Abstract
Background The data on clinical practice patterns in the evaluation and management of Graves' disease (GD) are limited in Asia. The aims of this survey were to report the current practices in the management of GD in Thailand and to examine any international differences in the management of GD. Methods Members of the Endocrine Society of Thailand who were board certified in endocrinology (N = 392) were invited to participate in an electronic survey on the management of GD using the same index case and questionnaire as in previous North American and European surveys. Results One hundred and twenty responses (30.6%) from members were included. TSH receptor antibody measurement (29.2%), thyroid ultrasound (6.7%), and isotopic studies (5.9%) were used less frequently to confirm the etiology compared with those in North American and European surveys. Treatment with an antithyroid drug (ATD) was the preferred first choice of therapy (90.8%). Methimazole at 10–15 mg/day with a beta-blocker was the initial treatment of choice. The preferred ATD in pregnancy was propylthiouracil in the first trimester and methimazole in the second and third trimesters, which was similar to the North American and European surveys. Conclusion Ultrasound and isotopic studies will be requested only by a small proportion of Thai endocrinologists. Higher physician preference for ATD is similar to Europe, Latin America, and other Asian countries. Geographical differences in the use of ATD, radioactive iodine, and thyroidectomy exist.
Highlights
Graves’ disease (GD) is the most common cause of hyperthyroidism in iodine-replete areas [1]. e development of GD is thought to be due to complex interactions between genetic and environmental factors
Its autoimmune origin is well known, and the stimulation of autoantibodies to the TSH receptor (TRAb) on thyroid follicular cells is responsible for hyperthyroidism and development of a goiter. e clinical features of GD are shared by other etiologies of thyrotoxicosis
GD is associated with distinct extrathyroidal manifestations, including Graves’ orbitopathy (GO), thyroid dermopathy, and acropachy. e diagnosis of GD can often be established on the basis of the clinical presentation, raised levels of thyroxine (T4), and suppressed levels of TSH
Summary
Graves’ disease (GD) is the most common cause of hyperthyroidism in iodine-replete areas [1]. e development of GD is thought to be due to complex interactions between genetic and environmental factors. Burch and colleagues conducted a 2011 questionnaire-based survey of actual clinical practice in the management of GD among international members of the Endocrine Society, the Journal of yroid Research. In Asia, the results of surveys on clinical practice patterns in the management of GD are available only from Japan, Korea, China, and India [7, 8]. To this purpose, we used the same questionnaire developed by Burch et al [5] and distributed it among members of the Endocrine Society of ailand (EST) to investigate the clinical practice patterns in the management of GD in ailand
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