ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P778 | DOI: 10.1530/endoabs.63.P778

Graves' disease: woman or man, is there a difference in clinical presentation or evolution?

Sondes Chermiti1,2, Yosra Hasni1,2, Ines Bayar1,2, Asma Abdelkarim1,2, Maha Kacem1,2, Molka Chaieb1,2, Amel Maaroufi1,2 & Koussay Ach1,2

1Department of Endocrinology and Diabetology, Farhat-Hached University Hospital, 4000, Sousse, Tunisia; 2Université de Sousse, Faculté de Médecine de Sousse,, 4000, Sousse, Tunisia.

Grave’s disease (GD), like all autoimmune diseases, is predominantly female, with sex ratio to 3 women for one man. The treatment of first intension is based on antithyroid drugs (ATD). Our objective is to compare the clinical presentation and the evolution of GD by gender. It’s a retrospective study. We studied patients with a first diagnosis of GD, in the department of endocrinology in Farhat Hached hospital in Susah, between Juanuary 2010 and December 2015. The patients were subdivised into two groups: G1 (42 men) and G2 contains (75 women). The clinical presentation and evolution were compared in 2 groups. The medium age was 40.6±15 years in G1 and 36.5±13.6 years in G2 with no significant statistical difference (P=0.14). A family history of thyroid illness was similar in men and women (P=0.6). Thyrotoxicosis symptoms were similirally identified in 90.5% of men and 88% of women (P=0.35). The most common symptoms were: weihgt loss, then palpitations and tremors with no significant difference between the groups. Ocular symptoms, especially exophtalmia, were similar in men and women (P=0.46). The mean value of fT4 was 59±24.2 pg/ml in G1 and 56±22.7 pg/ml in G2 with (P=0.55). TRAbs were positif in 88.1% of men and 89.3% of women (P=0.2). The ultrasound volume of thyroid was 37.5±18.6 cm3 in G1 and 27.6±11.2 cm3 in G2 with P=0.05. Methimazol (MMI) was prescribed to 12 men (28.6%) at a mean dose of 23.3±6.5 mg/day and to 28 women (37.3%) at a mean dose of 25.9±7.5 mg/day (P=0.29). Benzylthiouracil (BTU) was prescribed to 30 men (71.4%) at a mean dose of 257.5±64 mg/day and to 47 women (62.7%) at a mean dose of 248.4±60 mg/day with no significant difference (P=0.53). The mean durations of treatment with MMI and BTU were similar in both groups (respectively P=0.3 and P=0.23). Adverse effects were observed in 4 men (9.5%) and 10 women (13.3%) with no remarkable difference (P=0.2). ATD remission was higher in women than in men with a significant difference (47.3% vs. 32.5%, P=0.02). A relapse after discontinuation of ATD was noted in 10% of men and 16.2% of women, with a significant difference (P=0.02). The male sex is associated with a higher risk of failure of ATD during the GD. A higher thyroid volume in men may explain this difference, as a larger thyroid volume is considered a predictor of failure of medical treatment.

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