Impaired Quality of Life After Radioiodine Therapy Compared to Antithyroid Drugs or Surgical Treatment for Graves' Hyperthyroidism: A Long-Term Follow-Up with the Thyroid-Related Patient-Reported Outcome Questionnaire and 36-Item Short Form Health Status Survey

Törring, Ove; Watt, Torquil; Sjölin, Gabriel; Byström, Kristina; Abraham-Nordling, Mirna; Calissendorff, Jan; Cramon, Per; Nyström, Helena Filipsson; Hallengren, Bengt; Holmberg, Mats; Khamisi, Selwan; Lantz, Mikael; Wallin, Göran

doi:10.1089/thy.2018.0315

Cited by 74 publications

(64 citation statements)

References 52 publications

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“…This study (5) supports findings of previous studies (1,2), which showed worse QoL scores in patients with Graves' disease than in the general population. However, findings of a worse long-term QoL in those treated with RAI, as compared with those treated with ATD or surgery, is in contrast to previous studies.…”

Section: Commentarysupporting

confidence: 92%

Quality of Life Is Worse at 6-10 Years after Radioactive Iodine Treatment of Graves’ Disease as Compared with Antithyroid Drugs or Surgery

Lee

2019

Clinical Thyroidology

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Section: Commentarysupporting

confidence: 92%

Quality of Life Is Worse at 6-10 Years after Radioactive Iodine Treatment of Graves’ Disease as Compared with Antithyroid Drugs or Surgery

Lee

2019

Clinical Thyroidology

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“…While it is true that older patients are more likely to achieve remission (7), the worry that remissions are not necessarily lifelong makes definitive treatment more reasonable (3). However, in young and middle-aged patients, long-term therapy with methimazole may become a more widely accepted strategy, especially given recent data on the adverse effects of radioiodine therapy on quality of life (13). Failure to attain normal TRAb levels after 12 to 18 months of methimazole therapy does not rule out the possibility of remission occurring over a longer time horizon of 5 to 10 years.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Antithyroid Drug Treatment of Patients With Graves’ Disease

CooperDavid

2019

Clinical Thyroidology

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Background Antithyroid drugs remain an important treatment for hyperthyroidism due to Graves' disease (1). There are two main therapeutic protocols that are used; in the first scenario, antithyroid drugs are given for 12 to 18 months, and, if serum anti-TSH receptor antibody (TRAb) levels have normalized, the drug is discontinued and patients are monitored for recurrence. If antibodies persist, however, definitive treatment with radioiodine or surgery may be recommended (2,3), although continued antithyroid drug therapy is also reasonable in patients with well-controlled mild disease (2,3). In the second scenario, antithyroid drugs are given for as long as necessary, until TRAbs disappear. This could be for years or even for a lifetime (4,5). The aim of the current study was to describe long-term outcomes in 549 adult patients with Graves' disease treated with antithyroid drugs for >8 years and to relate remission and final outcomes to patterns of serum TRAb titers (6). Methods This retrospective study included 549 patients (mean age, 36-41 years) with untreated Graves' disease seen at the

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“…Other disadvantages with RAI treatment are the increased risks of TAO and cardiovascular morbidity as well as impaired long-term quality of life (QoL). [23][24][25][26][27][28][29][30][31][32]…”

Section: Radioactive Iodine Treatmentmentioning

confidence: 99%

The Long-Term Outcome of Treatment for Graves' Hyperthyroidism

Sjölin

Holmberg

Törring

et al. 2019

Thyroid

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Graves' disease (GD) is an autoimmune condition with elevated thyroid hormone levels and symptoms suggesting an affected brain. These symptoms often resolve with treatment but, for some patients, GD results in a long period of reduced wellbeing. The overall aim of this thesis is to characterize the consequences of GD with a special focus on the brain. Three studies were conducted with data from questionnaires and clinical assessments of patients with GD in both the hyperthyroid and the euthyroid phase. Paper I was a longitudinal cohort study that assessed long-term treatment results 6 10 years after the onset of GD. Among 1186 included patients, the 774 who were initially treated with antithyroid drugs had a 40% chance of being euthyroid without thyroid medication at follow-up. One in four patients did not feel fully recovered. Paper II was a longitudinal case-control study designed to characterize affective and cognitive symptoms in 65 premenopausal women with newly diagnosed untreated GD. At onset of GD, the patients were significantly more affected with depression, anxiety, and mental fatigue compared to controls. At follow-up after 15 months, these symptoms remained in a significant proportion of patients. Patients with eye symptoms or a history of psychiatric conditions were more likely to be affected with brain-related symptoms. Paper III was a longitudinal case-control study of 65 premenopausal women with newly diagnosed untreated GD designed to investigate the effect of GD on hippocampal volumes. At onset of GD, hippocampus and amygdala volumes of the patients were smaller compared to controls. These brain structures became larger with treatment and, after 15 months, only the left amygdala remained smaller than in controls. At inclusion, there was an inverse correlation between thyroid-stimulating hormone receptor antibody (TRAb) and the volumes of both amygdalae and the right hippocampus. There were also inverse correlations between TRAb and free triiodothyronine recovery and the recovery of most of the four assessed brain volumes. GD is a condition where a minority of patients can hope for a long-lasting restored thyroid function. A large proportion of GD patients do not feel recovered after 8 years. Mental fatigue is an important concept for understanding the brain-derived symptoms in GD. In summary, the studies demonstrate that Graves' hyperthyroidism has unexpected long-term consequences for many patients, provide extensive new data on the serious and chronic nature of GD, and show for the first time that GD is accompanied by reversible brain changes.

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Impaired Quality of Life After Radioiodine Therapy Compared to Antithyroid Drugs or Surgical Treatment for Graves' Hyperthyroidism: A Long-Term Follow-Up with the Thyroid-Related Patient-Reported Outcome Questionnaire and 36-Item Short Form Health Status Survey

Cited by 74 publications

References 52 publications

Quality of Life Is Worse at 6-10 Years after Radioactive Iodine Treatment of Graves’ Disease as Compared with Antithyroid Drugs or Surgery

Quality of Life Is Worse at 6-10 Years after Radioactive Iodine Treatment of Graves’ Disease as Compared with Antithyroid Drugs or Surgery

Long-Term Antithyroid Drug Treatment of Patients With Graves’ Disease

The Long-Term Outcome of Treatment for Graves' Hyperthyroidism

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