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. 2017 Jun;56(3):568-578.
doi: 10.1007/s12020-017-1306-5. Epub 2017 May 6.

Epidemiology, management and outcomes of Graves' disease-real life data

Y S Hussain  1 , J C Hookham  1 , A Allahabadia  2 , S P Balasubramanian  3   4
Affiliations

Epidemiology, management and outcomes of Graves' disease-real life data

Y S Hussain et al. Endocrine. 2017 Jun.

Abstract

Purpose: Treatment options in Graves' disease are clearly defined, but management practices and the perceptions of success are varied. The outcomes of treatment in large consecutive cohorts of Graves' disease have not been well characterised. The study describes the epidemiology, management strategies and medium term outcomes following anti-thyroid drug treatment, radio-iodine ablation and surgery in Graves' disease.

Methods: All patients (n = 659) who received treatment for a new diagnosis of Graves' disease in secondary care over a 5 year period were included with a median (interquartile range) follow-up of 42.9 (29-57.5) months.

Results: The age adjusted incidence of adult onset Graves' disease in Sheffield, UK was 24.8 per 100,000 per year. Excluding 35 patients lost to follow-up, 93.1% (n = 581) were controlled on anti-thyroid drug treatment. Of these, 73.6% went into remission following withdrawal of anti-thyroid drugs; 5.2% were still undergoing initial therapy; 13.3% lost control whilst on anti-thyroid drugs; and 7.9% went on to have either surgery or radio-iodine ablation whilst controlled on anti-thyroid drugs. Of the 428 patients who achieved remission, 36.7% relapsed. Of 144 patients who had radio-iodine ablation treatment, 5.6% relapsed and needed further treatment. Of 119 patients having surgery, 5.2% had long-term hypoparathyroidism and none had documented long-term recurrent laryngeal nerve palsy.

Conclusions: In the follow-up, 39.9% of patients underwent surgery or radio-iodine ablation with little morbidity. Up to two-thirds of patients who achieved remission did not relapse. Data on effectiveness and risks of treatments for Graves' disease presented in this study will help clinicians and patients in decision making.

Keywords: Anti-thyroid drugs; Graves’ disease; Hyperthyroidism; Radio-iodine; Surgery; Thyroid.

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Conflict of interest statement

Complicance with ethical standards

The study complies with ethical standards currently in UK for observational studies.

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

No specific approval was obtained from an ethics committee. As this is an observational study of a current clinical pathway and no intervention was involved, permission was only obtained from the audit and service evaluation office of the Sheffield Teaching Hospitals NHS Foundation Trust. As the data was anonymised and individual patients cannot be identified from the report, individual patient consent was not deemed to be necessary and was not obtained.

Figures

Fig. 1
Fig. 1
Postcode map of Sheffield (United Kingdom) with gender-adjusted and age-adjusted incidence rates for Graves’ disease. AA, age-adjusted incidence; GA, gender-adjusted incidence. Each outlined area refers to a postcode area in the city of Sheffield
Fig. 2
Fig. 2
Flow chart depicting management pathway for patients with Graves’ disease
Fig. 3
Fig. 3
Kaplan–Meier survival curve showing time to relapse in patients who were considered to have remission after ATD treatment
See this image and copyright information in PMC

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