ORIGINAL ARTICLE

Risk Factors for the Relapse of Graves’ Disease Following Withdrawal of Antithyroid Drugs
Antitiroid İlaçların Kesilmesini Takiben Graves’ Hastalığının Nüksü ile İlişkili Risk Faktörleri
Received Date : 11 Feb 2021
Accepted Date : 16 Jun 2021
Available Online : 05 Jul 2021
Doi: 10.25179/tjem.2021-82251 - Makale Dili: EN
Turk J Endocrinol Metab. 2021;25:272-278
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objectives: The treatment of Graves’ disease (GD) with antithyroid drugs (ATD) is associated with a risk of relapse. The rate and predictive factors of GD are controversial. This study aimed to assess the relapse rate after the withdrawal of ATD in patients with GD, as well as to identify its predictive factors. Material and Methods: This was a retrospective cohort study covering 35 patients with GD that were treated with ATD. Relapse was defined as the state when hyperthyroidism was detected after the withdrawal of medical therapy. Relapse was studied by establishing the survival curve according to Kaplan-Meier’s method. The Log-Rank test was used to compare the survival curves according to the clinical, biological, and therapeutic parameters of the patients. Results: The mean follow-up time after the withdrawal of ATD was 32.8±28.8 months. Relapse was observed in 13 patients (37%) after an average time of 7.8±8.8 months of ATD discontinuation. Factors associated with the risk of relapse were smoking (p=0.08), family history of thyroid disease (p=0.03), the presence of a triggering factor (p=0.004), FT4 level at the time of diagnosis at >2.3 times the normal range (p=0.002), thyroid-stimulating hormone level less than 0.76 mIU/L at three months after ATD withdrawal (p=0.05), and a benzylthiouracil dose of >125 mg/day at the time of ATD discontinuation (p=0.02). Conclusion: Relapse in patients with GD after the withdrawal of ATD is observed in almost a third of the patients. Identification of patients at a high risk of relapse is necessary to indicate radical treatment.
ÖZET
Amaç: Graves hastalığının [Graves’ disease (GD)] antitiroid ilaçlarla [antithyroid drugs (ATD)] tedavisi nüks riski ile ilişkilidir. GD’nin oranı ve prediktif faktörleri tartışmalıdır. Bu çalışmada, GD’li hastalarda ATD’nin kesilmesinden sonraki nüks oranını değerlendirmek ve ilgili prediktif faktörleri belirlemek amaçlanmıştır. Gereç ve Yöntemler: ATD ile tedavi edilen GD’li 35 hastayı kapsayan bu retrospektif kohort çalışmasında, nüks medikal tedavinin kesilmesinden sonra hipertiroidinin saptanması durumu olarak tanımlanmıştır. Nüks, Kaplan-Meier yöntemine göre sağkalım eğrisi oluşturularak incelenmiştir. Log-Rank testi, hastaların klinik, biyolojik ve terapötik parametrelerine göre sağkalım eğrilerini karşılaştırmak için kullanılmıştır. Bulgular: ATD’nin kesilmesinden sonraki ortalama takip süresi 32,8±28,8 aydır. ATD’nin kesilmesinden ortalama 7,8±8,8 ay sonra 13 hastada (%37) nüks gözlenmiştir. Nüks riski ile ilişkili faktörler sigara (p=0,08), ailede tiroid hastalığı öyküsü (p=0,03), tetikleyici faktör varlığı (p=0,004), tanı anındaki FT4 seviyesinin normalin >2,3 katı olması (p=0,002), ATD’nin kesilmesinden sonraki 3 ayda tiroid stimüle edici hormon düzeyinin 0,76 mIU/L'den düşük olması (p=0,05) ve ATD’nin kesilmesi sırasında benziltiyourasil dozunun >125 mg/gün olması (p=0,02) olarak bulunmuştur. Sonuç: GD’li hastalarda, ATD’nin kesilmesinden sonra hastaların yaklaşık 1/3’ünde nüks görülmektedir. Radikal tedavi endikasyonu için yüksek nüks riski taşıyan hastaların belirlenmesi gereklidir.
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