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The Long-Term Outcome of Treatment for Graves' Hyperthyroidism
Orebro Univ, Fac Med & Hlth, Dept Surg, SE-70185 Orebro, Sweden.
Univ Gothenburg, Sahlgrenska Acad, Inst Med, Gothenburg, Sweden;Karolinska Univ Hosp, ANOVA, Stockholm, Sweden.
Karolinska Inst, Inst Clin Sci & Educ, Stockholm, Sweden;Soder Sjukhuset, Dept Internal Med, Div Endocrinol, Stockholm, Sweden.
Orebro Univ, Dept Med, Orebro, Sweden;Univ Hosp, Orebro, 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 (ATD) therapy, radioactive iodine (I-131), or surgery for Graves' hyperthyroidism is well described. However, there are a few reports on the long-term total outcome of each treatment modality regarding 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 and 2005 (n = 2430). The patients were invited to participate in a longitudinal study spanning 8 +/- 0.9 years (mean +/- standard deviation) after diagnosis. We were able to follow 1186 (60%) patients who had been treated with ATD, I-131, or surgery. We determined the mode of treatment, remission rate, recurrence, quality of life, demographic data, comorbidities, and lifestyle factors through questionnaires and a review of the individual's 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 (vs. the 45.3% after the first course of ATD). The total number of patients who had undergone ablative treatment was 64.3% (763/1186), of whom 23% (278/1186) had received surgery, 43% (505/1186) had received I-131 therapy, including 2% (20/1186) who had received both surgery and I-131. Patients who received ATD as first-line 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 I-131 treated, 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
Endocrinology and Diabetes Surgery
Identifiers
URN: urn:nbn:se:uu:diva-398569DOI: 10.1089/thy.2019.0085ISI: 000496906000003PubMedID: 31482765OAI: oai:DiVA.org:uu-398569DiVA, id: diva2:1376328
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09Bibliographically approved

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