Predicting the Risk of Recurrence Before the Start of Antithyroid Drug Therapy in Patients With Graves' Hyperthyroidism

Vos, Xander G; Endert, E.; Zwinderman, A. H.; Tijssen, Jan G.P.; Wiersinga, Wilmar M.

doi:10.1210/jc.2015-3644

Cited by 135 publications

(148 citation statements)

References 33 publications

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“…In contrast to our previous report concerning the risk of relapse after the first course of treatment (36), we observed no independent effect on long-term remission rate of age, ethnicity or serum TRAb levels at diagnosis (40). Other factors, such as sex, iodine intake, smoking and genetic background are thought to modulate individual responsiveness in adults (44,48). This study was subjected to several limitations: a relatively small number of boys were included, possibly preventing the detection of male sex as a determinant of GD relapse, a lack of serum TRAb determinations during the follow-up and a lack of information about genetic background, precluding evaluations of the association of these factors with relapse rate (37).…”

Section: Recent Findings From Studies In Childrencontrasting

confidence: 99%

“…The prolonged use of low doses of MMI/CMZ was safe in these studies (45,47) and thyroid function seemed to remain more stable in the low-dose MMI group, with subclinical and overt hypothyroidism more frequently observed in the RAI + levothyroxine group than in the MMI group (45). An individual approach based on a predictive score at the time of diagnosis for the risk of recurrence after a first 2-year course of ATD has recently been described, with genetic background also modulating individual responsiveness in adults (48).…”

Section: Recent Findings From Adult Studiesmentioning

confidence: 74%

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

Léger

Carel

2017

European Journal of Endocrinology

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Graves' disease is an autoimmune disorder. It is the leading cause of hyperthyroidism, but is rare in children. Patients are initially managed with antithyroid drugs (ATDs), such as methimazole/carbimazole. A major disadvantage of treatment with ATD is the high risk of relapse, exceeding 70% of children treated for duration of 2 years, and the potential major side effects of the drug reported in exceptional cases. The major advantage of ATD treatment is that normal homeostasis of the hypothalamus-pituitary-thyroid axis may be restored, with periods of drug treatment followed by freedom from medical intervention achieved in approximately 40-50% of cases after prolonged treatment with ATD, for several years, in recent studies. Alternative ablative treatments such as radioactive iodine and, less frequently and mostly in cases of very high volume goiters or in children under the age of 5 years, thyroidectomy, performed by pediatric surgeons with extensive experience should be proposed in cases of noncompliance, intolerance to medical treatment or relapse after prolonged medical treatment. Ablative treatments are effective against hyperthyroidism, but they require the subsequent administration of levothyroxine throughout the patient's life. This review considers

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Section: Recent Findings From Studies In Childrencontrasting

confidence: 99%

Section: Recent Findings From Adult Studiesmentioning

confidence: 74%

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

Léger

Carel

2017

European Journal of Endocrinology

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“…Orbitopathy, smoking, thyroid volume, free T4, total T3, and TSH-R-Ab were significantly associated with relapse. In a prospective study introducing the quantitative predictive "GREAT" score for GD [75], 37% of patients with a first episode of Graves' hyperthyroidism relapsed within 2 years after ATD withdrawal. Lower age, higher serum TSH-R-Ab and free T4, larger goiters at diagnosis, PTPN22 C/T polymorphism, and HLA subtypes DQB1*02, DQA1*05, and DRB1*03 were independent predictors for recurrence.…”

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

609

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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“…It is generally accepted that younger GD patients have more severe immune disorders [32]. Previous studies showed that younger GD patients have a relatively poor response to ATD and often have a poor prognosis and higher recurrence risk [5, 33, 34]. A study by Allahabadia et al found that GD patients younger than 40 years had a higher recurrence rate than older patients [34].…”

Section: Influencing Factors For the Recurrence In Gd Patientsmentioning

confidence: 99%

“…ATD treatment has many advantages, including normalizing thyroid function in a short time, hardly causing hypothyroidism, and ameliorating immune disorder while avoiding radiation exposure and invasive procedures, so it is generally well accepted by patients and clinicians [3, 4]. However, the high recurrence rate is a main limitation of ATD treatment, which varies greatly among patients with different treatment strategies, clinical characteristics, and environmental and genetic factors [2, 5–8]. In this paper, we review the current knowledge of ATD treatment and mainly focus on influencing factors for recurrence in GD patients with ATD treatment.…”

Section: Introductionmentioning

confidence: 99%

Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

Liu

et al. 2017

International Journal of Endocrinology

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Graves' disease (GD) is the most common cause of hyperthyroidism worldwide. Current therapeutic options for GD include antithyroid drugs (ATD), radioactive iodine, and thyroidectomy. ATD treatment is generally well accepted by patients and clinicians due to some advantages including normalizing thyroid function in a short time, hardly causing hypothyroidism, and ameliorating immune disorder while avoiding radiation exposure and invasive procedures. However, the relatively high recurrence rate is a major concern for ATD treatment, which is associated with multiple influencing factors like clinical characteristics, treatment strategies, and genetic and environmental factors. Of these influencing factors, some are modifiable but some are nonmodifiable. The recurrence risk can be reduced by adjusting the modifiable factors as much as possible. The titration regimen for 12–18 months is the optimal strategy of ATD. Levothyroxine administration after successful ATD treatment was not recommended. The addition of immunosuppressive drugs might be helpful to decrease the recurrence rate of GD patients after ATD withdrawal, whereas further studies are needed to address the safety and efficacy. This paper reviewed the current knowledge of ATD treatment and mainly focused on influencing factors for recurrence in GD patients with ATD treatment.

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Predicting the Risk of Recurrence Before the Start of Antithyroid Drug Therapy in Patients With Graves' Hyperthyroidism

Abstract: Genotyping increases the accuracy of a clinical score (based on pretreatment age, goiter size, FT4, TBII) for predicting recurrence of Graves' hyperthyroidism after a course of antithyroid drugs: a prospective study.

Cited by 135 publications

References 33 publications

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

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

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

Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

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