The incidence of recurrence and hypothyroidism following treatment with antithyroid drugs, surgery or radioiodine in all patients with thyrotoxicosis in Malmö during the period 1970–1974

Berglund, J; Christensen, Svend Borup; Dymling, John‐Fredrik; Hallengren, Bengt

doi:10.1111/j.1365-2796.1991.tb00371.x

Cited by 54 publications

(22 citation statements)

References 36 publications

(3 reference statements)

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“…Swedish studies from the 1970s and 1980s report somewhat higher relapse rates than our study (7,20) even though definite ablative methods were used more frequently, and that would supposedly lead to fewer and more easily ATD-treated patients at that time. However, TRAb methods are more sensitive today (26), probably affecting the number of patients diagnosed with GD by such assays, as used in 2004 in our study, and may have a better prognosis with ATD.…”

Section: Discussioncontrasting

confidence: 44%

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

Mohlin

Nyström

Eliasson

2014

European Journal of Endocrinology

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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.

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Section: Discussioncontrasting

confidence: 44%

“…Only a few small observational studies from the 1970s and 1980s have reported on the prognosis after ATD treatment in Sweden, and only a minority of the eligible patients had been treated with ATDs (7,19,20). The cumulative relapse rates were 44-53%.…”

Section: Introductionmentioning

confidence: 99%

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

Mohlin

Nyström

Eliasson

2014

European Journal of Endocrinology

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“…The frequency of hypothyroidism varies from 0% to 36% in different surveys (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The main factors that have been associated with occurrence of hypothyroidism after 131I therapy in patients with solitary autonomous thy-roid nodules are: nonsuppressed serum TSH, 131I uptake in the paranodular tissue, thyroid autoantibodies, and the size of 131I dose.…”

Section: Discussionmentioning

confidence: 99%

“…In previous investigations of the effect of 131I treatment on autonomous solitary thyroid nodules, only a minority received antithyroid medication prior to 131I therapy (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The aim of this study was to investigate changes in the thyroid 99mTc-pertechnetate scintigram related to normalization of serum TSH with antithyroid drugs before and after subsequent 131I therapy.…”

Section: Introductionmentioning

confidence: 99%

Changes in the Thyroid Technetium-99m Scintigram after Antithyroid and Subsequent Radioiodine Treatment for Solitary Autonomous Nodules

Nygaard

1998

Thyroid

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In patients with solitary autonomous thyroid nodules, the treatment of choice is radioiodine (131I) therapy, eventually preceded by antithyroid drugs to avoid aggravation of hyperthyroidism. The aim of this study was to evaluate the scintigraphical results of 131I treatment when using antithyroid pretreatment. Twenty-four patients having a solitary autonomous thyroid nodule were studied. A technetium-99m (99mTc) pertechnetate scintigraphy was performed at the time of diagnosis, when serum thyrotropin (TSH) had been normal for about 3 months on antithyroid drug treatment, and finally when serum TSH was normalized after 131I treatment. The primary scintigram showed suppression of 99mTc pertechnetate in the paranodular thyroid tissue in all patients. The second scintigram showed normal uptake in the paranodular tissue in 22 patients and a continuing suppression of the paranodular tissue in 2 patients. The third scintigram showed a solitary adenoma in 14 patients with none or almost no uptake in the paranodular tissue, resembling the first scintigram. In 6 patients an adenoma was still present, but uptake was seen in the paranodular tissue; in 3 patients a homogenous uptake without any sign of the previous nodule, and in 1 patient very low uptake in the gland was seen. Four patients developed hypothyroidism in the follow-up period of approximately 1 year. Pretreatment with antithyroid drugs induced an increase in serum TSH, stimulating the paranodular tissue. 131I will therefore be distributed in the whole thyroid gland, and not only in the autonomous solitary nodule. After 131I treatment, we continuously found a solitary nodule with low uptake in the paranodular tissue in 20 of 24 patients.

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“…Current therapies for Graves' disease consist of antithyroid drugs, radioiodine and surgery (4). Antithyroid drugs, which are usually prescribed for at least 1 year, are associated with a sustained remission in only 30-40% of patients after 10 years (5,6). In addition, these drugs are accompanied by rare side effects, the most important being agranulocytosis and hepatic failure (6).…”

Section: Introductionmentioning

confidence: 99%

Rituximab in relapsing Graves' disease, a phase II study

Heemstra

Toes²,

Sepers³

et al. 2008

European Journal of Endocrinology

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Objective: Conventional therapies for Graves' disease, consisting of medical therapy or radioiodine are unsatisfactory, because of limited efficacy and adverse events. Interventions aimed at the underlying autoimmune pathogenesis of Graves' disease may be worthwhile to explore. We therefore performed a prospective, 26-week phase II study with open-ended observational extension to assess the efficacy of rituximab in patients with recurrent Graves' disease. Design: We performed a prospective, 26-week phase II study with open-ended observations. Methods: Thirteen patients with relapsing Graves' disease (9 females and 4 males, age 39.5G9.5 years) received 2 dosages of rituximab 1000 mg i.v. with a 2-week interval. Before administration and on several periods after the administration of TSH, free thyroxine (FT 4 ), thyrotropin binding inhibitory immunoglobulins (TBII) and the proportion of CD19 and MS4A1 positive peripheral blood mononuclear cells were measured. Results: The proportion of MS4A1 positive lymphocytes decreased in all patients from 5.8% at baseline to 1.4% at 26 weeks (PZ0.007). Four patients with high initial FT 4 levels did not respond to treatment. All remaining patients had a decrease in FT 4 levels at 26 weeks (PZ0.001) and an increase in TSH levels (PZ0.011). TBII decreased in all remaining patients (PZ0.003). At a follow-up time of 14-27 months, nine of these patients were still euthyroid with normal FT 4 (P!0.001) and TSH levels (PZ0.008). Conclusions: The present study results suggest a beneficial role of rituximab in mild relapsing Graves' disease. A subsequent randomized controlled trial with rituximab is recommended.European Journal of Endocrinology 159 609-615

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The incidence of recurrence and hypothyroidism following treatment with antithyroid drugs, surgery or radioiodine in all patients with thyrotoxicosis in Malmö during the period 1970–1974

Cited by 54 publications

References 36 publications

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

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

Changes in the Thyroid Technetium-99m Scintigram after Antithyroid and Subsequent Radioiodine Treatment for Solitary Autonomous Nodules

Rituximab in relapsing Graves' disease, a phase II study

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