Diagnosis and Management of Graves' Disease in Thailand: A Survey of Current Practice

Abstract

Background: The data on clinical practice patterns in the evaluation and management of Graves' disease (GD) are limited in Asia. The aims of this survey were to report the current practices in the management of GD in Thailand and to examine any international differences in the management of GD.

Methods: Members of the Endocrine Society of Thailand who were board certified in endocrinology (N = 392) were invited to participate in an electronic survey on the management of GD using the same index case and questionnaire as in previous North American and European surveys.

Results: One hundred and twenty responses (30.6%) from members were included. TSH receptor antibody measurement (29.2%), thyroid ultrasound (6.7%), and isotopic studies (5.9%) were used less frequently to confirm the etiology compared with those in North American and European surveys. Treatment with an antithyroid drug (ATD) was the preferred first choice of therapy (90.8%). Methimazole at 10-15 mg/day with a beta-blocker was the initial treatment of choice. The preferred ATD in pregnancy was propylthiouracil in the first trimester and methimazole in the second and third trimesters, which was similar to the North American and European surveys.

Conclusion: Ultrasound and isotopic studies will be requested only by a small proportion of Thai endocrinologists. Higher physician preference for ATD is similar to Europe, Latin America, and other Asian countries. Geographical differences in the use of ATD, radioactive iodine, and thyroidectomy exist.

Figure 1

Percentage of participants who would obtain the listed laboratory test (a) or functional and anatomic study (b) in a patient with uncomplicated Graves' disease. International differences in the selection of laboratory tests or imaging studies are also shown. USA and EU data are from references 5 and 6, respectively. CBC, complete blood count; EU, Europe; LFT, liver function test; T3, triiodothyronine; T4, thyroxine; Tg Ab, thyroglobulin antibody; TPO Ab, thyroperoxidase antibody; TRAb, TSH receptor antibody; USA, United States of America.

Figure 2

International differences in the selection of primary treatment modalities for the index case of uncomplicated Graves' disease. USA and EU data are from references [5] and [6], respectively. ATD, antithyroid drug; EU, Europe; RAI, radioactive iodine; USA, United States of America.

Figure 3

The effects of clinical variations on the selection of therapies for Graves' disease. (a) Uncomplicated Graves' disease (index case); (b) GO; (c) woman who planned to become pregnant in the next 6–12 months. ATD, antithyroid drug; CS, prophylactic corticosteroid therapy; GO, Graves' orbitopathy; RAI, radioactive iodine.