Independent Pretreatment Predictors of Graves’ Disease Outcome

Albertas Daukša,Dalia Daukšienė,Narseta Mickuvienė

doi:10.3390/medicina49100067

Abstract

BACKGROUND AND OBJECTIVE. Current treatment options of Graves' disease (GD) are often unsatisfactory. This study aimed at determining the independent baseline predictors of medical treatment failure in GD. MATERIAL AND METHODS. A retrospective study of 194 patients with GD was carried out. According to the disease outcome, patients were divided into groups. The remission group included the patients who achieved long-term remission after initial antithyroid drug (ATD) treatment with no relapse (group 1) or after 2 or 3 courses of ATD therapy (group 2). The treatment failure group included the patients who underwent thyroid ablation due to relapse (group 3) or without ATD withdrawal (group 4). RESULTS. A family history of thyroid disorders was associated with greater odds of failure (P=0.046). Higher thyrotropin receptor antibodies (TRAb) levels and a larger goiter size (grade 2/grade 3) at the onset of the disease were both independently associated with a greater likelihood of failure. The initial TRAb concentration of 30.2 U/L and the TRAb concentration of 12.97 U/L at the end of ATD therapy were found to be the best cutoff values predicting the treatment failure. A hypoechogenic thyroid after ATD therapy, but not before therapy, increased the likelihood of failure by nearly 7.5 times (P<0.001). CONCLUSIONS. Higher TRAb levels and a larger goiter size at the onset of the disease were found to be the independent predictors of medical treatment failure in GD.

Highlights

Autoimmune thyroid diseases (AITDs) are the most prevalent autoimmune endocrine disorders, affecting approximately 2%–5% of the general population [1]
Higher TRAb levels and a larger goiter size at the onset of the disease were found to be the independent predictors of medical treatment failure in Graves’ disease (GD)
Men and women had the same outcome after antithyroid drug (ATD) treatment with a remission rate of 34%

Summary

Introduction

Autoimmune thyroid diseases (AITDs) are the most prevalent autoimmune endocrine disorders, affecting approximately 2%–5% of the general population [1]. In patients younger than 40 years, Graves’ disease (GD) is the most common cause of hyperthyroidism, which occurs more frequently in women than men [3]. Autoimmunity against a thyroid-stimulating hormone receptor (TSHR) is the main pathogenetic element of GD. Antibodies against the TSH receptor (TRAb) stimulate the growth and the function of the thyroid follicular cells leading to the excessive production of thyroid hormones and goiter formation [4]. TRAb detection is often used for the differential diagnosis of GD in order to differentiate it from other causes of hyperthyroidism, for the followup of patients with GD during and after antithyroid

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