Goitre size and outcome of medical treatment of Graves' disease

Abstract

Abstract. One hundred and twenty-four patients with newly diagnosed hyperthyroidism received a combined thionamid-thyroxine medical therapy for approximately 2 years. According to the estimated goitre size before therapy and the type of goitre the patients were divided into 4 groups: Graves' disease no goitre (n = 19). Graves' disease small goitre (n = 57), Graves' disease medium or large goitre (n = 23), multinodular goitre (n = 25). The median follow-up period after cessation of medication was 64 (range 11–141) months. The remission rates in the different groups during follow-up were calculated using life table analysis. Graves' patients with no goitre or a small goitre had a significantly better outcome (remission % after 5 years 82.5 ± 15.4 (se) and 71.5 ± 7.8, respectively) than Graves' patients with a medium size or large goitre (remission % after 5 years 37.0 ± 11.1) (P <0.025). Most patients with multinodular goitre had a relapse within the first year after stop of medication (remission % after 5 years 15.5 ± 10.1). Hence patients with Graves' disease having a small thyroid gland should be treated medically while surgery or radioiodine may be a more reasonable choice in Graves' patients with medium size or large goitres. Medically treated patients with toxic multinodular goitres have a very small chance of prolonged remission if medication is stopped.

Determinants of serum T4 and T3 at the time of diagnosis in nosological types of thyrotoxicosis: a population-based study

“…In this study, comparing ten nosological types of thyrotoxicosis, GD patients presented the highest T 3 level and T 3 :T 4 ratio, which is in accordance with other studies (4,22,23,25). Similarly, amiodarone-associated thyrotoxicosis was dominated by high serum T 4 levels as previously reported by Martino et al (26).…”

“…Many studies have reported T 3 and T 4 levels in patients diagnosed with all types of thyrotoxicosis combined (20) or in a few (4,21,22,23) or even up to four nosological subtypes of thyrotoxicosis (24). In this study, comparing ten nosological types of thyrotoxicosis, GD patients presented the highest T 3 level and T 3 :T 4 ratio, which is in accordance with other studies (4,22,23,25).…”

THERAPY OF ENDOCRINE DISEASE: Antithyroid drug use in early pregnancy and birth defects: time windows of relative safety and high risk?

“…The woman had first received blockC replacement therapy for hyperthyroidism for 2 years. This is a common type of therapy for Graves' hyperthyroidism in Denmark (40). After withdrawal of medication, she received no medication for another 2 years before again starting treatment with MMIClevothyroxine (L-T 4 ), which was given for another 2-year period.…”

Association study of autoimmune thyroid disease at 5q23-q33 in Japanese patients

“…''GD with large goiter'' also tended to show a similar association pattern to these subgroups. This finding may reflect the fact that GD patients with large goiter are harder to become in remission by ATD treatment than those with small goiter (Young et al 1988;Laurberg et al 1986). The finding that ''GD with weak anti-TSH receptor antibody'' and ''GD of excellent drug response'' associated with the same allele (allele 4 of D5S410) also corresponds to the clinical observation that patients with weak anti-TSH receptor antibody tended to easily become in remission (Young et al 1988;Michelangeli et al 1998).…”