Endocrine Abstracts

JOINT3922

Introduction: Graves’ disease (GD) is the most common cause of hyperthyroidism. Patients with GD are typically treated with one of three medical interventions: antithyroid drugs (ATDs), radioactive iodine (RAI) therapy, or thyroidectomy. The majority of patients begin treatment with ATDs, with current clinical guidelines recommending a treatment duration of 12 to 18 months. This study aims to compare the clinical characteristics of patients with Graves’ disease who achieved remission after optimal medical treatment with those who were resistant to therapy, and to identify factors that predict remission.

Methods: This retrospective cohort study reviewed medical charts from 2020 to 2024. Patients who achieved euthyroidism with medical treatment within 18–24 months and remained relapse-free for at least one year after therapy cessation were classified as having achieved remission. Patients who failed to attain euthyroidism despite 18–24 months of medical treatment, could not discontinue therapy, or required definitive treatment for these reasons, were classified as non-remission. Of the 565 Graves’ patients, 108 met the inclusion criteria for the study. After completing antithyroid drug therapy, patients were divided into remission (n = 64) and non-remission (n = 44) groups. Predictive factors analyzed included age, gender, smoking history, presence of orbitopathy, thyroid volume, thyroid function tests (TSH, free T3, and free T4), TSH receptor antibody (TRAB) levels, and systemic inflammatory parameters (systemic immune inflammation index [SII], pan-immune-inflammation value [PIV]) at the time of initiation.

Results: There were no significant differences in age or gender between the remission and non-remission groups (P = 0.918 and P = 0.727). However, in the non-remission group, FT4, FT3 levels, TRAB levels, and thyroid volume were significantly higher compared to the remission group [(3.7±2.1 vs. 2.5±1 ng/dl; P < 0.001), (13.8±5.8 vs. 9.3±4.8 ng/l; P < 0.001), (13.1±9 vs. 4.6±3.5 IU/l; P < 0.001), (26.6±15.4 vs. 12.2±4.4 mL; P < 0.001)]. Smokers and patients with Graves’ orbitopathy were more prevalent in the non-remission group (P = 0.03 and P = 0.004). There were no significant differences in SII and PIV values between the groups. In multivariate regression analysis, lower thyroid volume and lower TRAB titers were identified as independent predictors of remission (OR [95% CI]: 1.620 [1.213–2.164]; P = 0.001, OR [95% CI]: 1.287 [1.081–1.532]; P = 0.005).

Conclusion: This study suggests that ultrasonographic thyroid volume measurements and TRAB titers at the time of diagnosis in Graves’ disease could serve as valuable prognostic indicators for predicting disease remission.