The long-term outcome of treatment for Graves' hyperthyroidismShow others and affiliations
2019 (English)In: Thyroid, ISSN 1050-7256, E-ISSN 1557-9077, Vol. 29, no 11, p. 1545-1557Article in journal (Refereed) Published
Abstract [en]
BACKGROUND: The treatment efficacy of antithyroid drug therapy (ATD), radioactive iodine (I131) or surgery for Graves' hyperthyroidism is well described. However, there are few reports on the long-term total outcome of each treatment modality as how many require levothyroxine supplementation, the need of thyroid ablation or the individual patient's estimation of their recovery.
METHODS: We conducted a pragmatic trial to determine the effectiveness and adverse outcome in a patient cohort newly diagnosed with Graves' hyperthyroidism between 2003-2005 (n=2430). The patients were invited to participate in a longitudinal study spanning 8±0.9years (mean±SD) after diagnosis. We were able to follow 1186 (60%) patients that had been treated with ATD, I131 or surgery. We determined the mode of treatment, remission rate, recurrence, quality of life, demographic data, comorbidities and lifestyle factors through questionnaires and review of the individual medical history records.
RESULTS: At follow-up the remission rate after first line treatment choice with ATD was 45.3% (351/774), with I-131 therapy 81.5% (324/264) and with surgery 96.3% (52/54). Among those patients who had a second course of ATD 29.4% achieved remission. The total number of patients who had undergone ablative treatment was 64.3% (763/1186), of which 23% (278/1186) had received surgery, 43% (505/1186) I-131 therapy including 2% (20/1186) who received both surgery and I-131. Patients who received ATD as first treatment and possibly additional ATD had 49.7% risk (385/774) of having undergone ablative treatment at follow-up. Levothyroxine replacement was needed in 23% (81/351) of the initially ATD treated in remission, in 77.3% (204/264) of the I131treated and in 96.2% (50/52) of the surgically treated patients. Taken together after 6-10 years, and all treatment considered, normal thyroid hormone status without thyroxine supplementation was only achieved in 35.7% (423/1186) of all patients and in only 40.3% of those initially treated with ATD. The proportion of patients that did not feel fully recovered at follow-up was 25.3%.
CONCLUSION: A patient selecting ATD therapy as the initial approach in the treatment of Graves' hyperthyroidism should be informed that they have only a 50.3% chance of ultimately avoiding ablative treatment and only a 40% chance of eventually being euthyroid without thyroid medication. Surprisingly, 1 in 4 patients did not feel fully recovered after 6-10 years. The treatment for Graves' hyperthyroidism, thus has unexpected long-term consequences for many patients.
Place, publisher, year, edition, pages
Mary Ann Liebert, 2019. Vol. 29, no 11, p. 1545-1557
Keywords [en]
hyperthyroidism, Graves' disease, antithyroid drugs, radioiodine, thyroidectomy, long-term follow-up, recurrence, remission
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-76165DOI: 10.1089/thy.2019.0085ISI: 000496906000003PubMedID: 31482765Scopus ID: 2-s2.0-85073522068OAI: oai:DiVA.org:oru-76165DiVA, id: diva2:1350089
2019-09-102019-09-102023-06-29Bibliographically approved
In thesis