A relapse rate of more than 50% is quoted for patients with Graves Disease (GD) treated with anti-thyroid drugs. Our aim was to audit the outcome/relapse rate and possible predictive factors in a series of patients managed in our Nurse-led Thyroid Clinic (NLTC). The notes of patients with newly-diagnosed GD seen in the NLTC between 20052011 who had completed 18 months of anti-thyroid drug were reviewed: 60 patients (48 females) were identified. After 18 months of treatment, 16 (26.7%) were not biochemically euthyroid; 11 opted for thyroidectomy and 5 for I-131 treatment. Twenty subjects (33.3%) remained euthyroid during a mean monitoring of 20.3 months (range 653). Twenty-four (40%) relapsed at a mean time of 14.7 months (range 158) and the option of definitive treatment was then considered. Kaplan-Meier analysis showed 40.4% and 54.0% recurrence rates at 24 and 36 months follow-up, respectively. Cox regression analysis showed that age at diagnosis and fT4 at 18 months of treatment were not independent predictors of relapse. The average dose of carbimazole before withdrawal was 4.9 mg/day in the relapse group (n=19) and 4.3 mg/day in the euthyroid group (n=18) (no significant difference) and of propylthiouracil 75 mg/day in the relapse group (n=5) and 100 mg/day in the euthyroid one (n=2). In this series of subjects with GD managed exclusively in our NLTC, thereby ensuring consistency of care, we have shown that, for 67% of patients, definitive treatment had to be considered after completion of 18 months of anti-thyroid medication. With longer follow-up this rate is expected to increase further, suggesting that definitive treatment should probably be considered more often as a primary approach in GD.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.