Abstract

BackgroundThe treatment of hyperthyroid Graves’ disease (GD) varies considerably among geographic areas. In this study, we aimed to evaluate practice patterns and treatment outcomes in Thai patients with hyperthyroid GD.MethodsA retrospective cohort study over 35 years (1985–2019) in patients with hyperthyroid GD was conducted. The trends of treatment options were compared periodically during the study period and the overall remission rate from each option was determined.ResultsA total of 2736 hyperthyroid GD patients were treated and followed-up for at least 3 months over the study period (female 82.0%, mean age at diagnosis 36.3 ± 12.0 years, median duration of follow-up 74.5 months). Anti-thyroid drug (ATD) was the most commonly used treatment (78.0%), followed by RAI (21.0%), and surgery (1.0%). There was a significant downward trend for surgery, from 12.3% in the 1980s to only 0.2% in last phase of the study period. The preference for RAI therapy has also decreased in the last 5 years. Among ATD-treated patients, the remission rate was achieved only in 30.7 and 16.0% of all ATD-treated patients were eventually treated with RAI. Spontaneous hypothyroidism developed in 2.7% of the ATD-treated patients during a follow-up period. Almost all RAI-treated patients (97.1%) developed hypothyroidism.ConclusionsOur present study highlighted the changing landscape of primary treatments for hyperthyroid GD toward ATD and the sharp downward trend in the surgical option. Even though ATD was associated with a low remission rate, it was preferred by many patients and physicians. The use of RAI as the primary treatment decreased in the last decade. However, RAI was a very effective treatment for Graves’ hyperthyroidism but will inevitably induce hypothyroidism and a requirement for life-long replacement therapy.

Highlights

  • The treatment of hyperthyroid Graves’ disease (GD) varies considerably among geographic areas

  • To better understand the changing landscape of GD in Thai patients, this study aimed to evaluate clinical characteristics, practice patterns, and treatment outcomes in Thai patients with hyperthyroid GD

  • Thyroid palpation data determined by treating physicians was transformed into thyroid volume on the basis of goiter size compared with normal thyroid size as following: small, medium (2–3 times when compared with normal thyroid gland), and huge

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Summary

Introduction

The treatment of hyperthyroid Graves’ disease (GD) varies considerably among geographic areas. Despite radioactive iodine (RAI) being the most common recommended first-line treatment in the United States (U.S.) [2] and recently in the National Institute for Health and Care Excellence (NICE) guideline from United Kingdom [3] due to its effectiveness and prevention of relapse, the first-choice treatments for this disease varies among different countries [4,5,6]. While RAI is the preferred choice of treatment for practicing clinicians in the U.S, other parts of the world especially in Asia are likely to offer the antithyroid drug (ATD) as the initial option [7]. Choice of treatment requires physicians to discuss both long-term (2021) 14:5 effectiveness and potential risks carefully with the patient. Patients’ preferences after understanding all available treatment options would represent the reason for the selected choice of treatment

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