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Recurrent hyperthyroidism after antithyroid drug therapy is common in patients with severe Graves’ eye disease
The background of the study. Some patients with hyperthyroidism caused by Graves’ disease have eye disease, which is thought to indicate more severe Graves’ disease. This study was done to determine the effect of varying degrees of eye disease on the natural history of Graves’ hyperthyroidism.
How the study was done. The study subjects were 158 patients with Graves’ hyperthyroidism and eye disease. All had the onset of eye disease within the preceding six months, had been treated with an antithyroid drug for at least one year, and were followed for at least 18 months. Hyperthyroidism was considered in remission if the patient remained euthyroid for one year after cessation of drug therapy.
The patients were examined at three-month intervals. The activity of eye disease was assessed using the Clinical Activity Score, a 10-point score based on eye redness, swelling, and impaired function (0, inactive; 10, active), and its severity was assessed using the NOSPECS score (0, no signs; 16, marked signs).
The results of the study. The onset of eye disease preceded the onset of hyperthyroidism in 7 percent, appeared at the same time in 50 percent, appeared later in 24 percent, and appeared after the recurrence of hyperthyroidism and destructive antithyroid therapy in 19 percent.
The course of ophthalmopathy was mild in 41 percent and severe in 59 percent. The median follow-up after diagnosis of hyperthyroidism and onset of eye disease in the two groups was similar (46 vs. 41 months and 35 vs. 36 months, respectively).
After one year of antithyroid drug therapy, 42 percent of the mild-course patients remained euthyroid for at least one year, as compared with 8 percent in the severe-course group. Age, sex, and smoking status were not associated with recurrent hyperthyroidism.
The conclusions of the study. Patients with severe Graves’ ophthalmopathy are likely to have recurrent hyperthyroidism.
The original article. Eckstein AK, Lax H, Losch C, Glowacka D, Plicht M, Mann K, Esser J, Morgenthaler NG. Patients with severe Graves’ ophthalmopathy have a higher risk of relapsing hyperthyroidism and are unlikely to remain in remission. Clin Endocrinol (Oxf) 2007;67:607-12.
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| Thyroid Digest Index | | | November 2007 Thyroid Digest |
