Epidemiology, management and outcomes of Graves’ disease—real life data

Abstract

PurposeTreatment options in Graves’ disease are clearly defined, but management practices and the perceptions of success are varied. The outcomes of treatment in large consecutive cohorts of Graves’ disease have not been well characterised. The study describes the epidemiology, management strategies and medium term outcomes following anti-thyroid drug treatment, radio-iodine ablation and surgery in Graves’ disease.MethodsAll patients (n = 659) who received treatment for a new diagnosis of Graves’ disease in secondary care over a 5 year period were included with a median (interquartile range) follow-up of 42.9 (29–57.5) months.ResultsThe age adjusted incidence of adult onset Graves’ disease in Sheffield, UK was 24.8 per 100,000 per year. Excluding 35 patients lost to follow-up, 93.1% (n = 581) were controlled on anti-thyroid drug treatment. Of these, 73.6% went into remission following withdrawal of anti-thyroid drugs; 5.2% were still undergoing initial therapy; 13.3% lost control whilst on anti-thyroid drugs; and 7.9% went on to have either surgery or radio-iodine ablation whilst controlled on anti-thyroid drugs. Of the 428 patients who achieved remission, 36.7% relapsed.Of 144 patients who had radio-iodine ablation treatment, 5.6% relapsed and needed further treatment. Of 119 patients having surgery, 5.2% had long-term hypoparathyroidism and none had documented long-term recurrent laryngeal nerve palsy.ConclusionsIn the follow-up, 39.9% of patients underwent surgery or radio-iodine ablation with little morbidity. Up to two-thirds of patients who achieved remission did not relapse. Data on effectiveness and risks of treatments for Graves’ disease presented in this study will help clinicians and patients in decision making.

Clinical profile of thyrotoxicosis and related cardiovascular morbidities among patients attending endocrine outpatient department in a tertiary care centre

“…(TRAb). 19 Thyroid hormones increase rate and force of systolic contraction (positive chronotropic and inotropic effect) and decrease the systemic vascular resistance. 20 As a result, thyrotoxicosis increases systolic blood pressure and heart rate and widens the pulse pressure.…”

Analysis of BAFF gene polymorphisms in UK Graves’ disease patients

“…Medical treatment of GD is often unsuccessful, and patients frequently require definitive surgical or radioiodine ablative therapy resulting in the requirement for lifelong levothyroxine replacement therapy . Given these extant clinical issues, there is a demand for innovative therapeutic options.…”

“…Graves’ disease (GD) is the commonest cause of hyperthyroidism, affecting approximately 0.5%‐2% of the Caucasian population over a lifetime, with an annual incidence of 24.8 cases per 100 000 in the UK, and an adjusted female to male ratio of 3.9:1 . GD is characterized by a dysfunctional humoral immune response, which results in autoantibodies that stimulate the cell‐surface thyroid‐stimulating hormone (TSH) receptor leading directly to excess thyroid hormone secretion.…”

“Our Self-Undoing”: Christina Rossetti’s Literary and Somatic Expressions of Graves’ Disease

“…Although the Rossetti family record characterizes Graves' disease as "rare," it is the most common type of hyperthyroidism, with an incidence of 22-25 per 100,000 people in the United Kingdom. The female to male ratio is 3.9 to 1(Hussain et al 2017). The Rossetti family referred to the condition as both "Dr. Graves's disease" and as "exophthalmic bronchocele".…”