Thyroid Eye Disease

Antithyroid drug treatment shown effective over 25 years for Graves’ disease

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A recent comprehensive 25-year study on Graves’ disease (GD) treatment underscores the importance of careful, lifelong monitoring for GD patients to detect potential recurrence, hypothyroidism, and other autoimmune diseases.

The study also emphasizes that long-term antithyroid drug (ATD) treatment is a beneficial first-line option, particularly for patients with an early onset of the disease or the presence of thyroid eye disease (TED).

The study was conducted as a retrospective follow-up of patients with GD who participated in a randomized trial from 1997 to 2001.

Of the original cohort consisting of 218 patients, 83% (n = 182) were included in the follow-up. At the conclusion of the study period, 34% of patients achieved normal thyroid function. The remaining individuals were categorized as having active disease (1%), spontaneous hypothyroidism (13%), or having undergone ablative treatment with either radioiodine (40%) or thyroidectomy (13%).

The research also identified several key predictors associated with relapse. Age, specifically ≤40 years, presence of TED, smoking, and elevated levels of interleukin 6 and tumor necrosis factor receptor superfamily member 9 (TNFRS9) were found to significantly increase the risk of recurring disease.

Furthermore, CD40 levels were observed to be lower in patients who maintained normal thyroid function at the end of treatment.

The authors note that 47% of patients developed one or more additional autoimmune diseases by the end of follow-up, including vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). Those who transitioned to hypothyroidism reported a reduced quality of life.

Meling Stokland AE, Austdal M, Nedrebø BG, et al. Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy. J Clin Endocrinol Metab. 2023;dgad538. doi: 10.1210/clinem/dgad538. Epub ahead of print. PMID: 37747433.