Results of 25 years of follow-up: Only 34% of Graves' disease has long-term remission, which is affected by 3 factors such as smoking | 2022 ATA

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Introduction: At present, there are no detailed studies of long-term follow-up after treatment for Graves disease (GD), and the results of a 25-year follow-up study that was published at the 2022 American Thyroid Association Annual Meeting (2022ATA) analyzed in detail the follow-up of relapse rates after GD treatment, thyroid eye disease (TED), and related autoimmune diseases
.

One study was followed for 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.

Patients with GD who participated in randomized antithyroid drug therapy trials from 1997 to 2001 were followed
retrospectively.
Demographic and clinical data obtained by reviewing medical records and follow-up questionnaires included a total of 83% (182/218) of patients
in the original study.

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

➤ At the end of follow-up, 34% of patients achieved long-term remission: the remaining patients had active disease (1%), spontaneous hypothyroidism (13%), or had received 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 younger than 40 years and long-term smoking reduced the probability of long-term remission (OR 0.
52 and 0.
46, respectively).

TED was found in 16% of patients at the first treatment for GD; It was 21%
at the end of follow-up.
The first occurrence of GD TED reduced the probability of long-term remission (OR of 0.
46).

➤ Of all included patients, 10% developed TED
requiring long-term treatment.
15% of patients treated with RAI had a sudden episode of TED
.

➤ At the end of follow-up, 46% 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 with GD achieved long-term remission, which had a significant impact on long-term morbidity, with smoking, young age of onset, and presence of TED reducing long-term remission rates
.
Therefore, lifelong follow-up
monitoring of patients is required.

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