Ye An Kim1,2, Sun Wook Cho1, Hoon Sung Choi3, Shinje Moon1, Jae Hoon Moon4, Kyung Won Kim1,2, Do Joon Park1, Ka Hee Yi5, Young Joo Park1, Bo Youn Cho6. 1. 1 Department of Internal Medicine, Seoul National University Hospital , Seoul, Korea. 2. 2 Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center , Seoul, Korea. 3. 3 Department of Internal Medicine, Kangwon National University School of Medicine , Chuncheon, Korea. 4. 4 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam, Korea. 5. 5 Department of Internal Medicine, Seoul National University Boramae Medical Center , Seoul, Korea. 6. 6 Department of Internal Medicine, Chung-Ang University College of Medicine , Seoul, Korea.
Abstract
BACKGROUND: Antithyroid drug (ATD) is a widely used treatment for Graves' disease (GD). However, its long-term efficiency remains unclear. This study investigated the long-term disease prognosis and predictive factors for relapse in ATD-treated GD patients. METHODS: Newly diagnosed, ATD-treated GD patients with at least four years of follow-up were recruited (n = 187). Remission was defined as maintaining a euthyroid status for more than one year after ATD withdrawal. RESULTS: During 11.1 years (range 4.0-23.7 years) of median follow-up, overall, 51.9% of the newly diagnosed ATD-treated GD patients achieved remission, 32.1% continued ATD treatment, and 13.4% underwent other ablation treatments. The 10-year remission rates were higher in the first (34.2%) and second (25.5%) ATD courses than in any of the other subsequent ATD courses, and decreased as ATD treatments were repeated. The 10-year relapse rate was the highest after the third ATD treatment (71.4%) compared with that after the first (60.5%) and second (58.3%) courses. Longer duration of ATD treatment (odds ratio [OR] = 1.4 [confidence interval (CI) 1.2-1.7], p < 0.001), higher number of relapses (OR = 4.7 [CI 2.3-9.8], p < 0.001), and moderate to severe Graves' ophthalmopathy (OR = 4.1 [CI 1.1-15.2], p = 0.032) were associated with persistent disease status. CONCLUSIONS: A second course of ATD can be considered for GD patients after the first relapse because the chance of remission and the relapse rate are similar to the one after the first ATD treatment course. For GD patients with more than two relapses, or with an ATD treatment duration of more than four to five years, low-dose maintenance of ATD or ablative treatment needs to be considered.
BACKGROUND: Antithyroid drug (ATD) is a widely used treatment for Graves' disease (GD). However, its long-term efficiency remains unclear. This study investigated the long-term disease prognosis and predictive factors for relapse in ATD-treated GDpatients. METHODS: Newly diagnosed, ATD-treated GDpatients with at least four years of follow-up were recruited (n = 187). Remission was defined as maintaining a euthyroid status for more than one year after ATD withdrawal. RESULTS: During 11.1 years (range 4.0-23.7 years) of median follow-up, overall, 51.9% of the newly diagnosed ATD-treated GDpatients achieved remission, 32.1% continued ATD treatment, and 13.4% underwent other ablation treatments. The 10-year remission rates were higher in the first (34.2%) and second (25.5%) ATD courses than in any of the other subsequent ATD courses, and decreased as ATD treatments were repeated. The 10-year relapse rate was the highest after the third ATD treatment (71.4%) compared with that after the first (60.5%) and second (58.3%) courses. Longer duration of ATD treatment (odds ratio [OR] = 1.4 [confidence interval (CI) 1.2-1.7], p < 0.001), higher number of relapses (OR = 4.7 [CI 2.3-9.8], p < 0.001), and moderate to severe Graves' ophthalmopathy (OR = 4.1 [CI 1.1-15.2], p = 0.032) were associated with persistent disease status. CONCLUSIONS: A second course of ATD can be considered for GDpatients after the first relapse because the chance of remission and the relapse rate are similar to the one after the first ATD treatment course. For GDpatients with more than two relapses, or with an ATD treatment duration of more than four to five years, low-dose maintenance of ATD or ablative treatment needs to be considered.
Authors: Suyeon Park; Eyun Song; Hye-Seon Oh; Mijin Kim; Min Ji Jeon; Won Gu Kim; Tae Yong Kim; Young Kee Shong; Doo Man Kim; Won Bae Kim Journal: Endocrine Date: 2019-06-24 Impact factor: 3.633
Authors: Min Joo Kim; Sun Wook Cho; Ye An Kim; Hoon Sung Choi; Young Joo Park; Do Joon Park; Bo Youn Cho Journal: Endocrinol Metab (Seoul) Date: 2022-06-16
Authors: Eyun Song; Mina Kim; Sojeong Park; Min Jeong Park; Jung A Kim; Eun Roh; Ji Hee Yu; Nam Hoon Kim; Ji A Seo; Sin Gon Kim; Nan Hee Kim; Kyung Mook Choi; Sei Hyun Baik; Hye Jin Yoo Journal: Front Endocrinol (Lausanne) Date: 2021-10-08 Impact factor: 5.555