Diagnosis and therapeutic practices of hyperthyroidism in france. results of a survey on 263 endocrinologists and 1214 patients (the thyrdel study)
B. Goichot1, P. Caron2, S. Bouée3, F. Luca1 & F. Landron4
There are considerable variations in diagnosis and therapeutical practices in hyperthyroidism (HT) between countries. Few of these differences rely on a scientific basis. we present the results of a study conducted among a representative sample of 263 French endocrinologists. All consecutive patients seen for HT during the study period were included. Symptoms, biological data and treatment were recorded. 1214 patients with hyperthyroidism were included, 1144 had an identified etiology: 802 Graves disease (GD), 121 multinodular goitres (MNG), 112 iatrogenic hyperthyroidism (mainly amiodarone), 69 toxic adenoma and 40 thyroiditis. Antithyroid antibodies were measured in about half of the population (antiTPO 48.2%, antiR-TSH 56.3%). Ultrasonography was performed in 93.8% whereas scintigraphy was done in only 40.3% of the patients. Therapeutic management depended on the etiology. For the first episode of GD, antithyroid drugs (ATD) alone were the first line treatment in 90.9% of the patients, combined to surgery in 6.1% and with radioiodine in 2.9%. Surgery was preferred to radiodiodine in MNG (51.7 vs 22%) and toxic adenoma (57.3 vs 23.5%).
Euthyroidism was achieved after 3 months in 64.4% of GD, whereas 17.1% were still hyperthyroid and 18.4% were hypothyroid. Block and replace antithyroid regimen was used in 54.6% of the patients. After 3 months, 74.2% patients were euthyroid in the group block and replace vs 64.2% patients in the group with ATD alone (P=0.009). For MNG, toxic adenoma and thyroiditis, around 75% of patients were euthyroid after 3 months, whereas it was the case for only 59.4% of patients with iatrogenic HT.
These results show large discrepancies between practices among a representative sample of French endocrinologists compared with recent American guidelines. Further studies are needed to determine the optimal management of HT.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.