Evaluation of the relapse rate in patients with graves disease and its relationship to the great score

Gil Sara Hami; Romero Porcel Jose Alvaro; Ariza Jimenez Jose Antonio; Ana-Belen Ariza-Jimenez; Cozar Leon Maria Victoria

doi:10.1530/endoabs.110.EP1464

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Endocrine Abstracts (2025) 110 EP1464 | DOI: 10.1530/endoabs.110.EP1464

ECEESPE2025 ePoster Presentations Thyroid (198 abstracts)

Evaluation of the relapse rate in patients with graves disease and its relationship to the great score

Sara Hami Gil ¹ , Jose Alvaro Romero Porcel ¹ , Jose Antonio Ariza Jimenez ² , Ana-Belen Ariza-Jimenez ³ & Maria Victoria Cózar León ¹

Author affiliations

¹Hospital Universitario Virgen de Valme, Endocrinology and Nutrition, Sevilla, Spain; ²Hospital Universitario Costa del Sol, Endocrinology and Nutrition, Marbella (Málaga), Spain; ³Hospital Universitario Reina Sofia, Instituto Maimonides de Investigación Biomédica de Cordoba. Cordoba University., Pediatric Endocrinology, Cordoba, Spain.

JOINT3862

Introduction: Antithyroid drugs are the first step of treatment in patients with Graves’ Basedow Disease (GBS). A treatment duration of 12 to 18 months is recommended, however, the relapse rate is high (up to 60% in some series); different authors recommend longer treatments. Vos et al. propose a scale (GREAT-Score), which classifies patients into 3 groups according to the risk of recurrence (class-1 lower risk, class-3 higher risk), taking into account age, analytical parameters (T4l, TRAb) and goitre.

Objective: To evaluate relapse in hyperthyroid patients after treatment, according to the duration of treatment and the GREAT-Score.

Material and Methods: Retrospective observational study in patients with GBS diagnosed between June/2020 and December/2020 and their relationship with GREAT Score, with a follow-up of 36 months.

Results: A sample of 54 patients was presented, 76% were women; mean age was 47+/-14.5 years, 33.3% smokers, clinically, nervousness, weight loss, palpitations and ophthalmopathy (67.3%, 46.2%, 29.6, 1.9%, respectively). Regarding the GREAT-Score, 48% were Class 1, 41% Class 2 and 11% Class 3. 59.3% were treated with Carbimazole, 40.7% with Thiamazole. Duration of treatment was less than 12 months in 18.5% of the sample, between 12-18 months in 38.9%, between 18-24 months in 35.2% and above 24 months in 7.4%. 93.8% had no side effects, with hypothyroidism and elevated transaminases (4.2%, 2.1%, respectively). The analytical values (median-ranges) at diagnosis were: TSH 0.01µIUI/ml(0.01-0.01), T4l 3.2ng/dl(1.97-4.58), T3l 9.59pg/ml(5.33-21), TRAb 6. 83U/L(4.04-13.30); at the end of treatment: TSH 1.78µIUI/ml(1.02-2.83), T4l 1.19ng/dl(1.03-1.31), T3l 3.1pg/ml(2.76-3.44), TRAb 1.65 U/L(0.8-1.23). Overall relapse was 46.3%, (66.7% smokers); relapse according to GREAT-Score was 42.3% in Class1 and 50% in class2-3. Relapse according to treatment duration was 60% in those with a duration of less than 12 months, 38% in those with a duration of 12-18 months, 50% in those with a duration of 18-24 months and 25% in those with a duration of 24-30 months.

Conclusions: Relapse in GBS after ATD is high, patients with GREAT-Score class2-3 had a higher relapse than those with class1, and treatment over 24 months had a lower relapse than those with shorter duration. It would be interesting to establish risk profiles (GREAT-Score) prior to pharmacological treatment, thus being able to select those patients who may benefit from longer treatment.