Suyeon Park1, Eyun Song2, Hye-Seon Oh2, Mijin Kim3, Min Ji Jeon2, Won Gu Kim2, Tae Yong Kim2, Young Kee Shong2, Doo Man Kim1, Won Bae Kim4. 1. Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea. 2. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 3. Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. 4. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. kimwb@amc.seoul.kr.
Abstract
OBJECTIVE: The use of antithyroid drug (ATD) therapy in patients with Graves' disease (GD) hyperthyroidism has been increasing, but ATD therapy is associated with a higher relapse rate. We aimed to evaluate clinical factors for predicting relapse of GD after ATD therapy. METHODS: Patients (n = 149) with newly diagnosed GD who achieved remission of hyperthyroidism after ATD therapy (≥6 months) were followed up for >18 months after ATD withdrawal. We evaluated the predictive factors of relapse during a median of 6.9 years of follow-up. RESULTS: Disease relapse occurred in 52 patients (34.9%). By multivariate analyses, a duration of the minimum maintenance dose therapy (MMDT) of <6 months was a significant factor in disease relapse (hazard ratio [HR], 2.58; 95% confidence interval [CI], 1.47-4.52; p < 0.001), and a T3/free T4 (fT4) ratio > 120 at ATD withdrawal was significantly more frequent in patients with relapse (HR 2.43; 95% CI, 1.36-4.34; p = 0.002). In the prediction-of-relapse model, the likelihood of relapse was greater in the high-risk group, which had a short MMDT duration and a T3/fT4 ratio ≥120 (HR, 5.81; 95% CI, 2.52-13.39; p < 0.001) and the intermediate-risk group, which had a short MMDT duration or a T3/fT4 ratio < 120 (HR, 2.77; 95% CI, 1.26-6.13; p < 0.001), than in the low-risk group, which had a long MMDT duration and a T3/fT4 ratio < 120. CONCLUSION: An MMDT longer than 6 months and a high T3/fT4 ratio at ATD withdrawal were independent predictors of relapse in patients who achieved initial remission after ATD for GD. These factors could be used to determine the optimal time to withdraw ATD during the treatment of GD hyperthyroidism.
OBJECTIVE: The use of antithyroid drug (ATD) therapy in patients with Graves' disease (GD) hyperthyroidism has been increasing, but ATD therapy is associated with a higher relapse rate. We aimed to evaluate clinical factors for predicting relapse of GD after ATD therapy. METHODS:Patients (n = 149) with newly diagnosed GD who achieved remission of hyperthyroidism after ATD therapy (≥6 months) were followed up for >18 months after ATD withdrawal. We evaluated the predictive factors of relapse during a median of 6.9 years of follow-up. RESULTS: Disease relapse occurred in 52 patients (34.9%). By multivariate analyses, a duration of the minimum maintenance dose therapy (MMDT) of <6 months was a significant factor in disease relapse (hazard ratio [HR], 2.58; 95% confidence interval [CI], 1.47-4.52; p < 0.001), and a T3/free T4 (fT4) ratio > 120 at ATD withdrawal was significantly more frequent in patients with relapse (HR 2.43; 95% CI, 1.36-4.34; p = 0.002). In the prediction-of-relapse model, the likelihood of relapse was greater in the high-risk group, which had a short MMDT duration and a T3/fT4 ratio ≥120 (HR, 5.81; 95% CI, 2.52-13.39; p < 0.001) and the intermediate-risk group, which had a short MMDT duration or a T3/fT4 ratio < 120 (HR, 2.77; 95% CI, 1.26-6.13; p < 0.001), than in the low-risk group, which had a long MMDT duration and a T3/fT4 ratio < 120. CONCLUSION: An MMDT longer than 6 months and a high T3/fT4 ratio at ATD withdrawal were independent predictors of relapse in patients who achieved initial remission after ATD for GD. These factors could be used to determine the optimal time to withdraw ATD during the treatment of GD hyperthyroidism.
Authors: Bjorn G Nedrebo; Pal I Holm; Sverre Uhlving; Jan Inge Sorheim; Svein Skeie; Geir Egil Eide; Eystein S Husebye; Ernst A Lien; Sylvi Aanderud Journal: Eur J Endocrinol Date: 2002-11 Impact factor: 6.664
Authors: Anja K Eckstein; Hildegard Lax; Christian Lösch; Diana Glowacka; Marco Plicht; Klaus Mann; Joachim Esser; Nils G Morgenthaler Journal: Clin Endocrinol (Oxf) Date: 2007-10 Impact factor: 3.478
Authors: S Costagliola; N G Morgenthaler; R Hoermann; K Badenhoop; J Struck; D Freitag; S Poertl; W Weglöhner; J M Hollidt; B Quadbeck; J E Dumont; P M Schumm-Draeger; A Bergmann; K Mann; G Vassart; K H Usadel Journal: J Clin Endocrinol Metab Date: 1999-01 Impact factor: 5.958
Authors: Mijin Kim; Bo Hyun Kim; Min Hee Jang; Jeong Mi Kim; Eun Heui Kim; Yun Kyung Jeon; Sang Soo Kim; In Joo Kim Journal: Endocrine Date: 2019-11-20 Impact factor: 3.633
Authors: C Happel; W T Kranert; D Gröner; B Bockisch; A Sabet; I Vardarli; R Görges; K Herrmann; F Grünwald Journal: Endocrine Date: 2020-03-16 Impact factor: 3.633
Authors: C Happel; W T Kranert; D Gröner; J Baumgarten; J Halstenberg; B Bockisch; A Sabet; F Grünwald Journal: Endocrine Date: 2021-01-13 Impact factor: 3.633
Authors: Meihua Jin; Ahreum Jang; Won Gu Kim; Tae Yong Kim; Won Bae Kim; Young Kee Shong; Min Ji Jeon Journal: PLoS One Date: 2022-03-11 Impact factor: 3.240