Predictive factors for recurrence in patients with Graves’ Disease following treatment with methimazole

https://doi.org/10.19106/JMedSci005303202102

Mohammad Robikhul Ikhsan(1), Raden Bowo Pramono(2), Hemi Sinorita(3*), Vina Yanti Susanti(4)

(1) Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(2) Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(3) Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(4) Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(*) Corresponding Author

Abstract


Graves’ disease (GD) contributes for 60–80% of all hyperthyroidism. Methimazole
is the first line drug and most commonly used as antithyroid drug (ATD). However,
the relapse rate following ATD therapy is 40–50%. The aimed of this study
was to evaluate long-term ATD treatments and to identify prognostic factors
that contribute to GD recurrence. A total of 46 GD patients who referred to the
Endocrinology Clinic, Dr. Sardjito General Hospital, Yogyakarta between January
2016 and December 2018 with thyrotropin receptor antibody (TRAb) tested and
treated with methimazole were included in this study. Size of goiter was measured
based on WHO grading system and eye syndrome based on NOSPEC score system.
Patients were classified into recurrence and remission groups based on TRAb
evaluation at 12 month following treatment. Result of thyroid hormone level (FT4)
and subject characteristic as predictive factors observed at 3-, 6- and 12-month post-
treatment were compared and analyzed.
Among 46 patient involved in this study, 23
patients demonstrated remission of hyperthyroidism based on TRAb evaluation at
12-month. The size of thyroid at onset of disease in 30 (65%) patients was grade 2 or
above (p<0.05). Free FT4 levels at the end of observation (12 month) was 1.9±0.6 ng/
dL in recurrent and 1.4±0.5 ng/dL in remission group (p<0.05). TRAb levels at early
of study was higher in the recurrent group (p<0.05). Logistic regression analysis
demonstrated that thyroid size, FT4 level, and TRAb at diagnosis were associated
with recurrencies. In conclusion, GD patients with large thyroids size, high TRAb
levels, and high FT4 level at the onset of disease tended to fail to respond to ATD and
were associated with recurrence incidence.

Full Text:

PDF


References

Jameson JL, Weetman AP. Disorders of thyroid gland. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL (eds). Harrison's Principles of Internal Medicine. 16th eds. New York, NY: McGrawHill, 2005; 2104-27.
2.Tomer Y. Mechanisms of autoimmune thyroid diseases: From genetics to epigenetics. Annu Rev Pathol 2014; 9:147-56.
https://doi.org/10.1146/annurev-pathol-012513-104713
3.Tozzoli R, Bagnasco M, Giavarina D, Bizzaro N. TSH receptor autoantibody immunoassay in patients with Graves’ disease: Improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis. Autoimmun Rev 2012; 12(2):107-13.
https://doi.org/10.1016/j.autrev.2012.07.003
4.Braverman L, Cooper D. Werner & Ingbar’s The Thyroid : a fundamental and clinical text, 10th. Philadelphia: Wolter Kluwers, 2013.
5.Bagnasco M, Venuti D, Caria M, Pizzamo G, Ferrini O, Canonica GW. Methimazole, γ”interferon and graves' disease. In: Pinchera A, Ingbar SH, McKenzie JM and Fenzi GF (eds). Thyroid autoimmunity, 1st ed. New York, NY: Springer US, 1987; 445-7.
6.Lewinski A. The problem of goitre with particular consideration of goitre resulting from iodine deficiency, classification, diagnostic and treatment. Neuro Endocrinol Lett 2002; 23(4):351-5.
7.Dolman PJ. Evaluating graves’ orbitopathy. Best Pract Res Clin Endocrinol Metab 2012; 26(3):229-48.
https://doi.org/10.1016/j.beem.2011.11.007
8.Abraham P, Avenell A, Park CM, Watson WA, Bevan JS. A systematic review of drug therapy for Graves' hyperthyroidism. Eur J Endocrinol 2005; 153(4):489-98.
https://doi.org/10.1530/eje.1.01993
9.Cooper DS. Antithyroid drugs. N Engl J Med 2005; 352(9):905-17.
https://doi.org/10.1056/NEJMra042972
10.Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016; 26(10):1343-1421.
https://doi.org/10.1089/thy.2016.0229
11.Kahaly GJ, Bartalena L, Hegedüs L, Leenhardt L, Poppe K, Pearce SH. 2018 European thyroid association guideline for the management of graves’ hyperthyroidism. Eur Thyroid J 2018; 7(4):167-86.
https://doi.org/10.1159/000490384
12.Shi BY. Antithyroid drugs: Rational and normative application all the more. Zhong Hua Nei Fen Mi Dai Xie Za Zhi 2009; 25:245-6.
13.Quadbeck B, Janssen OE, Mann K. Problems and new developments in the management of Graves' disease: Medical therapy. Z Arztl Fortbild Qualitatssich 2004; 98(Suppl 5):37-44.
14.Maugendre D, Gatel A, Campion L, Massart C, Guilhem I, Lorcy Y, et al. Antithyroid drugs and Graves' disease prospective randomized assessment of long term treatment. Clin Endocrinol 1999; 50(1):127-32.
https://doi.org/10.1046/j.1365-2265.1999.00629.x
15.Quadbeck B, Roggenbuck U, Janssen OE, Hahn S, Mann K, Hoermann R. Impact of smoking on the course of Graves' disease after withdrawal of antithyroid drugs. Exp Clin Endocrinol Diabetes 2006; 114(8):406-11.
https://doi.org/10.1055/s-2006-924065



DOI: https://doi.org/10.19106/JMedSci005303202102

Article Metrics

Abstract views : 574 | views : 1048




Copyright (c) 2021 Mohammad Robikhul Ikhsan, Raden Bowo Pramono, Hemi Sinorita, Vina Yanti Susanti

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

View My Stats

 

Creative Commons License
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) by  Universitas Gadjah Mada is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Based on a work at http://jurnal.ugm.ac.id/bik/.