Survey of Clinical Practice Patterns in the Management of 992 Hyperthyroid Patients in France

Abstract

Background: Considerable variations in diagnosis and therapeutic practices are reported for hyperthyroidism (HT) between countries. Methods: A clinical study was conducted among a representative sample of 263 endocrinologists in France. All consecutive patients seen for HT during the study period were included. Diagnosis and treatment modalities were recorded from hyperthyroid patients with Graves disease (GD, n = 802), multinodular goiter (MNG, n = 121), and toxic adenoma (TA, n = 69). Results: Antithyroid antibodies were measured in half of the population (anti-TPO in 48.5% and anti-TSH receptor in 57.8%). Patients had thyroid ultrasonography and scintigraphy in 93.8 and 40.3%, respectively. Therapeutic management depended on the etiology: for the first episode of GD, antithyroid drugs (ATDs) were the first-line treatment in 91% of the patients, combined with surgery in 6.1% and with radioiodine in 2.9%. Surgery was preferred to radioiodine in MNG (52.6 vs. 22.4%) and TA (59.1 vs. 24.2%). Euthyroid status was achieved after 3 months in 64.4% of GD. A “block and replace” protocol was used in 41.2% of patients. After 3 months, 73% of patients were euthyroid in the “block and replace” group compared to 56.2% in the group with ATDs alone (p = 0.009). For MNG and TA, more than 75% of patients were euthyroid at the 3-month follow-up. Conclusions: Large discrepancies remain between clinical practice and international guidelines. These results should boost efforts to improve adherence to these guidelines.

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

“…In addition to thyroid function and TSH-R-Ab determination, most clinicians would request thyroid ultrasound (US) and less often isotope scanning [22]. In a study conducted among 263 endocrinologists in 992 hyperthyroid patients, thyroid US and scintigraphy were used in 93.8 and 40.3%, respectively [46]. Ordinarily, there is no indication for CT scan, MRI, or PET-CT of the thyroid gland.…”

Hipertiroidismo

“…1 A utilização de fármacos antitiroideus de síntese constitui um tratamento conservador, sem exposição a radiação, com risco reduzido de hipotiroidismo subsequente ao tratamento, sem efeitos adversos na oftalmopatia de Graves e que pode ser realizada com segurança durante a gravidez e o aleitamento materno. 5,12 Contudo, tem como desvantagens uma elevada taxa de recidiva, necessita de monitorização clínica frequente, está associada a efeitos adversos e os pacientes demonstram uma fraca adesão ao esquema terapêutico. 5,7 O metimazol é o fármaco antitiroideu de primeira linha, exceto durante o primeiro trimestre de gravidez.…”

Review of European Thyroid Association Guideline (2018) for the Manage-ment of Graves’ Hyperthyroidism

“…Помимо определения функции ЩЖ и АТ-рТТГ, большинство клиницистов предлагают проводить ультразвуковое исследование (УЗИ) ЩЖ и, несколько реже, сцинтиграфию. По данным опроса, в который вошли 263 эндокринолога и обсуждались 992 пациента, УЗИ было рекомендовано опрошенными в 93,8%, а сцинтиграфия -в 40,4% случаев [46]. Крайне редко возникает необходимость в проведении компьютерной томографии (КТ), магнитно-резонансной томографии (МРТ) или позитронно-эмиссионной КТ (ПЭТ-КТ).…”