Abstract
IntroductionThe treatment strategies for a 42‐year‐old female index patient with moderate Graves’ disease (GD) vary according to several international surveys. The important question whether surveys of treatment preferences in theoretical patient cases also match how real patients are treated has not yet been addressed.Materials and MethodsFrom a Swedish cohort of 1186 GD patients (TT‐12 cohort), 27 women were identified using the same criteria as from the index patient surveys from the European and American Thyroid Associations. This ‘index patient cohort’ was age 40–45, otherwise healthy female, with two children and uncomplicated GD. The applied first‐line treatment of the patients in the index cohort, together with its variations, was compared with the treatment preferences according to international surveys. A comparison with the TT‐12 cohort was also performed.ResultsIn the ‘Index cohort’, 77.8% were treated with antithyroid drugs (ATD), and 22.2% were treated with radioiodine (131I). This preference for ATD is in line with most countries/regions, with the exception of USA and the Middle East/North Africa, where 131I was preferred. The distribution of treatment in the TT‐12 cohort did not significantly differ from the index cohort. ATD was the preferred treatment in male and young (age 19–22) patients, as was RAI in old (age 69–73) patients. The age‐related, but not the gender‐related, cases differed significantly from the entire TT‐12 cohort.ConclusionThe treatment choice in an index patient in Sweden seems in line with European practice, where ATD is the preferred first choice. This differs compared to US and North African survey intentions, where 131I is more often used. Age more than gender influences the treatment choice of GD patients. This is, to our best knowledge, the first time an index patient from ‘real life’ has been presented and compared to treatment preferences of international thyroid association surveys.
Highlights
The treatment strategies for a 42-year-old female index patient with moderate Graves’ disease (GD) vary according to several international surveys
At least 14 Thyroid Association surveys of treatment preferences for an index patient from over 10 countries or regions, spanning more than three decades, have been published.4–9,17–25 The documentation illustrates that the preferences for treatment depends on the country or region and differs in treatment strategies chosen during various time-periods
Comparisons were made with several other index patient questionnaires (IPQ) surveys from different international thyroid associations around the world.4–9,17–25 Cohorts of index male patients, young patients (19–22 years old), older patients (69–73 years old) and patients with a relapse after antithyroid drugs (ATD) were examined as variants of the index case
Summary
The treatment strategies for a 42-year-old female index patient with moderate Graves’ disease (GD) vary according to several international surveys. The treatment preferences of a hypothetical ‘index patient’ vary internationally, as illustrated by several authors.4–9 Several factors influence the choice of treatment, such as age, sex, the patient's preferences, planned pregnancy, smoking, eye symptoms and cost- effectiveness[10,11]; local traditions and access to treatments can influence the choice of treatment These issues may explain why different treatment strategies are used for an ‘index case’ of GD.4–9. On the other side, is less frequently used as a first-line treatment option, but it is more common in France (6.1%) and Sweden (4.6%) than in the USA, Taiwan and South Korea (2.0–2.9%).12–16 These clinical studies do not take into account the previously mentioned factors influencing the treatment choice. At least 14 Thyroid Association surveys of treatment preferences for an index patient from over 10 countries or regions, spanning more than three decades, have been published.4–9,17–25 The documentation illustrates that the preferences for treatment depends on the country or region and differs in treatment strategies chosen during various time-periods
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