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The long-term outcome of treatment for Graves' hyperthyroidism
Örebro University, School of Medical Sciences. Department of Surgery.
Karolinska Universitetssjukhuset, ANOVA, Stockholm, Sweden.
Karolinska Institute, Stockholm County, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Dept. of Medicine, Örebro University Hostpital, Örebro, Sweden.
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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
Available from: 2019-09-10 Created: 2019-09-10 Last updated: 2023-06-29Bibliographically approved
In thesis
1. Hyperthyroidism: a chronic disease?
Open this publication in new window or tab >>Hyperthyroidism: a chronic disease?
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During 2003-2005, approximately 3,000 de novo hyperthyroid patients were collected in Sweden and became one of the world's largest hyperthyroidism studies. This dissertation shows that many people diagnosed with hyperthyroidism live with its impacts even after excess of thyroid hormone has ended. These include repeated recurrences, multiple treatments, replacement therapy, little sense of recovery, and reduced Quality Of life(QoL). Patients were categorised into two groups, Graves' disease (GD) and toxic nodular goitre (TNG), studied separately. Overall, just over 1,400 patients, or 60% of dispatches, answered the questionnaires. 1186 GD, 237 TNG. Most patients were women and GD's mean age was around 40 years, while TNG patients were 20 years older, reflecting the same patternas previous studies. The incidence of 27/100,000 persons per year might not seem large, but considering the proposed chronic nature of hyperthyroidism, prevalence is high (0.7%). Around two in three people diagnosed with hyperthyroidism will live with thyroid hormone replacement. This could be attributed, that GD patients over time receive more ablative treatment, despite the fact that less receive it as the first treatment. Another explanation the recurrence risk of ATD-treated patients exceeds 50%. Levothyroxine treatment did not vary between TNG treatments. Repeated, often multiple, treatments in TNG patients are rarely described. This implies TNG may be more complex than anticipated. Hyperthyroid patients have worse QoL 6-10 years following diagnosis than the general public. RAI treated patients with GD had more affected long-term thyroid-specific and generic QoL than ATD and surgical patients. Surprisingly, there was no clear QoL difference between GD and TNG. GD is often seen as a severe condition than TNG, as TNG has a milder course of disease. Hyperthyroidism has long-term impacts, affecting a relatively large population. This dissertation's findings indicate a chronic nature of hyperthyroidism.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2021. p. 58
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 230
Keywords
Hyperthyroidism, Graves’ disease, toxic nodular goitre, longterm follow-up, Quality of Life, radioactivated iodine, antithyroid drugs, thyroidectomy, index patient
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-86380 (URN)978-91-7529-370-7 (ISBN)
Public defence
2021-02-19, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2020-10-12 Created: 2020-10-12 Last updated: 2021-02-09Bibliographically approved

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Sjölin, GabrielByström, KristinaWallin, Göran

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