Rajeev Parameswaran1,2, Samantha Peiling Yang3,4, Mechteld Christine de Jong5, James Lee Wai Kit5, Kathleen Sek6, Tran Quang Nam7, Tran Viet Thang7, Nguyen Thy Khue8, Than Than Aye9, Phone Myint Tun10, Timothy Cole11, Julie A Miller12, Michael Villa13, Benjapa Khiewvan14, Sirinart Sirinvaravong15, Yong Lit Sin16, Rohaizak Muhammad17, Tjin Shing Jap18, Amit Agrawal19, Rajesh Rajput20, Ranil Fernando21, Manilka Sumanatilleke22, Ketut Suastika23, Young Kee Shong24, Brian Lang25, Luigi Bartalena26. 1. Department of Endocrine Surgery, National University Hospital, Singapore, Singapore. rajeev_parameswaran@nuhs.edu.sg. 2. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. rajeev_parameswaran@nuhs.edu.sg. 3. Department of Endocrinology, National University Hospital, Singapore, Singapore. surrp@nus.edu.sg. 4. Division of Endocrinology, Yong Loo Lin School of Medicine, National University of, Singapore, Singapore. surrp@nus.edu.sg. 5. Department of Endocrine Surgery, National University Hospital, Singapore, Singapore. 6. Department of Endocrinology, National University Hospital, Singapore, Singapore. 7. Department of Endocrinology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. 8. Department of Endocrinology, University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Vietnam. 9. Department of Diabetes and Endocrinology, University of Medicine 2, Yangon, Myanmar. 10. Department of Otolaryngology, Grand Hantha International Hospital, Yangon, Myanmar. 11. Department of Biochemistry & Molecular Biology, Monash University, Wellington Road, Clayton, VIC, 3800, Australia. 12. Endocrine Surgery Unit, The Royal Melbourne Hospital, and Department of Surgery, Melbourne University, Parkville, VIC, Australia. 13. Philippines Center for Diabetes, Thyroid and Endocrine Disorders, St. Luke's Medical Center, Global City, Taguig, Philippines. 14. Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 15. Division of Endocrinology and Metabolism, Department of Medicine, Siriraj Hospital, Mahidol University, Nakhon, Thailand. 16. Department of Medicine, Hospital Tuanku Jaa'far Seremban, Seremban, Malaysia. 17. Department of Surgery, Univ Keb Malaysia Medical Centre, Kuala Lumpur, Malaysia. 18. Department of Endocrinology, Taipei Veterans General Hospital, Taipei, Taiwan. 19. Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. 20. Department of Endocrinology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India. 21. Department of Surgery, North Colombo Teaching Hospital Ragama, Ragama, Sri Lanka. 22. Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka. 23. Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia. 24. Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 25. Division of Endocrine Surgery at Queen Mary Hospital, Pok Fu Lam, Hong Kong. 26. Division of Endocrinology, University of Insubria, Varese, Italy.
Abstract
AIM: Although Graves' disease (GD) is common in endocrine practices worldwide, global differences in diagnosis and management remain. We sought to assess the current practices for GD in countries across Asia and the Pacific (APAC), and to compare these with previously published surveys from North America and Europe. METHODS: A web-based survey on GD management was conducted on practicing clinicians. Responses from 542 clinicians were received and subsequently analysed and compared to outcomes from similar surveys from other regions. RESULTS: A total of 542 respondents participated in the survey, 515 (95%) of whom completed all sections. Of these, 86% were medical specialists, 11% surgeons, and 3% nuclear medicine physicians. In addition to serum thyroid-stimulating hormone (TSH) and free thyroxine assays, most respondents would request TSH-receptor autoantibody (TRAb) measurement (68%) during initial work-up. Thyroid ultrasound is requested by about half of respondents (53%), while the use of nuclear medicine scans is limited. The preferred first-line treatment is anti-thyroid drug (ATD) therapy (79%) with methimazole (MMI) or carbimazole (CBZ), followed by radioiodine (RAI; 19%) and surgery (2%). In case of surgery, one-third of respondents would opt for a subtotal rather than a total thyroidectomy. In case of mild Graves orbitopathy (GO), ATDs (67%) remains the preferred treatment, but a larger proportion of clinicians prefer surgery (20%). For a patient with intention to conceive, the preferred treatment pattern remained unchanged, although propylthiouracil (PTU) became the preferred ATD-agent during the first trimester. In comparison to European and American practices, marked differences were noted in the relatively infrequent usage of nuclear medicine scans and the overall higher use of a ATDs and β-blockers and adjunctive ATD-treatment during RAI in the APAC-group. CONCLUSION: Although regional differences regarding the diagnosis and management of GD are apparent in this first pan-Asia-Pacific survey, this study reveals the overall approach to the management of this disease in Asia-Pacific generally tends to fall between the trends appreciated in the American and European cohorts.
AIM: Although Graves' disease (GD) is common in endocrine practices worldwide, global differences in diagnosis and management remain. We sought to assess the current practices for GD in countries across Asia and the Pacific (APAC), and to compare these with previously published surveys from North America and Europe. METHODS: A web-based survey on GD management was conducted on practicing clinicians. Responses from 542 clinicians were received and subsequently analysed and compared to outcomes from similar surveys from other regions. RESULTS: A total of 542 respondents participated in the survey, 515 (95%) of whom completed all sections. Of these, 86% were medical specialists, 11% surgeons, and 3% nuclear medicine physicians. In addition to serum thyroid-stimulating hormone (TSH) and free thyroxine assays, most respondents would request TSH-receptor autoantibody (TRAb) measurement (68%) during initial work-up. Thyroid ultrasound is requested by about half of respondents (53%), while the use of nuclear medicine scans is limited. The preferred first-line treatment is anti-thyroid drug (ATD) therapy (79%) with methimazole (MMI) or carbimazole (CBZ), followed by radioiodine (RAI; 19%) and surgery (2%). In case of surgery, one-third of respondents would opt for a subtotal rather than a total thyroidectomy. In case of mild Graves orbitopathy (GO), ATDs (67%) remains the preferred treatment, but a larger proportion of clinicians prefer surgery (20%). For a patient with intention to conceive, the preferred treatment pattern remained unchanged, although propylthiouracil (PTU) became the preferred ATD-agent during the first trimester. In comparison to European and American practices, marked differences were noted in the relatively infrequent usage of nuclear medicine scans and the overall higher use of a ATDs and β-blockers and adjunctive ATD-treatment during RAI in the APAC-group. CONCLUSION: Although regional differences regarding the diagnosis and management of GD are apparent in this first pan-Asia-Pacific survey, this study reveals the overall approach to the management of this disease in Asia-Pacific generally tends to fall between the trends appreciated in the American and European cohorts.