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Several clinical findings predict the outcome of hyperthyroidism caused by Graves’ disease
The background of the study. Patients
with hyperthyroidism due to Graves’ disease who are treated
with an antithyroid drug may have hyperthyroidism again after the
drug is stopped. Treatment decisions would be easier if the course
could be reliably predicted. This study determined the importance
of clinical and biochemical variables for predicting outcome in
these patients.
How the study was done. Seventy-one patients (55 women, 16 men) with hyperthyroidism due to Graves’ disease were studied. They were treated with 10 to 40 mg of methimazole daily until they were euthyroid, after which the dose was reduced to maintain normal serum free thyroxine concentrations. The average maintenance dose was 5 mg daily. The total duration of therapy was 18 months, after which the patients were followed for two years or until recurrence of hyperthyroidism.
The analysis was based on 25 variables for which information was collected before and during therapy, including personal characteristics, mental changes, and clinical and biochemical findings such as weight loss, heart rate, serum free thyroxine values, thyroid size, and time to euthyroidism.
The results of the study. During the two-year follow-up period, 27 patients (38 percent) remained euthyroid and 44 (62 percent) had recurrent hyperthyroidism. The pretherapy findings that predicted recurrence of hyperthyroidism were the presence of smoking, mental changes requiring psychotropic drug therapy, rapid heart rate, presence of high thyroid blood flow, a high serum free thyroxine concentration, a high serum antithyroglobulin antibody concentration, and thyroid volume >20 ml. Based on these findings, the outcome was predicted correctly in 77 percent of the patients who had a recurrence and 85 percent of the patients who remained well.
The conclusions of the study. Among patients with hyperthyroidism due to Graves’ disease, the likelihood of prolonged remission can be predicted based on several findings at the time of diagnosis.
The original article. Orunesu E,
Bagnasco M, Salmaso C, Altrinetti V, Bernasconi D, Del Monte P,
Pesce G, Marugo M, Mela GS. Use of an artificial neural network
to predict Graves’ disease outcome within 2 years of drug
withdrawal. Eur J Clin Invest 2004;34:210-7.
Next Article: High serum thyrotropin-receptor
antibody levels predict recurrent hyperthyroidism in patients
with Graves’ disease
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| Thyroid Digest Index | | | July 2004 Thyroid Digest |
