Endocrine Abstracts

After treatment, hyperthyroidism will relapse in approximately half of the Graves’ diseases patients, and clinically relevant orbitopathy will develop in about 25% of the diseased. Therefore, predicting who will relapse or develop orbitopathy is both clinically important and contributes to understanding of the pathophysiology of the disease. To predict the risk of recurrence of hyperthyroidism, before the start of antithyroid drug therapy, GREAT (based on clinical markers) and GREAT+ (based on clinical and genetic markers) scores were proposed. GREAT score is based on age, free thyroxin (fT4) concentration, thyrotropin-binding inhibitor immunoglobulin (TBII) concentration, and goitre size (according to the World Health Organization). GREAT+ score also includes HLA polymorphisms (DQB1-02, DQA1-05, DRB1-03) and PTPN22 C/T polymorphism. Higher score was correlated with the greater risk of hyperthyroidism relapse. Recurrence of hyperthyroidism occurred in 16% of the patients with the GREAT score 0–1, 44% when GREAT score is 2–3, and in 68% of the patients with the GREAT score 4–6. GREAT+ score further improved classification. Only 4% of subjects with GREAT+ score 0-2, had hyperthyroidism relapse, while 84% with GREAT+ score 7–10 relapsed. Independent, external validation of the GREAT score proved good validity of this score to predict disease relapse. To predict development or progression of Graves’ orbitopathy in patients with Graves’ hyperthyroidism PREDIGO score has been recently proposed. This score is based on clinical activity score (0 vs. > 0), TBII concentration, duration of hyperthyroid symptoms before therapy, and smoking. This score has very good negative predictive value (0.91). Predictive scores allow choosing appropriate therapy for the patients (drugs, surgery, radioactive iodine), thus enabling to prevent or minimize adverse effects of the chosen therapy.