ORIGINAL ARTICLE

Clinical Spectrum and Outcome of Patients with Graves’ Disease: A Single-Center Experience from a Tertiary Care Institution in the Kashmir Valley, India
Graves Hastalığı Olan Hastaların Klinik Spektrumu ve Sonuçları: Keşmir Vadisindeki (Hindistan) Üçüncü Basamak Bir Sağlık Kurumunda Tek-Merkezli Deneyim
Received Date : 17 Jun 2020
Accepted Date : 26 Nov 2020
Available Online : 19 Jan 2021
Doi: 10.25179/tjem.2020-77446 - Makale Dili: EN
Turk J Endocrinol Metab. 2021;25:21-31
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: Graves’ disease (GD) is a common autoimmune disorder with variable outcomes. To study the clinical manifestations and treatment outcome of GD in the post-iodization scenario. Material and Methods: The present study was designed as a cross-sectional study, in which a total of 180 patients with GD (127 males and 53 females) attending our center were reviewed retrospectively. The demographic data, modes of treatment, comorbidities, remission, and recurrence rates were determined for the patients. All patients were initially treated with anti-thyroid drugs (ATDs), with the subsequent management depending on the course of the disease. Results: The mean (±SD) age at diagnosis was 38.30 (10.73) years and the lag period between the onset of symptoms and the diagnosis was 5.12 (2.69) months, with the male patients having a significantly shorter duration of illness compared to females (4.36 vs. 5.44 months; P=0.015). Majority of the patients presented with the typical symptoms and signs associated with hyperthyroidism and/or goiter, although the atypical presentations were not uncommon. ATDs were the most preferred treatment modality employed to achieve clinical and biochemical remission. The mean duration of achieving euthyroidism and the normalization of TSH levels were 3.31±1.51 and 7.45±3.35 months, respectively. On follow-up at three months, 46.1% of the patients were euthyroid, with normalization of the TSH levels in 15.6% of them. Failure to achieve early remission/disease control was significantly higher in males (p=0.003) and smokers (p=0.036). Between the 72 patients who completed medical therapy, 49 patients achieved remission, of whom 20 patients relapsed with a firstyear relapse rate of 20.4%. Disease relapse was significantly associated with higher initial 99 mTechnetium (99mTc) uptake (p=0.022) and higher grade of goiter (p=0.026) at presentation. The logistic regression analysis revealed male gender (p=0.048) and orbitopathy (p=0.036) as the independent risk factors predicting relapse of the GD. Conclusion: Graves’ disease manifests with varied clinical manifestations, including the atypical ones, warranting careful clinical assessment to ensure an accurate diagnosis. Gender and orbitopathy are the independent risk factors predicting the relapse of the disease.
ÖZET
Amaç: Graves hastalığı (GD), çeşitli sonuçları olan yaygın bir otoimmün bozukluktur. İyodizasyon sonrasında GD’nin klinik belirtilerinin ve tedavi sonuçlarının incelenmesi. Gereç ve Yöntemler: Bu çalışma, merkezimize başvuran toplam 180 GD'li (127 erkek ve 53 kadın) hastanın retrospektif olarak incelendiği kesitsel bir çalışma olarak tasarlandı. Hastaların demografik verileri, tedavi şekilleri, komorbiditeleri, remisyon ve relaps oranları belirlendi. Tüm hastalar başlangıçta anti-tiroid ilaçlar (ATD'ler) ile tedavi edildi ve ardından hastalığın seyrine bağlı olarak yönetildi. Bulgular: Tanı anındaki ortalama (±SS) yaş 38,30 (10,73) idi, semptomların başlangıcı ile tanı arasındaki gecikme süresi 5,12 (2,69) aydı, erkek hastalar kadınlara göre anlamlı olarak daha kısa hastalık süresine sahipti (4,36 vs 5,44 ay; p=0,015). Hastaların çoğunluğu hipertiroidizm ve/veya guatr ile ilişkili tipik semptom ve bulgularla başvurdu, ancak atipik tablolar da nadir değildi. ATD'ler, klinik ve biyokimyasal remisyon sağlamak için en çok tercih edilen tedavi yöntemiydi. Ötiroidizme ulaşılması ve TSH düzeylerinin normalleşmesi için geçen ortalama süre sırasıyla 3,31±1,51 ve 7,45±3,35 aydı. Üç aylık takipte, hastaların %46,1'i ötiroid oldu ve %15,6'sında TSH seviyeleri normalleşti. Erken remisyon/hastalık kontrolü sağlanamaması erkeklerde (p=0,003) ve sigara içenlerde (p=0,036) anlamlı olarak daha yüksekti. Medikal tedaviyi tamamlayan 72 hastadan 49'unda remisyon sağlandı, bunlardan 20'sinde relaps izlendi, ilk yıl relaps oranı %20,4 idi. Hastalığın relapsı, başvuru sırasındaki daha yüksek başlangıç 99 mTechnetium (99mTc) alımı (p=0,022) ve daha yüksek guatr derecesi (p=0,026) ile anlamlı şekilde ilişkiliydi. Lojistik regresyon analizine göre, GD relapsını öngördüren bağımsız risk faktörleri erkek cinsiyet (p=0,048) ve orbitopati (p=0,036) idi. Sonuç: Graves hastalığı, atipik olanlar da dahil olmak üzere çeşitli klinik belirtilerle kendini gösterir ve doğru tanı için dikkatli bir klinik değerlendirme gereklidir. Cinsiyet ve orbitopati, hastalığın relapsını öngördüren bağımsız risk faktörleridir.
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