25-year follow-up: Only 1/3 of patients with Graves' disease were in remission, affected by 3 factors such as smoking| 2022 ATA

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Introduction: Currently, there are no detailed studies of long-term follow-up after treatment of Graves disease (GD), and a 25-year follow-up study fills this gap, presented at the 2022 American Thyroid Association Annual Meeting (2022ATA), which provides a detailed analysis of follow-up including recurrence rates after GD treatment, thyroid eye disease (TED), and related autoimmune diseases
.

One study followed up to 25 years

Graves disease (GD) is an organ-specific autoimmune disease that is the leading cause of
hyperthyroidism worldwide.
The short-term clinical course is well described, but detailed studies of long-term outcomes, including recurrence rates, thyroid eye disease (TED), and associated autoimmunity
, are lacking.

Retrospective follow-up of patients with GD who participated in randomized antithyroid drug therapy trials from 1997 to 2001
.
Demographic and clinical data obtained through a review of medical records and accompanying access volumes resulted in the inclusion of 83% (182/218) of patients
in the original study.

Long-term remission in 34% of patients is influenced by multiple factors

➤ By the end of follow-up, 34 percent of patients had achieved long-term remission
.
Of the remaining patients, those with active disease (1%), spontaneous hypothyroidism (13%), or radioactive iodine therapy (RAI) (40%) or thyroidectomy (12%)
.

➤ The long-term response rate was 12% in patients who relapsed within two years, and 62% in patients who did not relapse within the first two years (odds ratio OR 12).

➤ Age less than 40 years and long-term smoking reduced the probability of long-term remission (OR 0.
52 and 0.
46, respectively).

16% of patients found TED at the time of first treatment with GD; At the end of follow-up, it was 21%.

The first occurrence of TED in GD reduced the probability of long-term remission (OR of 0.
46).

➤ 10% of patients developed TED that required long-term treatment, and 15% of patients developed a TED flare-up
while receiving RAI.

At the end of follow-up, 46 percent of patients were treated for
one or more autoimmune-related diseases.
Vitamin B12 deficiency (26%), hypothyroidism (13%) and rheumatoid arthritis (6%) were the most common
.

Patients with autoimmune diseases had an increased risk of developing TED during the course of the disease (28.
6% vs.
15.
8%, P=0.
04, OR 2.
13).

Summary of this article

This long-term follow-up study showed that only 34% of patients treated with GD achieved long-term remission, which had a significant impact on long-term morbidity, with smoking, young age of onset, and the presence of TED reducing long-term remission rates
.
Therefore, lifelong follow-up monitoring
of patients is required.

REFERENCE: LONG‐TERM MORTALITY AND CARDIOMETABOLIC EFFECTS OF TREATMENT FOR HYPERTHYROIDISM: EGRET STUDY.
THYROIDVolume 32， Supplement 1，2022.
https：//doi.
org/10.
1089/thy.
2022.
29140.
lb.
abstracts