The following is a summary of “Outcomes of Patients With Graves Disease 25 Years After Initiating Antithyroid Drug Therapy,” published in the March 2024 issue of Endocrinology by Stokland, et al.

Graves’ disease (GD) is a common cause of hyperthyroidism, but its long-term outcomes have not been detailed. For a study, researchers sought to investigate the outcomes of GD patients 25 years after initiating antithyroid drug (ATD) treatment, including disease course, predictors of relapse, and quality of life.

A retrospective follow-up was conducted on GD patients who participated in a randomized trial from 1997 to 2001. Data were collected from medical records and questionnaires. Biobank samples were analyzed for inflammatory biomarkers and compared with healthy controls.

Of the original 218 patients, 182 (83%) were included. At follow-up, 34% achieved normal thyroid function, while others had active disease (1%), spontaneous hypothyroidism (13%), or underwent radioiodine ablation (40%) or thyroidectomy (13%). Factors associated with relapse (odds ratio 3.22; 2.26; 2.21; 1.99; 2.36) included age ≤ 40 years, thyroid eye disease (TED), smoking, elevated interleukin 6, and tumor necrosis factor receptor superfamily member 9 (TNFRS9) levels. Lower CD40 levels were observed in patients with maintained normal thyroid function. Additionally, 47% developed one or more autoimmune diseases, such as vitamin B12 deficiency (26%) and rheumatoid arthritis (5%). Patients with hypothyroidism experience reduced quality of life.

Lifelong monitoring is essential to detect recurrence, hypothyroidism, and other autoimmune conditions in GD patients. Long-term ATD treatment showed promise, especially in younger patients or those with TED.

Reference: academic.oup.com/jcem/article/109/3/827/7281824