Antithyroid drug treatment for Graves' disease: baseline predictive models of relapse after treatment for a patient-tailored management

E Masiello, G Veronesi, D Gallo, P Premoli, E Bianconi, S Rosetti, C Cusini, J Sabatino, S Ippolito, E Piantanida, M L Tanda, Luca Chiovato, W M Wiersinga, L Bartalena

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Antithyroid drugs (ATDs) are first-line treatment for Graves' hyperthyroidism worldwide, but relapses are frequent. The reliability of individual risk factors to predict at baseline subsequent relapse is poor. Predictive scores grouping single risk factors might help to select the best treatment (pharmacological vs. ablative).

OBJECTIVE: To assess the predictivity of a recently developed score (Clinical Severity Score, CSS) and to compare it with another score (GREAT score).

PATIENTS: A retrospective observational, single-center study was conducted of 387 consecutive, newly diagnosed Graves' patients, who completed an 18-24 months ATD course and were followed for at least 2 years.

RESULTS: Hyperthyroidism relapsed in 185 patients (48%). At diagnosis and before treatment, the relapse group had higher serum TSH-receptor antibody and free thyroxine levels and larger goiters than the remission group, with no differences in Graves' orbitopathy prevalence and severity. In the multivariate analyses, only large goiter size was significantly associated with an increased recurrence hazard ratio. Using CSS, the risk of relapse increased from 36% in the mild category and 49% in the moderate category to 59% in the severe category, with quite a good area under the curve (AUC) (0.60; 95% CI: 0.55; 0.66). GREAT score showed an increase in relapse from 34% for class I (mild) and 49% for class II (moderate) to 64% for class III (severe) (AUC, 0.63; CI: 0.58; 0.68).

CONCLUSIONS: Both CSS and GREAT score are useful, although imperfect, tools to predict at baseline relapse of hyperthyroidism after treatment. In real life they may help the clinician to tailor a treatment for newly diagnosed Graves' hyperthyroidism.

Original languageEnglish
Pages (from-to)1425-1432
Number of pages8
JournalJournal of Endocrinological Investigation
Volume41
Issue number12
DOIs
Publication statusPublished - Dec 2018

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Antithyroid Agents
Graves Disease
Recurrence
Hyperthyroidism
Goiter
Therapeutics
Area Under Curve
Thyroxine
Multivariate Analysis
Pharmacology
Serum

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Antithyroid drug treatment for Graves' disease : baseline predictive models of relapse after treatment for a patient-tailored management. / Masiello, E; Veronesi, G; Gallo, D; Premoli, P; Bianconi, E; Rosetti, S; Cusini, C; Sabatino, J; Ippolito, S; Piantanida, E; Tanda, M L; Chiovato, Luca; Wiersinga, W M; Bartalena, L.

In: Journal of Endocrinological Investigation, Vol. 41, No. 12, 12.2018, p. 1425-1432.

Research output: Contribution to journalArticle

Masiello, E, Veronesi, G, Gallo, D, Premoli, P, Bianconi, E, Rosetti, S, Cusini, C, Sabatino, J, Ippolito, S, Piantanida, E, Tanda, ML, Chiovato, L, Wiersinga, WM & Bartalena, L 2018, 'Antithyroid drug treatment for Graves' disease: baseline predictive models of relapse after treatment for a patient-tailored management', Journal of Endocrinological Investigation, vol. 41, no. 12, pp. 1425-1432. https://doi.org/10.1007/s40618-018-0918-9
Masiello, E ; Veronesi, G ; Gallo, D ; Premoli, P ; Bianconi, E ; Rosetti, S ; Cusini, C ; Sabatino, J ; Ippolito, S ; Piantanida, E ; Tanda, M L ; Chiovato, Luca ; Wiersinga, W M ; Bartalena, L. / Antithyroid drug treatment for Graves' disease : baseline predictive models of relapse after treatment for a patient-tailored management. In: Journal of Endocrinological Investigation. 2018 ; Vol. 41, No. 12. pp. 1425-1432.
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title = "Antithyroid drug treatment for Graves' disease: baseline predictive models of relapse after treatment for a patient-tailored management",
abstract = "BACKGROUND: Antithyroid drugs (ATDs) are first-line treatment for Graves' hyperthyroidism worldwide, but relapses are frequent. The reliability of individual risk factors to predict at baseline subsequent relapse is poor. Predictive scores grouping single risk factors might help to select the best treatment (pharmacological vs. ablative).OBJECTIVE: To assess the predictivity of a recently developed score (Clinical Severity Score, CSS) and to compare it with another score (GREAT score).PATIENTS: A retrospective observational, single-center study was conducted of 387 consecutive, newly diagnosed Graves' patients, who completed an 18-24 months ATD course and were followed for at least 2 years.RESULTS: Hyperthyroidism relapsed in 185 patients (48{\%}). At diagnosis and before treatment, the relapse group had higher serum TSH-receptor antibody and free thyroxine levels and larger goiters than the remission group, with no differences in Graves' orbitopathy prevalence and severity. In the multivariate analyses, only large goiter size was significantly associated with an increased recurrence hazard ratio. Using CSS, the risk of relapse increased from 36{\%} in the mild category and 49{\%} in the moderate category to 59{\%} in the severe category, with quite a good area under the curve (AUC) (0.60; 95{\%} CI: 0.55; 0.66). GREAT score showed an increase in relapse from 34{\%} for class I (mild) and 49{\%} for class II (moderate) to 64{\%} for class III (severe) (AUC, 0.63; CI: 0.58; 0.68).CONCLUSIONS: Both CSS and GREAT score are useful, although imperfect, tools to predict at baseline relapse of hyperthyroidism after treatment. In real life they may help the clinician to tailor a treatment for newly diagnosed Graves' hyperthyroidism.",
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TY - JOUR

T1 - Antithyroid drug treatment for Graves' disease

T2 - baseline predictive models of relapse after treatment for a patient-tailored management

AU - Masiello, E

AU - Veronesi, G

AU - Gallo, D

AU - Premoli, P

AU - Bianconi, E

AU - Rosetti, S

AU - Cusini, C

AU - Sabatino, J

AU - Ippolito, S

AU - Piantanida, E

AU - Tanda, M L

AU - Chiovato, Luca

AU - Wiersinga, W M

AU - Bartalena, L

PY - 2018/12

Y1 - 2018/12

N2 - BACKGROUND: Antithyroid drugs (ATDs) are first-line treatment for Graves' hyperthyroidism worldwide, but relapses are frequent. The reliability of individual risk factors to predict at baseline subsequent relapse is poor. Predictive scores grouping single risk factors might help to select the best treatment (pharmacological vs. ablative).OBJECTIVE: To assess the predictivity of a recently developed score (Clinical Severity Score, CSS) and to compare it with another score (GREAT score).PATIENTS: A retrospective observational, single-center study was conducted of 387 consecutive, newly diagnosed Graves' patients, who completed an 18-24 months ATD course and were followed for at least 2 years.RESULTS: Hyperthyroidism relapsed in 185 patients (48%). At diagnosis and before treatment, the relapse group had higher serum TSH-receptor antibody and free thyroxine levels and larger goiters than the remission group, with no differences in Graves' orbitopathy prevalence and severity. In the multivariate analyses, only large goiter size was significantly associated with an increased recurrence hazard ratio. Using CSS, the risk of relapse increased from 36% in the mild category and 49% in the moderate category to 59% in the severe category, with quite a good area under the curve (AUC) (0.60; 95% CI: 0.55; 0.66). GREAT score showed an increase in relapse from 34% for class I (mild) and 49% for class II (moderate) to 64% for class III (severe) (AUC, 0.63; CI: 0.58; 0.68).CONCLUSIONS: Both CSS and GREAT score are useful, although imperfect, tools to predict at baseline relapse of hyperthyroidism after treatment. In real life they may help the clinician to tailor a treatment for newly diagnosed Graves' hyperthyroidism.

AB - BACKGROUND: Antithyroid drugs (ATDs) are first-line treatment for Graves' hyperthyroidism worldwide, but relapses are frequent. The reliability of individual risk factors to predict at baseline subsequent relapse is poor. Predictive scores grouping single risk factors might help to select the best treatment (pharmacological vs. ablative).OBJECTIVE: To assess the predictivity of a recently developed score (Clinical Severity Score, CSS) and to compare it with another score (GREAT score).PATIENTS: A retrospective observational, single-center study was conducted of 387 consecutive, newly diagnosed Graves' patients, who completed an 18-24 months ATD course and were followed for at least 2 years.RESULTS: Hyperthyroidism relapsed in 185 patients (48%). At diagnosis and before treatment, the relapse group had higher serum TSH-receptor antibody and free thyroxine levels and larger goiters than the remission group, with no differences in Graves' orbitopathy prevalence and severity. In the multivariate analyses, only large goiter size was significantly associated with an increased recurrence hazard ratio. Using CSS, the risk of relapse increased from 36% in the mild category and 49% in the moderate category to 59% in the severe category, with quite a good area under the curve (AUC) (0.60; 95% CI: 0.55; 0.66). GREAT score showed an increase in relapse from 34% for class I (mild) and 49% for class II (moderate) to 64% for class III (severe) (AUC, 0.63; CI: 0.58; 0.68).CONCLUSIONS: Both CSS and GREAT score are useful, although imperfect, tools to predict at baseline relapse of hyperthyroidism after treatment. In real life they may help the clinician to tailor a treatment for newly diagnosed Graves' hyperthyroidism.

U2 - 10.1007/s40618-018-0918-9

DO - 10.1007/s40618-018-0918-9

M3 - Article

C2 - 29946800

VL - 41

SP - 1425

EP - 1432

JO - Journal of Endocrinological Investigation

JF - Journal of Endocrinological Investigation

SN - 0391-4097

IS - 12

ER -