Surgical Intervention for Medically Refractory Hyperthyroidism

Knollman, Philip D; Giese, Ann; Bhayani, Mihir K.

doi:10.3928/00904481-20160411-01

Cited by 2 publications

(4 citation statements)

References 12 publications

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“…As a first-line treatment for patients with GD, MMI, a representative drug of ATD, can not only alleviate clinical symptoms of GD but also significantly improve thyroid function. However, there was still evidence of relapse in patients with GD after ATD withdrawal ( 11 – 13 , 21 ) and during drug reduction ( 17 – 20 ). Previous studies mainly considered age (<40 years), gender, smoking history, FT3/FT4 ratio at withdrawal, goiter degree, TRAb titer, TSH level (at withdrawal) and duration of treatment were closely associated with relapse after ATD withdrawal ( 2 , 13 , 22 – 24 ), while there were barely evidence suggested that relapse risk factors during drug reduction.…”

Section: Discussionmentioning

confidence: 99%

“…Enrolled GD patients were divided into two groups: Drug reduction relapse group ( n = 88): During ATD treatment, patients with GD were cured or the clinical symptoms were relieved. While after FT3, FT4, and TSH returned to normal levels, the situation of increased FT3 and FT4 appeared again ( 17 – 20 ). Drug reduction remission group ( n = 137): During ATD treatment, the clinical symptoms were relieved, and FT3, FT4, and TSH returned to normal levels ( 18 – 20 ).…”

Section: Methodsmentioning

confidence: 99%

“…While after FT3, FT4, and TSH returned to normal levels, the situation of increased FT3 and FT4 appeared again ( 17 – 20 ). Drug reduction remission group ( n = 137): During ATD treatment, the clinical symptoms were relieved, and FT3, FT4, and TSH returned to normal levels ( 18 – 20 ). Normal ranges of hormones: FT3 (range 2.43–6.01 pmol/L), FT4 (range 9.01–19.50 pmol/L), TSH (range 0.35–4.94 uIU/mL), TRAb (range 0–1.5IU/L).…”

Section: Methodsmentioning

confidence: 99%

“…According to the current guidelines ( 3 , 15 , 16 ), it is recommended to decrease the dose to 2.5–10 mg/d or 100–150 mg/d after starting with a higher dose of Methimazole (MMI) (10–20 mg/d) or Propylthiouracil (PTU) (150–300 mg/d) after thyroid function returns to normal. However, some studies have shown that certain patients with GD relapsed during drug reduction ( 17 – 20 ). Hence, in order to achieve individualized treatment for patients with GD, it is necessary to study the independent risk factors of relapse in those with drug reduction.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between atherosclerotic disease and relapse during ATD treatment

Zhu

Zhang²,

Zhao³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundClinical relapse is a potential risk for traditional antithyroid drug (ATD) treatment in hyperthyroid patients. Evidence suggests that atherosclerotic disease is closely associated with hyperthyroidism, while the relationship between atherosclerosis and relapse remains unclear.MethodsTwo hundred and twenty-five patients with GD who underwent ATD as their first treatment were studied; 88 and 137 patients were categorized as drug reduction relapse and drug reduction remission, respectively. Logistic regression was used to analyze risk factors of drug reduction relapse in patients with GD.ResultsDuring a median of 48 months followed up 88 patients who relapsed. According to multivariate analyses, atherosclerosis related diseases, FT4, goiter, and anxiety rating scores are independent risk factors for drug reduction. According to K-M survival analysis, patients with atherosclerosis related diseases, FT4 > 18.82 pmol/L, anxiety rating scores > 23, and gradation of goiter ≥ Grade II had a higher risk of relapse than those with lower levels. ROC analysis shown atherosclerosis related diseases significantly improved the predictive accuracy of relapse.ConclusionsAtherosclerotic disease is closely related to the relapse of hyperthyroidism, ATD treatment in hyperthyroid patients with atherosclerosis should be given more attention.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The relationship between atherosclerotic disease and relapse during ATD treatment

Zhu

Zhang²,

Zhao³

et al. 2022

Front. Cardiovasc. Med.

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Enhanced predictive validity of integrative models for refractory hyperthyroidism considering baseline and early therapy characteristics: a prospective cohort study

Wang,

Li,

et al. 2024

J Transl Med

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Background A subset of Graves’ disease (GD) patients develops refractory hyperthyroidism, posing challenges in treatment decisions. The predictive value of baseline characteristics and early therapy indicators in identifying high risk individuals is an area worth exploration. Methods A prospective cohort study (2018–2022) involved 597 newly diagnosed adult GD patients undergoing methimazole (MMI) treatment. Baseline characteristics and 3-month therapy parameters were utilized to develop predictive models for refractory GD, considering antithyroid drug (ATD) dosage regimens. Results Among 346 patients analyzed, 49.7% developed ATD-refractory GD, marked by recurrence and sustained Thyrotropin Receptor Antibody (TRAb) positivity. Key baseline factors, including younger age, Graves’ ophthalmopathy (GO), larger goiter size, and higher initial free triiodothyronine (fT3), free thyroxine (fT4), and TRAb levels, were all significantly associated with an increased risk of refractory GD, forming the baseline predictive model (Model A). Subsequent analysis based on MMI cumulative dosage at 3 months resulted in two subgroups: a high cumulative dosage group (average ≥ 20 mg/day) and a medium–low cumulative dosage group (average < 20 mg/day). Absolute values, percentage changes, and cumulative values of thyroid function and autoantibodies at 3 months were analyzed. Two combined predictive models, Model B (high cumulative dosage) and Model C (medium–low cumulative dosage), were developed based on stepwise regression and multivariate analysis, incorporating additional 3-month parameters beyond the baseline. In both groups, these combined models outperformed the baseline model in terms of discriminative ability (measured by AUC), concordance with actual outcomes (66.2% comprehensive improvement), and risk classification accuracy (especially for Class I and II patients with baseline predictive risk < 71%). The reliability of the above models was confirmed through additional analysis using random forests. This study also explored ATD dosage regimens, revealing differences in refractory outcomes between predicted risk groups. However, adjusting MMI dosage after early risk assessment did not conclusively improve the prognosis of refractory GD. Conclusion Integrating baseline and early therapy characteristics enhances the predictive capability for refractory GD outcomes. The study provides valuable insights into refining risk assessment and guiding personalized treatment decisions for GD patients.

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Surgical Intervention for Medically Refractory Hyperthyroidism

Cited by 2 publications

References 12 publications

The relationship between atherosclerotic disease and relapse during ATD treatment

The relationship between atherosclerotic disease and relapse during ATD treatment

Enhanced predictive validity of integrative models for refractory hyperthyroidism considering baseline and early therapy characteristics: a prospective cohort study

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