Choroba gravesa-basedowa – Rokowania, prognozy i postęp choroby

Choroba gravesa-basedowa
Rokowania, prognozy i postęp choroby

Choroba Gravesa-Basedowa (GD) jest autoimmunologiczną przyczyną nadczynności tarczycy, charakteryzującą się stymulacją receptora TSH przez przeciwciała TRAb. Długoterminowe obserwacje wskazują, że trwała remisja funkcji tarczycy występuje u około 27-34% pacjentów, podczas gdy większość rozwija niedoczynność tarczycy wymagającą terapii substytucyjnej. Czynniki zwiększające ryzyko nawrotu to m.in. wiek <40 lat (iloraz szans 3,22), obecność oftalmopatii tarczycowej (iloraz szans 2,26), palenie tytoniu (iloraz szans 2,21), wysokie miano TRAb, duża objętość wola oraz podwyższone stężenia cytokin zapalnych (IL-6, TNFRS9). Skala prognostyczna GREAT, oparta na wieku, poziomie wolnej T4, miano TRAb i wielkości wola, pozwala na stratifikację ryzyka nawrotu: 16% (0-1 pkt), 44% (2-3 pkt) i 68% (4-6 pkt). Rozszerzenie GREAT+ uwzględnia czynniki genetyczne, co szczególnie poprawia ocenę u pacjentów z umiarkowanym ryzykiem nawrotu.

Choroba Gravesa-Basedowa – rokowanie i przewidywanie wyników leczenia

Naturalna historia choroby i długoterminowe wyniki
Czynniki prognostyczne nawrotu choroby
Skala GREAT – narzędzie prognostyczne
Wyniki leczenia różnymi metodami
Odległe powikłania i choroby współistniejące
Opcje terapeutyczne i ich wpływ na rokowanie
Monitorowanie i prognozowanie długoterminowe
Podsumowanie rokowania
Kolejne rozdziały

Choroba Gravesa-Basedowa – rokowanie i przewidywanie wyników leczenia

Choroba Gravesa-Basedowa (GD) jest najczęstszą przyczyną nadczynności tarczycy w regionach z wystarczającą podażą jodu. Jako choroba autoimmunologiczna charakteryzuje się aktywacją receptora TSH przez przeciwciała stymulujące (TRAb), co prowadzi do niekontrolowanej produkcji hormonów tarczycy.¹ Rokowanie w chorobie Gravesa-Basedowa zależy od wielu czynników, a przewidywanie długoterminowych wyników leczenia stanowi istotne wyzwanie kliniczne, mające znaczenie dla wyboru optymalnej strategii terapeutycznej.²

Naturalna historia choroby i długoterminowe wyniki

Długoterminowe badania obserwacyjne pokazują, że tylko około jedna trzecia pacjentów z chorobą Gravesa-Basedowa osiąga trwałą normalizację funkcji tarczycy. W 25-letniej obserwacji pacjentów po rozpoczęciu leczenia tyreostatykami, prawidłową funkcję tarczycy stwierdzono jedynie u 34% pacjentów. Pozostali pacjenci mieli albo aktywną chorobę (1%), samoistną niedoczynność tarczycy (13%), lub przeszli leczenie ablacyjne jodem radioaktywnym (40%) albo tyreoidektomię (13%).³⁴

Naturalny przebieg choroby Gravesa-Basedowa wskazuje, że większość pacjentów ostatecznie rozwija niedoczynność tarczycy i wymaga terapii zastępczej. Podobnie, oftalmopatia tarczycowa z czasem zwykle staje się nieaktywna. Jednak w niektórych przypadkach nadczynność tarczycy może nawracać z powodu przetrwałej tkanki tarczycowej po ablacji i wysokich mian przeciwciał anty-TSI.⁵

Czynniki prognostyczne nawrotu choroby

Zidentyfikowano szereg czynników klinicznych i biochemicznych, które zwiększają ryzyko nawrotu choroby Gravesa-Basedowa:

Wiek – wiek poniżej 40 lat istotnie zwiększa ryzyko nawrotu (iloraz szans 3,22)⁶⁷
Oftalmopatia tarczycowa (TED) – jej obecność zwiększa ryzyko nawrotu (iloraz szans 2,26)⁸
Palenie tytoniu – zwiększa ryzyko nawrotu (iloraz szans 2,21)⁹
Poziom cytokin zapalnych – podwyższone stężenia interleukiny 6 i czynnika martwicy nowotworów TNFRS9 zwiększają ryzyko nawrotu (iloraz szans odpowiednio 1,99 i 2,36)¹⁰
Wielkość wola – duża objętość tarczycy przy rozpoznaniu jest związana z gorszym rokowaniem¹¹¹²
Poziom przeciwciał przeciwko receptorowi TSH (TRAb) – utrzymujące się wysokie miano TRAb jest istotnym czynnikiem prognostycznym nawrotu¹³¹⁴
Stosunek FT3/FT4 – wysoki stosunek wolnej trójjodotyroniny do wolnej tyroksyny przy rozpoznaniu wiąże się z gorszym rokowaniem¹⁵
Płeć męska – mężczyźni mają wyższe ryzyko nawrotu choroby¹⁶¹⁷
Wzorzec zmian poziomu TRAb – fluktuujący lub tlący się typ zmian poziomu TRAb wiąże się z wyższym ryzykiem nawrotu (odpowiednio 53% i 62%) w porównaniu do pacjentów z płynnym zanikiem TRAb (36%)¹⁸

Skala GREAT – narzędzie prognostyczne

W celu lepszego przewidywania ryzyka nawrotu choroby Gravesa-Basedowa po zakończeniu leczenia lekami przeciwtarczycowymi (ATD) opracowano skalę prognostyczną GREAT (Graves’ Recurrent Events After Therapy). Wykorzystuje ona cztery podstawowe zmienne wyjściowe: wiek, poziom wolnej T4, poziom TRAb oraz wielkość wola.¹⁹²⁰

Wynik GREAT klasyfikuje pacjentów do trzech grup ryzyka nawrotu:

Wynik 0-1 punktów: ryzyko nawrotu 16%
Wynik 2-3 punktów: ryzyko nawrotu 44%
Wynik 4-6 punktów: ryzyko nawrotu 68%

²¹

Skala GREAT może być łatwo obliczona w momencie rozpoznania choroby i pomaga przewidzieć skuteczność leczenia lekami przeciwtarczycowymi. Dzięki temu pacjenci mogą podejmować świadome decyzje dotyczące wyboru innych opcji leczenia już na początku terapii.²²

Rozszerzeniem skali GREAT jest GREAT+, która uwzględnia dodatkowo czynniki genetyczne. Największą korzyść z zastosowania GREAT+ obserwowano u pacjentów z umiarkowanym ryzykiem nawrotu (klasa II wg GREAT), u których dodanie genotypowania znacząco zmieniało oszacowanie ryzyka nawrotu.²³

Wyniki leczenia różnymi metodami

Leczenie lekami przeciwtarczycowymi

Średni wskaźnik remisji po standardowym kursie leków przeciwtarczycowych (ATD) wynosi około 50%. Większość nawrotów występuje w ciągu 4 lat po zakończeniu leczenia. Badania długoterminowe wskazują, że po przerwaniu leczenia ATD u około 50% pacjentów dochodzi do nawrotu w ciągu 4 lat.²⁴ W 20-letniej obserwacji około 62% pacjentów rozwinęło nawrotową nadczynność tarczycy, 8% subkliniczną niedoczynność tarczycy, a 3% jawną niedoczynność tarczycy związaną z przeciwciałami blokującymi receptor TSH i przeciwciałami przeciwko peroksydazie tarczycowej. Tylko 27% pacjentów pozostawało w remisji i mogłoby być uznane za wyleczonych.²⁵

Wskaźnik remisji po 2 latach leczenia ATD u młodych osób wynosi jedynie 20-30%. Czas trwania leczenia ATD jest jednym z niewielu modyfikowalnych czynników ryzyka, a ostatnie przeglądy systematyczne wskazują na pewne dowody, że dłuższy czas leczenia zwiększa wskaźnik remisji.²⁶

Przy rozważaniu zakończenia leczenia ATD kluczowe jest zmierzenie poziomu TRAb, ponieważ jeśli przeciwciała są podwyższone, szanse na remisję są niskie. Pacjenci z niskim lub niewykrywalnym poziomem TRAb mają wysokie prawdopodobieństwo trwałej remisji, z nawrotem u około 20-30% po zakończeniu terapii ATD. Z drugiej strony, pacjenci z trwale podwyższonym poziomem TRAb prawdopodobnie nie osiągną remisji i wymagają dalszego leczenia, a GD może nawrócić u około 80-100% takich pacjentów po odstawieniu leków przeciwtarczycowych.²⁷

Leczenie jodem radioaktywnym

Leczenie jodem radioaktywnym (RIT) jest zalecane jako preferowana opcja dla wielu pacjentów z chorobą Gravesa-Basedowa, jednak czynniki predykcyjne jego klinicznych wyników nie są w pełni poznane. Badania wskazują, że podejście oparte na obliczonej dawce jodu radioaktywnego jest skuteczne, ale należy spodziewać się wysokich wskaźników niepowodzenia u pacjentów z niskim 24-godzinnym wychwytem jodu radioaktywnego (RAIU), szczególnie u tych z RAIU poniżej 46,31%.²⁸

Ultrasonograficzny pomiar objętości tarczycy 3 miesiące po podaniu jodu-131 może być klinicznie użyteczny do przewidywania poablacyjnej niedoczynności tarczycy. Około 90% pacjentów, u których objętość tarczycy 3 miesiące po podaniu jodu-131 była mniejsza niż 50% objętości wyjściowej, rozwinęło niedoczynność tarczycy w ciągu roku po leczeniu (dodatnia wartość predykcyjna 88%, czułość 75,9%, swoistość 85,0%).²⁹

Leczenie chirurgiczne

Całkowita tyreoidektomia prowadzi do eliminacji nadczynności tarczycy, jednak kosztem wytworzenia innej choroby (niedoczynności tarczycy) wymagającej dożywotniego leczenia lewotyroksyną.³⁰ Celem zarówno leczenia radiojodem, jak i całkowitej tyreoidektomii jest ablacja lub usunięcie całej funkcjonalnej tkanki tarczycy, co będzie wymagać dożywotniej substytucji lewotyroksyną.³¹

Odległe powikłania i choroby współistniejące

Choroba Gravesa-Basedowa może wiązać się z rozwojem innych chorób autoimmunologicznych oraz powikłań, które wpływają na długoterminowe rokowanie:

Choroby autoimmunologiczne – po 25 latach obserwacji 47% pacjentów miało jedną lub więcej chorób autoimmunologicznych, w tym niedobór witaminy B12 (26%) i reumatoidalne zapalenie stawów (5%)³²
Obniżona jakość życia – pacjenci z chorobą Gravesa-Basedowa, którzy rozwinęli niedoczynność tarczycy, mieli obniżoną jakość życia³³
Oftalmopatia tarczycowa – TRAb są niezależnymi czynnikami ryzyka wystąpienia oftalmopatii Gravesa i pomagają przewidzieć ciężkość i wynik choroby³⁴
Cukrzyca – badanie Song i wsp. wykazało, że u pacjentów z długotrwałą chorobą Gravesa-Basedowa, po 2-letnim leczeniu lekami przeciwtarczycowymi, ryzyko rozwoju cukrzycy jest 1,18 razy wyższe niż w grupie kontrolnej³⁵
Nowotwory tarczycy – pacjenci z chorobą Gravesa-Basedowa mają wysoką częstość występowania guzków tarczycy i znaczące ryzyko raka tarczycy, szczególnie w przypadku mnogich i większych guzków (ryzyko zwiększa się 2,96 razy na każde 10 mm wzrostu wielkości guzka)³⁶
Powikłania sercowo-naczyniowe – nieleczona choroba Gravesa-Basedowa wiąże się z wyższym ryzykiem powikłań sercowych i zwiększoną śmiertelnością³⁷

Opcje terapeutyczne i ich wpływ na rokowanie

Wybór metody leczenia powinien uwzględniać czynniki ryzyka nawrotu choroby i preferencje pacjenta:

Długotrwałe leczenie lekami przeciwtarczycowymi jawi się jako korzystna opcja pierwszego rzutu, szczególnie u pacjentów z młodym wiekiem w momencie zachorowania lub obecnością oftalmopatii tarczycowej³⁸
Optymalny czas leczenia powinien być ustalany indywidualnie z uwzględnieniem czynników ryzyka nawrotu³⁹
Terapie immunomodulujące – nie jest jasne, czy zmieniają długoterminowy wynik choroby Gravesa-Basedowa, czy tylko opóźniają nawrót⁴⁰

Monitorowanie i prognozowanie długoterminowe

Ze względu na stosunkowo częste nawroty choroby, nawet u pacjentów, którzy początkowo osiągnęli remisję, konieczne jest długoterminowe monitorowanie funkcji tarczycy.⁴¹ Staranne dożywotnie monitorowanie jest wskazane w celu wykrycia nawrotu, niedoczynności tarczycy i innych chorób autoimmunologicznych.⁴²

Obecne wytyczne kliniczne powinny rozważyć zalecenie długotrwałego leczenia lekami przeciwtarczycowymi jako standardowego podejścia u pacjentów z młodym wiekiem, palących tytoń lub z oftalmopatią tarczycową na początku choroby.⁴³

Podsumowanie rokowania

Trwałe wyleczenie choroby Gravesa-Basedowa jest możliwe, choć przy niskim wskaźniku około 27%. Wskaźnik wyleczenia byłby jeszcze niższy, gdyby definicja wyleczenia zakładała również brak przeciwciał przeciwko receptorowi TSH.⁴⁴

Choroba Gravesa-Basedowa nie jest śmiertelna, ale powikłania mogą negatywnie wpływać na ogólny stan zdrowia lub oczekiwaną długość życia pacjenta. Powikłania, takie jak arytmia, niewydolność serca lub udar, mogą skrócić oczekiwaną długość życia, ale te powikłania nie są powszechne wśród osób, które kontrolują swoją chorobę.⁴⁵

Przy właściwym leczeniu rokowanie w chorobie Gravesa-Basedowa jest generalnie dobre. Leczenie jest jednak zazwyczaj dożywotnie. Pacjenci, którzy otrzymują definitywne leczenie (jod radioaktywny lub tyreoidektomię), ostatecznie rozwiną niedoczynność tarczycy, która wymaga dożywotniego podawania leków. Osoby przyjmujące leki przeciwtarczycowe zwykle muszą przyjmować je przez całe życie.⁴⁶

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Materiały źródłowe

#1 Best practices in the laboratory diagnosis, prognostication, prediction, and monitoring of Gravesâ disease: role of TRAbs | BMC Endocrine Disorders | Full Text
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-024-01809-9
Graves’ disease (GD) is an autoimmune disorder characterized by activation of the TSH receptor by stimulatory autoantibodies (TSH Receptor Antibodies, or TRAbs), leading to unregulated thyroid hormone production. […] Establishment of elevated serum levels of TRAbs by competitive binding assay or cell-binding assay has its unique role in diagnosis and management of GD, especially in the differential diagnosis, therapy selection, prognostication, evaluation of thyroid function during pregnancy, peri-conceptional and neonatal thyroid workup, and in certain special situation. […] The core clinical feature of GD include palpitations, heat intolerance, and weight loss, due to TSAbs-induced thyrotoxicosis; the diagnostic laboratory findings of GD include typical serum picture of elevated T3 and T4 with suppressed TSH and detectable levels of TRAbs (to be specific, TSAbs).
#2 Graves, disease in clinical perspective
https://www.imrpress.com/journal/FBL/24/1/10.2741/4708/htm
Graves’ disease (GD) is the most common cause for hyperthyroidism in iodine-replete areas. […] Risk factors for relapse are a large thyroid volume, persistence of high TRAb serum titer, smoking, and others. […] We also describe recent developments of TRAb measurement, which is used for the diagnosis of GD as well as for outcome prediction. […] The aim of the present review article is to give an overview on the recent understanding of the pathogenesis of GD as well as clinical aspects for diagnosing, predicting prognosis, and treating GD patients. […] The appearance of TRAbs is presumed to be highly specific for the diagnosis of GD. Therefore the diagnosis GD is confirmed by demonstrating elevated TRAbs. […] Using this assay method, the sensitivity of TRAb testing improved to about 1 IU/I. Of note, this assay system has also been used for outcome prediction (remission vs. relapse) of GD.
#3 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
Graves disease (GD) is a leading cause of hyperthyroidism. Detailed investigations and predictors of long-term outcomes are missing. […] This work aimed to investigate the outcomes in GD 25 years after initiating antithyroid drug treatment, including disease course, clinical and biochemical predictors of relapse, and quality of life. […] At the end of follow-up, normal thyroid function was achieved in 34%. The remaining had either active disease (1%), spontaneous hypothyroidism (13%), or had undergone ablative treatment with radioiodine (40%) or thyroidectomy (13%). […] Age younger than or equal to 40 years, thyroid eye disease (TED), smoking, and elevated levels of interleukin 6 and tumor necrosis factor receptor superfamily member 9 (TNFRS9) increased the risk of relapsing disease (odds ratio 3.22; 2.26; 2.21; 1.99; 2.36).
#4 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
At the end of follow-up, 47% had one or more autoimmune diseases, including vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). […] GD patients who developed hypothyroidism had reduced quality of life. […] Careful lifelong monitoring is indicated to detect recurrence, hypothyroidism, and other autoimmune diseases. Long-term ATD treatment emerges as a beneficial first-line treatment option, especially in patients with young age at onset or presence of TED. […] We confirm that only one-third of GD patients obtain normal thyroid function. Many develop hypothyroidism and permanently reduced quality of life, either spontaneously or secondary to ablative treatment, arguing for longer ATD treatment as a beneficial treatment option. […] Current clinical guidelines should consider recommending long-term ATD treatment as a standard approach in patients with young age, smoking, or TED at onset.
#5 Graves Disease: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/120619-overview
The natural history of Graves disease is that most patients become hypothyroid and require replacement. Similarly, the ophthalmopathy generally becomes quiescent. On occasion, hyperthyroidism returns because of persisting thyroid tissue after ablation and high antibody titers of anti-TSI. Further therapy may be necessary in the form of surgery or radioactive iodine ablation. […] A study by Tun et al indicated that in patients with Graves disease receiving thionamide therapy, high TSH receptorstimulating antibody (TRab) levels at diagnosis of the disease and/or high TRab levels at treatment cessation are risk factors for relapse, particularly within the first two years. The study included 266 patients. […] A retrospective study by Rabon et al indicated that in children with Graves disease, antithyroid drugs usually do not induce remission, although most children who do achieve remission through these agents do not relapse. Of 268 children who were started on an antithyroid drug, 57 (21%) experienced remission, with 16 of them (28%) relapsing.
#6 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
Graves disease (GD) is a leading cause of hyperthyroidism. Detailed investigations and predictors of long-term outcomes are missing. […] This work aimed to investigate the outcomes in GD 25 years after initiating antithyroid drug treatment, including disease course, clinical and biochemical predictors of relapse, and quality of life. […] At the end of follow-up, normal thyroid function was achieved in 34%. The remaining had either active disease (1%), spontaneous hypothyroidism (13%), or had undergone ablative treatment with radioiodine (40%) or thyroidectomy (13%). […] Age younger than or equal to 40 years, thyroid eye disease (TED), smoking, and elevated levels of interleukin 6 and tumor necrosis factor receptor superfamily member 9 (TNFRS9) increased the risk of relapsing disease (odds ratio 3.22; 2.26; 2.21; 1.99; 2.36).
#7 Long-term follow-up result of antithyroid drug treatment of Gravesâ hyperthyroidism in a large cohort in: European Thyroid Journal Volume 12 Issue 2 (2023)
https://etj.bioscientifica.com/view/journals/etj/12/2/ETJ-22-0226.xml
The positive TRAb level at ATD discontinuation was also associated with short RFS after initial ATD therapy. […] In multivariate analysis, younger age (45 years), male sex, and changing patterns of TRAb (fluctuating group and smoldering group) were independent risk factors associated with short RFS of Graves hyperthyroidism.
#8 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
Graves disease (GD) is a leading cause of hyperthyroidism. Detailed investigations and predictors of long-term outcomes are missing. […] This work aimed to investigate the outcomes in GD 25 years after initiating antithyroid drug treatment, including disease course, clinical and biochemical predictors of relapse, and quality of life. […] At the end of follow-up, normal thyroid function was achieved in 34%. The remaining had either active disease (1%), spontaneous hypothyroidism (13%), or had undergone ablative treatment with radioiodine (40%) or thyroidectomy (13%). […] Age younger than or equal to 40 years, thyroid eye disease (TED), smoking, and elevated levels of interleukin 6 and tumor necrosis factor receptor superfamily member 9 (TNFRS9) increased the risk of relapsing disease (odds ratio 3.22; 2.26; 2.21; 1.99; 2.36).
#9 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
Graves disease (GD) is a leading cause of hyperthyroidism. Detailed investigations and predictors of long-term outcomes are missing. […] This work aimed to investigate the outcomes in GD 25 years after initiating antithyroid drug treatment, including disease course, clinical and biochemical predictors of relapse, and quality of life. […] At the end of follow-up, normal thyroid function was achieved in 34%. The remaining had either active disease (1%), spontaneous hypothyroidism (13%), or had undergone ablative treatment with radioiodine (40%) or thyroidectomy (13%). […] Age younger than or equal to 40 years, thyroid eye disease (TED), smoking, and elevated levels of interleukin 6 and tumor necrosis factor receptor superfamily member 9 (TNFRS9) increased the risk of relapsing disease (odds ratio 3.22; 2.26; 2.21; 1.99; 2.36).
#10 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
Graves disease (GD) is a leading cause of hyperthyroidism. Detailed investigations and predictors of long-term outcomes are missing. […] This work aimed to investigate the outcomes in GD 25 years after initiating antithyroid drug treatment, including disease course, clinical and biochemical predictors of relapse, and quality of life. […] At the end of follow-up, normal thyroid function was achieved in 34%. The remaining had either active disease (1%), spontaneous hypothyroidism (13%), or had undergone ablative treatment with radioiodine (40%) or thyroidectomy (13%). […] Age younger than or equal to 40 years, thyroid eye disease (TED), smoking, and elevated levels of interleukin 6 and tumor necrosis factor receptor superfamily member 9 (TNFRS9) increased the risk of relapsing disease (odds ratio 3.22; 2.26; 2.21; 1.99; 2.36).
#11 Predicting relapse of Graves’ disease following treatment with antithyroid drugs
https://www.spandidos-publications.com/10.3892/etm.2016.3058
The aim of the present study was to monitor long term antithyroid drug treatments and to identify prognostic factors for Graves’ disease (GD). […] Following longterm treatment, 141 patients (46%) demonstrated remission of hyperthyroidism with a mean duration of 18.71.9 months. […] Logistic regression analysis demonstrated that elevated thyroid size, FT3/FT4 ratio and TRAb at diagnosis were associated with poor outcomes. […] Patients with GD exhibiting large thyroids, high premediation TRAb levels and elevated FT3/FT4 ratios responded less markedly to antithyroid drug treatments, as compared with patients not exhibiting these prognostic factors. […] The present study demonstrated that a high relapse rate following ATD therapy was significantly associated with goiter size at the onset of disease and enlarged glands at the time of drug withdrawal.
#12 Graves, disease in clinical perspective
https://www.imrpress.com/journal/FBL/24/1/10.2741/4708/htm
Graves’ disease (GD) is the most common cause for hyperthyroidism in iodine-replete areas. […] Risk factors for relapse are a large thyroid volume, persistence of high TRAb serum titer, smoking, and others. […] We also describe recent developments of TRAb measurement, which is used for the diagnosis of GD as well as for outcome prediction. […] The aim of the present review article is to give an overview on the recent understanding of the pathogenesis of GD as well as clinical aspects for diagnosing, predicting prognosis, and treating GD patients. […] The appearance of TRAbs is presumed to be highly specific for the diagnosis of GD. Therefore the diagnosis GD is confirmed by demonstrating elevated TRAbs. […] Using this assay method, the sensitivity of TRAb testing improved to about 1 IU/I. Of note, this assay system has also been used for outcome prediction (remission vs. relapse) of GD.
#13 Graves, disease in clinical perspective
https://www.imrpress.com/journal/FBL/24/1/10.2741/4708/htm
Persistently elevated TRAb levels (â¥ 10 IU/I 6 months after initial diagnosis) seem also to represent a further risk factor for relapse prediction as mentioned above. […] A high TRAb at diagnosis and/or positive TRAb at cessation of therapy were described to suggest a high likelihood of relapse, mostly within the first two years. […] Interestingly, Vos et al. also confirmed these risk factors by his prediction model. […] Here, again a larger goiter size at diagnosis and higher serum TRAb levels but also PTPN22 C/T polymorphism and some HLA subtypes were described as independent predictors for recurrence. […] Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease.
#14 Best practices in the laboratory diagnosis, prognostication, prediction, and monitoring of Gravesâ disease: role of TRAbs | BMC Endocrine Disorders | Full Text
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-024-01809-9
The measurement of TRAbs is a sensitive and specific tool for differential diagnosis of thyrotoxicosis. […] The measurement of TRAbs is a sensitive and specific tool for accurate and rapid diagnosis of Graves disease. […] Baseline levels of TRAbs, along with other clinical indicators, can help in predicting treatment response to therapy in Graves Disease. […] Baseline levels of TRAbs can help in predicting prognosis and recurrence of Graves Disease, especially in young individuals. […] Higher baseline TRAbs levels were associated with greater risk of GD relapse, […] Higher baseline TRAbs levels were also associated with poorer prognosis after 12-18 months of therapy, irrespective of whether the patients received antithyroid drugs, radioiodine therapy, or surgical therapy. […] A scoring system was constructed and validated for predicting the risk of recurrent GD after 18 months of antithyroid drug (ATD) therapy using four baseline variables: age, serum fT4, TRAbs, and goitre size; the resultant GREAT (Graves Recurrent Events After Therapy) score of 0-1, 2-3, and 4-6 were associated with a recurrence risk of 16%, 44%, and 68% respectively.
#15 Predicting relapse of Graves’ disease following treatment with antithyroid drugs
https://www.spandidos-publications.com/10.3892/etm.2016.3058
Furthermore, it was also demonstrated that the FT3/FT4 ratio at the onset of GD was elevated in the non-remission group, as compared with the remission group, which is consistent with the study conducted by Yoshimura et al (22), which suggested that the ratio may be used as an index to predict treatment outcomes of hyperthyroidism following ATD therapy. […] The results of the present study indicated that patients in the non-remission group experienced delayed sTSH restoration, and patients demonstrating sTSH suppression had a high tendency for GD recurrence if ATG therapy was prematurely terminated. […] Overall, GD patients with large thyroids, high TRAb levels, and high FT3/FT4 ratios at the onset of disease tended to fail to respond to ATD. […] In conclusion, patients with large thyroids and ophthalmopathy following treatment with ATD demonstrated increased recurrence rates; and patients with euthyroid and TSH restoration following treatment with ATD were more likely to experience recurrence.
#16 Long-term follow-up result of antithyroid drug treatment of Gravesâ hyperthyroidism in a large cohort in: European Thyroid Journal Volume 12 Issue 2 (2023)
https://etj.bioscientifica.com/view/journals/etj/12/2/ETJ-22-0226.xml
ATD treatment is an acceptable option for the initial treatment of Graves hyperthyroidism as well as for recurrent disease. The optimal treatment period for ATD treatment needs to be determined using the individual risk factors of recurrence. […] Younger age (45 years), male sex, and fluctuating or smoldering of TRAb levels were independent risk factors of the first recurrence after ATD treatment. […] The change of TRAb helps predict the individual risk of recurrence, which can optimize the treatment duration. […] Patients with smooth disappearance of TRAb had shorter treatment duration, and the recurrence rate was the lowest (36%). In contrast, patients with a fluctuating or smoldering type of TRAb had longer treatment periods and higher recurrence rates of 53% and 62%, respectively. Treating these patients for a longer period is reasonable because they are expected to have worse outcomes.
#17 Long-term follow-up result of antithyroid drug treatment of Gravesâ hyperthyroidism in a large cohort in: European Thyroid Journal Volume 12 Issue 2 (2023)
https://etj.bioscientifica.com/view/journals/etj/12/2/ETJ-22-0226.xml
The positive TRAb level at ATD discontinuation was also associated with short RFS after initial ATD therapy. […] In multivariate analysis, younger age (45 years), male sex, and changing patterns of TRAb (fluctuating group and smoldering group) were independent risk factors associated with short RFS of Graves hyperthyroidism.
#18 Long-term follow-up result of antithyroid drug treatment of Gravesâ hyperthyroidism in a large cohort in: European Thyroid Journal Volume 12 Issue 2 (2023)
https://etj.bioscientifica.com/view/journals/etj/12/2/ETJ-22-0226.xml
ATD treatment is an acceptable option for the initial treatment of Graves hyperthyroidism as well as for recurrent disease. The optimal treatment period for ATD treatment needs to be determined using the individual risk factors of recurrence. […] Younger age (45 years), male sex, and fluctuating or smoldering of TRAb levels were independent risk factors of the first recurrence after ATD treatment. […] The change of TRAb helps predict the individual risk of recurrence, which can optimize the treatment duration. […] Patients with smooth disappearance of TRAb had shorter treatment duration, and the recurrence rate was the lowest (36%). In contrast, patients with a fluctuating or smoldering type of TRAb had longer treatment periods and higher recurrence rates of 53% and 62%, respectively. Treating these patients for a longer period is reasonable because they are expected to have worse outcomes.
#19 Best practices in the laboratory diagnosis, prognostication, prediction, and monitoring of Gravesâ disease: role of TRAbs | BMC Endocrine Disorders | Full Text
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-024-01809-9
The measurement of TRAbs is a sensitive and specific tool for differential diagnosis of thyrotoxicosis. […] The measurement of TRAbs is a sensitive and specific tool for accurate and rapid diagnosis of Graves disease. […] Baseline levels of TRAbs, along with other clinical indicators, can help in predicting treatment response to therapy in Graves Disease. […] Baseline levels of TRAbs can help in predicting prognosis and recurrence of Graves Disease, especially in young individuals. […] Higher baseline TRAbs levels were associated with greater risk of GD relapse, […] Higher baseline TRAbs levels were also associated with poorer prognosis after 12-18 months of therapy, irrespective of whether the patients received antithyroid drugs, radioiodine therapy, or surgical therapy. […] A scoring system was constructed and validated for predicting the risk of recurrent GD after 18 months of antithyroid drug (ATD) therapy using four baseline variables: age, serum fT4, TRAbs, and goitre size; the resultant GREAT (Graves Recurrent Events After Therapy) score of 0-1, 2-3, and 4-6 were associated with a recurrence risk of 16%, 44%, and 68% respectively.
#20 The „GREAT” score, a clinical tool that predicts the success of antithyroid drug therapy for Graves’ disease
https://www.thyroid.org/patient-thyroid-information/ct-for-patients/may-2017/vol-10-issue-5-p-11-12/
Graves disease is an autoimmune condition that affects the thyroid and is the most common cause of hyperthyroidism. […] Many studies have tried to identify factors which can predict the success of ATD therapy to determine whether or not a given patient treated with ATDs will have a recurrence of their hyperthyroidism after stopping their medication. […] A recent study from the Netherlands established a prediction tool called the Graves Recurrent Events After Therapy (GREAT) score. […] The present study seeks to validate the GREAT score and to predict the outcome of ATD treatment in large group of patients with Graves disease. […] Thus a higher GREAT score predicted a higher risk of relapse after stopping ATDs. […] The current study supports using the GREAT score, which can be easily calculated at the time of diagnosis, to predict the success of ATD therapy to treat Graves disease. […] Consequently, they may decide to pursue other treatment options from the outset.
#21 Best practices in the laboratory diagnosis, prognostication, prediction, and monitoring of Gravesâ disease: role of TRAbs | BMC Endocrine Disorders | Full Text
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-024-01809-9
The measurement of TRAbs is a sensitive and specific tool for differential diagnosis of thyrotoxicosis. […] The measurement of TRAbs is a sensitive and specific tool for accurate and rapid diagnosis of Graves disease. […] Baseline levels of TRAbs, along with other clinical indicators, can help in predicting treatment response to therapy in Graves Disease. […] Baseline levels of TRAbs can help in predicting prognosis and recurrence of Graves Disease, especially in young individuals. […] Higher baseline TRAbs levels were associated with greater risk of GD relapse, […] Higher baseline TRAbs levels were also associated with poorer prognosis after 12-18 months of therapy, irrespective of whether the patients received antithyroid drugs, radioiodine therapy, or surgical therapy. […] A scoring system was constructed and validated for predicting the risk of recurrent GD after 18 months of antithyroid drug (ATD) therapy using four baseline variables: age, serum fT4, TRAbs, and goitre size; the resultant GREAT (Graves Recurrent Events After Therapy) score of 0-1, 2-3, and 4-6 were associated with a recurrence risk of 16%, 44%, and 68% respectively.
#22 The „GREAT” score, a clinical tool that predicts the success of antithyroid drug therapy for Graves’ disease
https://www.thyroid.org/patient-thyroid-information/ct-for-patients/may-2017/vol-10-issue-5-p-11-12/
Graves disease is an autoimmune condition that affects the thyroid and is the most common cause of hyperthyroidism. […] Many studies have tried to identify factors which can predict the success of ATD therapy to determine whether or not a given patient treated with ATDs will have a recurrence of their hyperthyroidism after stopping their medication. […] A recent study from the Netherlands established a prediction tool called the Graves Recurrent Events After Therapy (GREAT) score. […] The present study seeks to validate the GREAT score and to predict the outcome of ATD treatment in large group of patients with Graves disease. […] Thus a higher GREAT score predicted a higher risk of relapse after stopping ATDs. […] The current study supports using the GREAT score, which can be easily calculated at the time of diagnosis, to predict the success of ATD therapy to treat Graves disease. […] Consequently, they may decide to pursue other treatment options from the outset.
#23
https://link.springer.com/article/10.1007/s11154-023-09848-8
Several of the genetic variants associated with particular clinical/biochemical phenotypes have also been independently associated with an increased risk of GD reoccurrence, albeit inconsistently across different study populations. […] Identifying genetic variants that are associated with both clinical phenotype and prognosis may be clinically valuable to recognise patients at higher risk of relapse, and may help elucidate mechanistic insight into the functional impacts of genetic variation in GD. […] A scoring model developed for predicting relapse of GD, GREAT (Graves Recurrent Events After Therapy), uses specific clinical parameters (age, serum TRAb, goitre size) to stratify GD patients into different classes of recurrence risk. […] The greatest benefit of using the GREAT+ score was described in those with a moderate risk of GD relapse (GREAT score class II), in whom the addition of genotyping significantly changed the recurrence risk. […] Genotyping of GD patients may have significant translational potential by enabling a personalised treatment plan and the future implementation of novel immunomodulatory therapies for appropriate patients.
#24 Graves’ Disease: Can It Be Cured?
https://e-enm.org/DOIx.php?id=10.3803/EnM.2019.34.1.29
If the definition of cure would also include the disappearance of thyroid antibodies in serum, the proportion of cured patients would become even lower. […] The average remission rate after a course of ATD is about 50%. Most recurrences occur within 4 years after discontinuation of ATD. Although prognosis is excellent after 4 years without relapse, late recurrences do occur and only one in three patients experiences permanent remission. […] Permanent cure of Graves’ hyperthyroidism is possible albeit at a low rate of about 27%. The cure rate would be even lower if cure also supposes the absence of TSH receptor antibodies.
#25 Graves’ Disease: Can It Be Cured?
https://e-enm.org/DOIx.php?id=10.3803/EnM.2019.34.1.29
Whether or not Graves’ hyperthyroidism can be really cured, depends on the definition of cure. If eradication of thyroid hormone excess suffices for the label cure, then all patients can be cured because total thyroidectomy or high doses of 131I will abolish hyperthyroidism albeit at the expense of creating another disease (hypothyroidism) requiring lifelong medication with levothyroxine. […] Discontinuation of antithyroid drugs is followed by 50% recurrences within 4 years; before starting therapy the risk of recurrences can be estimated with the Graves’ Recurrent Events After Therapy (GREAT) score. At 20-year follow-up about 62% had developed recurrent hyperthyroidism, 8% had subclinical hypothyroidism, and 3% overt hypothyroidism related to TSH receptor blocking antibodies and thyroid peroxidase antibodies. Only 27% was in remission, and might be considered cured.
#26 Gravesâ disease: moving forwards | Archives of Disease in Childhood
https://adc.bmj.com/content/108/4/276
Graves disease is a rare disorder that continues to present clinicians and families with a series of challenges. […] We understand more about long-term outcomes and their determinants and have greater awareness about the impact of the disease and its treatment on quality of life. […] The overall remission rate after 2 years of ATD in young people is only 20%â30%. […] The duration of ATD is one of the few modifiable risk factors, with a recent systematic review reporting some evidence of longer treatment duration increasing remission rate. […] When considering whether ATD treatment should be stopped, it is essential that a TRAb level is measured because if TRAbs are elevated, the chances of remission are low. […] Many young people will ultimately experience a relapse of their GD. […] The aim of RAI or a total thyroidectomy is to ablate or remove all functional thyroid tissue and so will necessitate lifelong levothyroxine replacement.
#27 Best practices in the laboratory diagnosis, prognostication, prediction, and monitoring of Gravesâ disease: role of TRAbs | BMC Endocrine Disorders | Full Text
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-024-01809-9
At the end of 18 months of ATD therapy, TRAb assessment will help define further course of action. […] Patients with low or undetectable TRAbs levels have a high probability of permanent remission: GD may relapse in around 20-30% of such patients after stopping ATD therapy. […] On the other hand, patients with persistently elevated TRAbs levels are unlikely to be in remission and require further therapy, and GD may relapse in around 80-100% of such patients after stopping ATD therapy. […] By considering baseline TRAbs in addition to clinical variables such as age, gender, thyroid volume, and severity of hyperthyroidism, it is possible to identify and stratify patients into categories with low or high risk of remission following treatment, as well as predict the prognosis and recurrence of GD.
#28 Predictive factors for the outcomes of Gravesâ disease patients with radioactive iodine (131I) treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC6944668/
Although radioactive iodine (131I) treatment (RIT) is recommended as the preferred option for patients with Graves disease (GD), the predictive factors for its clinical outcomes are still unclear. […] The present study implied that a calculated dose approach for GD is effective, but high failure rates are expected in patients presenting poor 24-h RAIU, particularly those with 24-h RAIU below 46.31%. […] The present study shows that a calculated dose of RAI based on TV was efficient for the treatment of GD. Besides, the 24-h RAIU may be an important reference to predict the therapeutic outcomes in this approach. […] An exorbitant RAI dosage may not benefit but induce extra TPO and TG antibody expression. […] In conclusion, our study has shown that a calculated dose for treatment of GD is effective, but high failure rates are expected in patients presenting poor 24-h RAIU, particularly those with 24-h RAIU below 46.31%.
#29 Prediction of post-treatment hypothyroidism using changes in thyroid volume after radioactive iodine therapy in adolescent patients with Graves’ disease | International Journal of Pediatric Endocrinology | Full Text
https://ijpeonline.biomedcentral.com/articles/10.1186/1687-9856-2011-14
The goal of iodine-131 therapy for pediatric Graves’ disease is to induce hypothyroidism. […] The aim of this retrospective study was to examine whether changes in thyroid volume predict post-treatment hypothyroidism in adolescent Graves’ disease patients. […] About 90% of patients whose thyroid volume at 3 months after iodine-131 administration was less than 50% of the original volume were hypothyroid by one year after treatment (positive predictive value 88%, sensitivity 75.9%, specificity 85.0%). […] We believe ultrasonographic measurement of thyroid volume at 3 months after iodine-131 to be clinically useful for predicting post-treatment hypothyroidism in adolescent Graves’ disease patients. […] We found that about 90% of our patients had become hypothyroid at one year when thyroid volume was less than 50% of the original volume at 3 months after iodine-131 administration (positive predictive value 88%, sensitivity 75.9%, specificity 85.0%). […] We also demonstrated that approximately 90% of patients became hypothyroid within one year when thyroid volume was less than 50% of the original volume at 3 months after RAI therapy.
#30 Graves’ Disease: Can It Be Cured?
https://e-enm.org/DOIx.php?id=10.3803/EnM.2019.34.1.29
Whether or not Graves’ hyperthyroidism can be really cured, depends on the definition of cure. If eradication of thyroid hormone excess suffices for the label cure, then all patients can be cured because total thyroidectomy or high doses of 131I will abolish hyperthyroidism albeit at the expense of creating another disease (hypothyroidism) requiring lifelong medication with levothyroxine. […] Discontinuation of antithyroid drugs is followed by 50% recurrences within 4 years; before starting therapy the risk of recurrences can be estimated with the Graves’ Recurrent Events After Therapy (GREAT) score. At 20-year follow-up about 62% had developed recurrent hyperthyroidism, 8% had subclinical hypothyroidism, and 3% overt hypothyroidism related to TSH receptor blocking antibodies and thyroid peroxidase antibodies. Only 27% was in remission, and might be considered cured.
#31 Gravesâ disease: moving forwards | Archives of Disease in Childhood
https://adc.bmj.com/content/108/4/276
Graves disease is a rare disorder that continues to present clinicians and families with a series of challenges. […] We understand more about long-term outcomes and their determinants and have greater awareness about the impact of the disease and its treatment on quality of life. […] The overall remission rate after 2 years of ATD in young people is only 20%â30%. […] The duration of ATD is one of the few modifiable risk factors, with a recent systematic review reporting some evidence of longer treatment duration increasing remission rate. […] When considering whether ATD treatment should be stopped, it is essential that a TRAb level is measured because if TRAbs are elevated, the chances of remission are low. […] Many young people will ultimately experience a relapse of their GD. […] The aim of RAI or a total thyroidectomy is to ablate or remove all functional thyroid tissue and so will necessitate lifelong levothyroxine replacement.
#32 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
At the end of follow-up, 47% had one or more autoimmune diseases, including vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). […] GD patients who developed hypothyroidism had reduced quality of life. […] Careful lifelong monitoring is indicated to detect recurrence, hypothyroidism, and other autoimmune diseases. Long-term ATD treatment emerges as a beneficial first-line treatment option, especially in patients with young age at onset or presence of TED. […] We confirm that only one-third of GD patients obtain normal thyroid function. Many develop hypothyroidism and permanently reduced quality of life, either spontaneously or secondary to ablative treatment, arguing for longer ATD treatment as a beneficial treatment option. […] Current clinical guidelines should consider recommending long-term ATD treatment as a standard approach in patients with young age, smoking, or TED at onset.
#33 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
At the end of follow-up, 47% had one or more autoimmune diseases, including vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). […] GD patients who developed hypothyroidism had reduced quality of life. […] Careful lifelong monitoring is indicated to detect recurrence, hypothyroidism, and other autoimmune diseases. Long-term ATD treatment emerges as a beneficial first-line treatment option, especially in patients with young age at onset or presence of TED. […] We confirm that only one-third of GD patients obtain normal thyroid function. Many develop hypothyroidism and permanently reduced quality of life, either spontaneously or secondary to ablative treatment, arguing for longer ATD treatment as a beneficial treatment option. […] Current clinical guidelines should consider recommending long-term ATD treatment as a standard approach in patients with young age, smoking, or TED at onset.
#34 Graves, disease in clinical perspective
https://www.imrpress.com/journal/FBL/24/1/10.2741/4708/htm
Persistently elevated TRAb levels (â¥ 10 IU/I 6 months after initial diagnosis) seem also to represent a further risk factor for relapse prediction as mentioned above. […] A high TRAb at diagnosis and/or positive TRAb at cessation of therapy were described to suggest a high likelihood of relapse, mostly within the first two years. […] Interestingly, Vos et al. also confirmed these risk factors by his prediction model. […] Here, again a larger goiter size at diagnosis and higher serum TRAb levels but also PTPN22 C/T polymorphism and some HLA subtypes were described as independent predictors for recurrence. […] Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease.
#35 Graves Disease: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/120619-overview
A study by Song et al indicated that in patients with long-standing Graves disease, following a 2-year course of antithyroid drugs, the risk of developing diabetes mellitus is 1.18 times higher than that of controls. More specifically, the investigators reported that in patients who, following a 2-year course of antithyroid drugs, continued on such medications for at least 1 more year, with no radioactive iodine ablation, the risk for diabetes was 1.17 times higher. For those who at some point after the initial 24-month drug course underwent radioactive iodine ablation, the risk was 1.88 times higher. It was also found that the diabetes risk rose as the duration of antithyroid drug treatment increased.
#36 The role of Gravesâ disease in the development of thyroid nodules and thyroid cancer in: European Thyroid Journal Volume 12 Issue 4 (2023)
https://etj.bioscientifica.com/view/journals/etj/12/4/ETJ-23-0055.xml
Patients with Graves disease had a high prevalence of thyroid nodules and their nodules had a significant risk of thyroid cancer. The risk was higher in those with multiple and larger nodules. Most had low-grade papillary thyroid cancer. […] The prevalence of thyroid nodules and the risk of thyroid cancer in patients with Graves disease is uncertain. […] Patients with multiple nodules on ultrasound (OR 1.61, 95%CI 1.04-2.49) and with larger nodules (OR 2.96, 95%CI 1.08-8.14, for 10 mm increase in size) had a greater risk of thyroid cancer diagnosis. […] All of the thyroid cancers diagnosed were low-grade papillary carcinomas. Patients with multiple nodules and larger nodules had a higher risk of thyroid malignancy. […] Our study suggests that patients who had more and larger nodules have an increased risk of developing thyroid cancer.
#37 Prediction model of Gravesâ disease in general clinical practice based on complete blood count and biochemistry profile
https://www.jstage.jst.go.jp/article/endocrj/69/9/69_EJ21-0741/_html/-char/en
Although untreated Graves disease (GD) is associated with a higher risk of cardiac complications and mortality, there is no well-established way to predict the onset of thyrotoxicosis in clinical practice. […] Early diagnosis of GD may be of benefit in preventing severe cardiac or musculoskeletal complications. […] The prediction model using Prediction One enabled us to predict thyrotoxicosis and differentiate between GD and PT with high predictive values based on the complete blood count and biochemistry parameter values. […] The results of this study showed that by using artificial intelligence software and logistic regression models it is possible to predict a diagnosis of GD with high discriminative ability on the basis of only information on age and serum CRE, T-Cho, ALP, and TP levels.
#38 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
At the end of follow-up, 47% had one or more autoimmune diseases, including vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). […] GD patients who developed hypothyroidism had reduced quality of life. […] Careful lifelong monitoring is indicated to detect recurrence, hypothyroidism, and other autoimmune diseases. Long-term ATD treatment emerges as a beneficial first-line treatment option, especially in patients with young age at onset or presence of TED. […] We confirm that only one-third of GD patients obtain normal thyroid function. Many develop hypothyroidism and permanently reduced quality of life, either spontaneously or secondary to ablative treatment, arguing for longer ATD treatment as a beneficial treatment option. […] Current clinical guidelines should consider recommending long-term ATD treatment as a standard approach in patients with young age, smoking, or TED at onset.
#39 Long-term follow-up result of antithyroid drug treatment of Gravesâ hyperthyroidism in a large cohort in: European Thyroid Journal Volume 12 Issue 2 (2023)
https://etj.bioscientifica.com/view/journals/etj/12/2/ETJ-22-0226.xml
ATD treatment is an acceptable option for the initial treatment of Graves hyperthyroidism as well as for recurrent disease. The optimal treatment period for ATD treatment needs to be determined using the individual risk factors of recurrence. […] Younger age (45 years), male sex, and fluctuating or smoldering of TRAb levels were independent risk factors of the first recurrence after ATD treatment. […] The change of TRAb helps predict the individual risk of recurrence, which can optimize the treatment duration. […] Patients with smooth disappearance of TRAb had shorter treatment duration, and the recurrence rate was the lowest (36%). In contrast, patients with a fluctuating or smoldering type of TRAb had longer treatment periods and higher recurrence rates of 53% and 62%, respectively. Treating these patients for a longer period is reasonable because they are expected to have worse outcomes.
#40 Gravesâ disease: moving forwards | Archives of Disease in Childhood
https://adc.bmj.com/content/108/4/276
The short-term and long-term impact of GD on the young person from a physical, psychological and social perspective should not be underestimated. […] Whether immunomodulatory therapies alter the long-term outcome of GD as opposed to simply delaying relapse is unclear. […] The emergence of potential novel therapeutic options is an exciting prospect for the future management of GD.
#41 Long term outcomes of patients with Gravesâ Disease
https://www.thyroid.org/patient-thyroid-information/ct-for-patients/february-2024/vol-17-issue-2-p-7-8/
HYPERTHYROIDISM Long term outcomes of patients with Graves Disease […] Patients frequently ask their physician how long they will need to take anti-thyroid medications or whether they will have Graves disease forever. Unfortunately, the long-term behavior of Graves disease remains unknown. This study examines the clinical outcomes of individuals with Graves disease more than 20 years after their initial diagnosis and treatment. […] This research shows that Graves disease is a challenging condition with unpredictable long-term results. Many patients go through a persistent or recurring pattern and need either decisive treatment or prolonged use of antithyroid medications. Additionally, many develop other autoimmune disorders or thyroid eye disease. Given the relatively frequent rate of disease recurrence, even in those who initially achieved remission, long term monitoring of thyroid function is necessary.
#42 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
At the end of follow-up, 47% had one or more autoimmune diseases, including vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). […] GD patients who developed hypothyroidism had reduced quality of life. […] Careful lifelong monitoring is indicated to detect recurrence, hypothyroidism, and other autoimmune diseases. Long-term ATD treatment emerges as a beneficial first-line treatment option, especially in patients with young age at onset or presence of TED. […] We confirm that only one-third of GD patients obtain normal thyroid function. Many develop hypothyroidism and permanently reduced quality of life, either spontaneously or secondary to ablative treatment, arguing for longer ATD treatment as a beneficial treatment option. […] Current clinical guidelines should consider recommending long-term ATD treatment as a standard approach in patients with young age, smoking, or TED at onset.
#43 Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy
https://pmc.ncbi.nlm.nih.gov/articles/PMC10876387/
At the end of follow-up, 47% had one or more autoimmune diseases, including vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). […] GD patients who developed hypothyroidism had reduced quality of life. […] Careful lifelong monitoring is indicated to detect recurrence, hypothyroidism, and other autoimmune diseases. Long-term ATD treatment emerges as a beneficial first-line treatment option, especially in patients with young age at onset or presence of TED. […] We confirm that only one-third of GD patients obtain normal thyroid function. Many develop hypothyroidism and permanently reduced quality of life, either spontaneously or secondary to ablative treatment, arguing for longer ATD treatment as a beneficial treatment option. […] Current clinical guidelines should consider recommending long-term ATD treatment as a standard approach in patients with young age, smoking, or TED at onset.
#44 Graves’ Disease: Can It Be Cured?
https://e-enm.org/DOIx.php?id=10.3803/EnM.2019.34.1.29
If the definition of cure would also include the disappearance of thyroid antibodies in serum, the proportion of cured patients would become even lower. […] The average remission rate after a course of ATD is about 50%. Most recurrences occur within 4 years after discontinuation of ATD. Although prognosis is excellent after 4 years without relapse, late recurrences do occur and only one in three patients experiences permanent remission. […] Permanent cure of Graves’ hyperthyroidism is possible albeit at a low rate of about 27%. The cure rate would be even lower if cure also supposes the absence of TSH receptor antibodies.
#45 Graves’ Disease > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/graves-disease
Graves disease is not fatal, but complications may negatively impact a persons overall health or life expectancy. […] Complications of Graves disease, including arrhythmia, heart failure, or stroke, may shorten an individuals life expectancy, but these complications are not common among people who manage their disease. […] People with Graves disease may be able to manage their condition with medication and other treatments. A small percentage of people with Graves disease, especially those with mild Graves disease, may go into remission. The remission may only be temporary, particularly among children.
#46 Gravesâ Disease: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/15244-graves-disease
If Graves disease is properly treated, the prognosis (outlook) is generally good. […] Treatment for Graves disease is lifelong. People who receive definitive treatment for Graves disease (radioactive iodine or thyroidectomy) will eventually develop hypothyroidism (underactive thyroid), which requires lifelong medication. People who take antithyroid drugs to treat Graves disease usually have to take them throughout their life. […] Untreated or poorly managed Graves disease increases your risk for these complications: […] If you have thyroid eye disease (Graves ophthalmopathy) that isnt properly treated, it can cause severe swelling that can damage your optic nerve and lead to vision loss.