Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects

Singhal, Neha; Pavithran, Praveen V; Bhavani, Nisha; Arun, Chankramath S; Menon, Usha; Abraham, Nithya; Kumar, Harish; JayKumar, R V; Nair, Vasantha; Sundaram, Shanmugha; Sundaram, P Shanmuga

doi:10.4103/2230-8210.176360

Cited by 7 publications

(10 citation statements)

References 20 publications

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“…Among the patients who reached the legal treatment duration, only 36% had a sustained remission. Our results are consistent with those reported of 32.7% in India [14], 46% in China [6] and 41.9% in Pakistan [15]. However, in Mexico Bolanos et al [12] reported a lower remission rate of 17.5%.…”

Section: Evolutionary Aspectssupporting

confidence: 93%

“…However in the series of Cappeli et al [13] the goiter size and FT4 level were not predictive factors of the long-term prognosis. In the series of Shingai et al [14] in India, a higher Technetium uptake was found to be significantly associated with relapse.…”

Section: Evolutionary Aspectsmentioning

confidence: 84%

“…Rates of 53.9% and 82.5% were reported by Lin et al [5] in China and Bolanos et al [12] in Mexico, respectively. In India 19.2% of patients in remission in the series of Shingai et al [14] relapsed.…”

Section: Evolutionary Aspectsmentioning

confidence: 91%

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Graves’ Disease in Senegal: Clinical and Evolutionary Aspects

Sarr¹,

Diédhiou²,

Ndour-Mbaye³

et al. 2016

OJIM

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Objectives: To assess the clinical particularities and management of Graves' disease at the Medical Clinic II of the Abass Ndao Hospital Centre in Dakar. Patients and methods: This was a retrospective, descriptive study on records of patients monitored for Graves' disease from 1 January 2010 to 31 December 2014 (5 years). Socio-demographic, clinical treatment and changing parameters were evaluated. Outcomes: 878 patients were included and among them 542 had been monitored for at least 18 months. The sex ratio (M/F) was 0.2 and the average age was 34.8 ± 12 years. The average consultation period was 10.7 ± 2 months. Free T4 at diagnosis was > 80 pmol/l (36.6%). Prolonged medical treatment was reported in 96.7% of patients. The average dose for initial therapy with Carbimazole was 37 ± 9 mg/day. Beta-blockers were used in 64% and anxiolytics in 40.5% of cases. The average period for administering the maintenance dose was 5.6 months. Patients' attendance and compliance stood at 17.7% and 53.1% respectively. Complications, mainly cardiothyreosis, were found in 13% of cases. Goitre regression was found in 13.9% of cases and that of exophthalmos stood at 19.5%. Among our patients, 38.2% were lost to follow-up. The remission rate was 36.5% and thyroidectomy involved 14.5% of patients. Only stage of goiter (p = 0.007) and initial free T4 value (p = 0.003) were statistically associated with remission. Conclusion: Graves' disease management raises follow-up problems. Indeed, the medical treatment is long while the number of patients lost to follow-up is high. As the only radical alternative available is surgery, it is therefore essential to promote the development of radioactive iodine therapy to expand the therapeutic choice.

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Section: Evolutionary Aspectssupporting

confidence: 93%

Section: Evolutionary Aspectsmentioning

confidence: 84%

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Graves’ Disease in Senegal: Clinical and Evolutionary Aspects

Sarr¹,

Diédhiou²,

Ndour-Mbaye³

et al. 2016

OJIM

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“…Higher initial TSH (p=0.007), smoking status (0.026), higher 99 m Tc uptake (p=0.05), and pharmaceutical hypothyroidism (p=0.023) were significantly associated with remission. The level of 99 m Tc uptake at initial presentation is reported to predict remission in a previous study as well (30). Similarly, smoking status and higher TSH levels are associated with remission (29).…”

Section: Discussionmentioning

confidence: 79%

Clinical Spectrum and Outcome of Patients with Graves’ Disease: A Single-Center Experience from a Tertiary Care Institution in the Kashmir Valley, India

Bhat¹,

Bhat²,

Masoodi³

et al. 2021

Turk J Endocrinol Metab

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Objective: Graves' disease (GD) is a common autoimmune disorder with variable outcomes. We aim to study the clinical manifestations and treatment outcome of GD in the post-iodization scenario. Material and Methods: The present study was designed as a cross-sectional study, in which a total of 180 patients with GD (127 males and 53 females) attending our center were reviewed retrospectively. The demographic data, modes of treatment, comorbidities, remission, and recurrence rates were determined for the patients. All patients were initially treated with anti-thyroid drugs (ATDs), with the subsequent management depending on the course of the disease. Results: The mean (±SD) age at diagnosis was 38.30 (10.73) years and the lag period between the onset of symptoms and the diagnosis was 5.12 (2.69) months, with the male patients having a significantly shorter duration of illness compared to females (4.36 vs. 5.44 months; P=0.015). Majority of the patients presented with the typical symptoms and signs associated with hyperthyroidism and/or goiter, although the atypical presentations were not uncommon. ATDs were the most preferred treatment modality employed to achieve clinical and biochemical remission. The mean duration of achieving euthyroidism and the normalization of TSH levels were 3.31±1.51 and 7.45±3.35 months, respectively. On follow-up at three months, 46.1% of the patients were euthyroid, with normalization of the TSH levels in 15.6% of them. Failure to achieve early remission/disease control was significantly higher in males (p=0.003) and smokers (p=0.036). Among the 72 patients who completed medical therapy, 49 patients achieved remission, of whom 20 patients relapsed with a first-year relapse rate of 20.4%. Disease relapse was significantly associated with higher initial 99 mTechnetium (99 m Tc) uptake (p=0.022) and higher grade of goiter (p=0.026) at presentation. The logistic regression analysis revealed male gender (p=0.048) and orbitopathy (p=0.036) as the independent risk factors predicting relapse of the GD. Conclusion: Graves' disease manifests with varied clinical manifestations, including the atypical ones, warranting careful clinical assessment to ensure an accurate diagnosis. Gender and orbitopathy are the independent risk factors predicting the relapse of the disease.

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“…Hyperthyroidism is the most common organ-specific autoimmune disease and the most important reason for Graves' ophthalmopathy ( 13 – 15 ). Although the pathogenesis of hyperthyroidism has not been completely elucidated, recent studies indicated that the change of immunologic function may be closely correlated with the occurrence of hyperthyroidism ( 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

Percentage and function of CD4+CD25+ regulatory T cells in patients with hyperthyroidism

et al. 2017

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The current study observed the percentage of peripheral blood (PB) CD4+CD25+ regulatory T cells (Tregs) and the influence of CD4+CD25+ Tregs on the proliferation of naïve CD4 T cells in patients with hyperthyroidism. Furthermore, preliminary discussions are presented on the action mechanism of CD4+CD25+ Tregs on hyperthyroidism attacks. The present study identified that compared with the percentage of PB CD4+CD25+ Tregs in healthy control subjects, no significant changes were observed in the percentage of PB CD4+CD25+ Tregs in patients with hyperthyroidism (P>0.05). For patients with hyperthyroidism, CD4+CD25+ Tregs exhibited significantly reduced inhibition of the proliferation of naïve CD4 T cells and decreased secretion capacity on the cytokines of CD4 T cells, compared with those of healthy control subjects (P<0.05). In addition, it was demonstrated that thyroid function of patients with hyperthyroidism was significantly improved (P<0.05) subsequent to receiving medication. Compared with the percentage of PB CD4+CD25+ Tregs in patients with hyperthyroidism before treatment, no significant changes were observed in the percentage of PB CD4+CD25+ Tregs in hyperthyroidism patients following treatment (P>0.05). In the patients with hyperthyroidism, following treatment, CD4+CD25+ Tregs exhibited significantly increased inhibition of the proliferation of naïve CD4 T cells and increased secretion capacity of CD4 T cell cytokines, compared with those of the patients with hyperthyroidism prior to treatment (P<0.05). PB CD4+CD25+ Tregs function was decreased in patients with hyperthyroidism, and its non-proportional decrease may be closely associated with the occurrence and progression of hyperthyroidism.

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Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects

Cited by 7 publications

References 20 publications

Graves’ Disease in Senegal: Clinical and Evolutionary Aspects

Graves’ Disease in Senegal: Clinical and Evolutionary Aspects

Clinical Spectrum and Outcome of Patients with Graves’ Disease: A Single-Center Experience from a Tertiary Care Institution in the Kashmir Valley, India

Percentage and function of CD4+CD25+ regulatory T cells in patients with hyperthyroidism

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