Recurrence and euthyroidism rates in graves patients receiving oral anti thyroid medication

SUMMARY OBJECTIVES: For TSH receptor antibody (TRAb) positive, 18 year or older Graves patients who were treated with oral antithyroid drugs, rates of recurrence and euthyroidism after treatment would be retrospectively reviewed in the endocrinology and general internal medicine outpatient clinic. In addition, the treatment results of patients who were applied with permanent treatment will also be investigated. MATERIALS AND METHODS: A total of 194 patients with hyperthyroidism and TRAb positive who were admitted to the endocrinology and general internal medicine outpatient clinic between March/2010-November/2017 were included in our study. Laboratory values and clinical status of the patients were followed. The number of patients receiving medication and the number of recurrent patients were evaluated. In patients who received Radioactive Iodine (RAI), RAI dose and recurrence rate were investigated. The probability of beningn / malign in patients who received surgery was evaluated. RESULTS: Of the patients included in the study, 144 (74.2%) were female and 50 (25.8%) were male. The median age was calculated as 45 (18-78). 30 (15.5%) of the patients had ophthalmopathy. It was seen that methimazole (MMI, 125 persons, 64.4%) was used as the first choice in the treatment of graves, and propylthiouracil (PTU) was used in a lesser proportion. In 13 patients, 9 (5%) of PTU and 3 (1.5%) of MMI had side effects. 46 (23.7%) of the patients did not have any relapse after drug treatment, 10 (5.2%) had no permanent treatment after recurrence, 54 (27.8%) were treated with RAI and 83 (42.8%) were treated with surgery. For the patients with nodules who received surgery, the risk of malignancy was significantly higher than the patients without nodules. In binary logistic regression analysis, the presence of nodules increased the risk of malignancy 8.3 times (19 and 2, OR = 8.34, P = 0.007, respectively). In our study, patients who had no relapse and needed permanent treatment were compared. Among the two groups, only the end-of-treatment result (p: 0.005) of ophthalmopathy (p: 0.002), TRAb (p: 002) and sT4 were significantly different. In the ROC analysis, when the level of TRAb was 8.45 and above, it was determined that remission could not be achieved with drug treatment in 83% specificity and ophthalmopathy close to 70% specificity is predicted in these patients. CONCLUSION: In 23.7% of patients treated for Graves, remission was achieved, whereas in most of them, permanent treatment (RAI therapy or surgical treatment) was needed. KEYWORDS: Graves disease, TRAb positivity, Recurrence and euthyroi