Background Treatment patterns and outcomes of Graves’ disease (GD) are variable around the world. However, studies on treatment outcomes of GD from the Asian populations are limited. We aimed to evaluate treatment outcomes of GD in Thailand. Methods Patients with new diagnoses of GD in a single center between 2014–2018 were retrospectively reviewed. The diagnosis of GD was based on clinical features, which included diffuse goiter, Graves’ orbitopathy (GO), pretibial myxedema and acropachy. Results The age-adjusted incidence of GD was 26.57 per 100,000 per year. The study included 355 patients aged 15 years or above with a follow-up period of at least 24 months. Antithyroid drug (ATD) was the most popular first-line treatment modality with 98.7% patients receiving the treatment, followed by radioactive iodine (RAI) treatment in 1.3% patients. The most effective treatment modality was surgery with a remission rate of 100%. ATD had a lowest remission rate of 23.8%. Multivariable Cox regression analysis showed GO (HR 1.76, 95% CI 1.08–2.88) and initial TSH < 0.01 uIU/ml (HR 1.61, 95% CI 1.14–2.28) were significant factors associated with an increased treatment failure rate. Conclusion Treatment failure with ATD in patients with GD was frequent in this population. The diagnosis of GD based solely on clinical features may explain the high treatment failure rate in this study. More definitive treatment could be used to prevent relapse and complications of the disease.

Purpose This article aims to review and assess the post-operative management and treatment outcomes of papillary thyroid microcarcinoma (PTMC) in risk-stratified patients. Methods We retrospectively analyzed the data of PTMC patients who underwent thyroid surgery with or without radioactive iodine treatment (RAI) in a single center between January 2011 and December 2017. Demographic and clinicopathologic data were collected. Risk stratification according to the 2015 American Thyroid Association guideline was applied. Results Three hundred forty PTMC patients were included. Post-operative RAI was performed in 216/340 (63.53%) patients. In the non-RAI scenario, there were 122 low-risk and two intermediate-risk patients. In total, 261 (76.77%), 57 (16.76%), and 22 (6.47%) patients were classified as low, intermediate, and high risk, respectively. With a median follow-up time of 36 months (interquartile range: 23, 52), we found unfavorable outcomes (evidenced by imaging or out-of-range serum tumor marker levels: high thyroglobulin [Tg] or rising Tg antibody [TgAb] levels) in 8/340 (2.35%) patients, all of which received RAI. PTMC patients with unfavorable outcomes were stratified as low risk (4/261 [1.53%]), intermediate risk (1/57 [1.75%]), or high risk (3/22 [13.64%]). One death occurred in a patient with initial distant metastasis in the high-risk group. Initial high-risk stratification and initial stimulated Tg (of at least 10 ng/mL) were demonstrated as independent predictors for PTMC unfavorable outcomes (persistent or recurrent disease). Five patients with unfavorable outcomes (four with persistent disease and one with recurrent disease) had abnormal Tg or TgAb values despite unremarkable imaging findings. Moreover, 79/124 (63.71%) patients in the non-RAI scenario were only followed up with neck ultrasound. Conclusions In general, at least 98% of low-risk and intermediate-risk PTMC patients showed favorable outcomes without persistent or recurrent disease, defined by either imaging or serum tumor markers. Nevertheless, aggressive disease could occur in few PTMC patients. Decisions on post-operative management and follow-up may be guided by initial high-risk stratification and initial stimulated Tg levels (≥10 ng/mL) as independent predictors for PTMC unfavorable outcomes. Monitoring using both imaging and serum tumor markers is crucial and should be implemented for patients with PTMC.

Background: Treatment patterns and outcomes of Graves’ disease (GD) are various around the world. Studies of the Asian population are lacking. The aim was to evaluate Thai patients with GD.Methods: Patients with new diagnoses of GD between 2014-2018 were retrospectively reviewed in a single center.Results: The age-adjusted incidence of GD was 26.57 per 100,000 per year. The analysis included 355 patients with follow-up at least 12 months and age of at least 15. Antithyroid drug (ATD) was the most popular treatment with 99.7%, followed by radioactive iodine (RAI) with 0.3%. The most effective treatment was RAI with a remission rate of 78.4% and time to failure of 54 months (p = 0.014), compared to ATD and surgery. ATD was the worst effective treatment with a remission rate of 21.5% and time to failure of 43.9 months. Multivariable Cox regression analysis showed TSH <0.01 uIU/ml was a significant factor for time to failure (HR 1.42, CI 1.03-1.96).Conclusion: Treatment failure with ATD was frequent in this population. More effective treatment could be preferred to prevent relapse and complications of the disease.