Graves’ Disease 101: Treatment and Cardiac Problems.
- Cardiac morbidity and mortality after the two forms of therapy for Graves’ disease.
- 4189 patients with Graves’ disease studied.
- Antithyroid drugs and Radioiodine had increased all cause mortality.
- Antithyroid drug group, mortality was lower among those in radioiodine group.
- Failed early treatment to get thyroid blood tests to normal is a cause of increased mortality.
- “Regardless of the method of treatment, early and effective control of hyperthyroidism among patients with Graves’ disease is associated with improved survival compared with less effective control.”
- “Definitive treatment with radioiodine should be offered to patients who are unlikely to achieve remission with antithyroid drugs alone.”
- Rapid control of hyperthyroidism can be obtained in my center.
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Primary therapy of Graves’ disease and cardiovascular morbidity and mortality: a linked-record cohort study
Graves’ disease is routinely treated with antithyroid drugs, radioiodine, or surgery, but whether the choice of initial therapy influences long-term outcomes is uncertain. We evaluated cardiovascular morbidity and mortality according to the method and effectiveness of primary therapy in Graves’ disease.
We extracted patient-level data on 4189 patients (3414 [81·5%] females and 775 [18·5%] males) with Graves’ disease and 16 756 controls (13 656 [81·5%] females and 3100 [18·5%] males). In landmark analyses, 3587 patients were in the antithyroid drug group, 250 were in radioiodine group A, 182 were in radioiodine group B. Patients had increased all-cause mortality compared with controls (hazard ratio [HR] 1·22, 95% CI 1·05–1·42). Compared with patients in the antithyroid drug group, mortality was lower among those in radioiodine group A (HR 0·50, 95% CI 0·29–0·85), but not for those in radioiodine group B (HR 1·51, 95% CI 0·96–2·37). Persistently low TSH concentrations at 1 year after diagnosis were associated with increased mortality independent of treatment method (HR 1·55, 95% CI 1·08–2·24). Spline regressions showed a positive non-linear relationship between FT4 concentrations at 1 year and all-cause mortality.
Regardless of the method of treatment, early and effective control of hyperthyroidism among patients with Graves’ disease is associated with improved survival compared with less effective control. Rapid and sustained control of hyperthyroidism should be prioritised in the management of Graves’ disease and early definitive treatment with radioiodine should be offered to patients who are unlikely to achieve remission with antithyroid drugs alone.