cumulative relapse rates were 22.6, 30.2, 36.9 and 41.5% after 6 months, 1, 3 and 5 years respectively. The presence of goitre (PZ0.014) predicted relapse. Previous smoking was protective against relapse (PZ0.003). The levels of free thyroxine or free tri-iodothyronine, age, gender, current smoking and ophthalmopathy did not predict relapse. Agranulocytosis was found in 1.7% (95% CI 0.7-4.0%). Conclusion: A long-term remission of 56.5%, in an iodine-sufficient area where ATD is offered to most patients in the real world of central and district hospitals, is higher than in most studies. Relapse was most common during the first year, and prognosis was excellent after 4 years without relapse. The protective effect of previous smoking merits further research.

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

“…Relapse occurs within 6 months of the end of drug treatment in 75% of patients, whereas only 10% of patients present a relapse more than 18 months after the end of the treatment (36,40,41). However, the definition of remission differs between studies, with patients being considered to be in remission if they display euthyroidism for a period of 0.5-2 years after the end of the ATD therapy, although most studies have reported the recurrence of hyperthyroidism after at least 1 year off ATD treatment (Table 1) …”

Treatment for Graves’ Disease and its Recurrence

“…The higher risk of recurrence in male GD patients might be associated with bigger goiter size and genetic background. However, this is still a conflicting issue since other studies have inconsistent results [20] .…”

“…Meanwhile, quitting smoking has also been demonstrated to protect against recurrence in GD patients [20] . A study showed that smokers had significant higher TRAb levels than nonsmokers at 4 weeks after ATD withdrawal [21] .…”

“…These studies suggested that enlarged goiter size at the time of GD diagnosis and drug withdrawal is associated with a higher recurrence risk. Graves' orbitopathy is present in around 30% of patients at the time of diagnosis of GD [20,28] . The presence of Graves' orbitopathy often suggested a worse disorder of the immune system.…”

Patients’ perceptions and views of surgery and radioiodine ablation in the definitive management of Graves’ disease

“…Management options are antithyroid drugs, radioiodine ablation (RIA) and surgery. Antithyroid drugs are usually first-line treatment but up to 60% relapse 2 3. In patients who relapse, options include a further course of antithyroid drugs, RIA or surgery.…”