Endocrine Abstracts

Context: Identification of risk factors predicting relapse in patients with hyperthyroidism of Graves’ disease after the first cycle with standard thyreostatic therapy [ATD] is important to guide therapeutic options.

Objective: We performed a systematic review and meta-analysis to study predictors for risk of relapse after the first treatment episode with ATD in patients with Graves’ disease induced hyperthyroidism.

Data sources: Based on a pre-specified protocol, we searched PubMed, EMBASE and Cochrane in July 2015 for case-control, controlled, and randomized-controlled trials analyzing risk factors for relapse after ATD treatment. The endpoint was relapse of disease until follow-up.

Data extraction: PRISMA and SIGN statements were used for reviewing the data and assessing quality of included trials.

Data synthesis: We included 54 trials with totally 8206 participants. Most trials were small with moderate to high risk for bias. Gene data were only qualitatively assessed. 31 trials were assessed quantitatively. There were 2053 relapses in 4398 patients. By random-effects meta-analysis (standardized mean difference - Hedges’ g; 95% CI) orbitopathy (1.16; 1.08; 1.25), goiter (0.18; 0.07; 0.30), smoking (1.13; 1.02; 1.25), thyroid volume by sonography (−0.58; −0.90; −0.18), fT4 (−0.16; −0.28; −0.05), tT3 (−0.25; −0.46; −0.04), TRAb (−0.33; −0.62; −0.04), TBII (−0.36; −0.63; −0.09), TSAb (−0.26; −0.45; −0.06) did show a significant predictive value, whereas male (1.08; 1.0; 1.18) or female (0.98; 0.93; 1.02) sex, age (0.14; −0.07; 0.35), and tT4 (0.04; 0.23; 0.31) did not.

Conclusions: This analysis found several risk factors to predict relapse in Graves’ disease which can be combined in a risk score. Prospective studies should evaluate the prognostic accuracy of such a score to guide treatment decisions.