Medical treatment for Graves’ Disease (GD) results in only around 50% treated achieving sustained remission. 1 Anecdotally, a high proportion of patients with GD managed at Cairns Hospital fail to achieve sustained remission with anti-thyroid drug (ATD) therapy.
The clinical audit aimed to determine the rate of ATD failure in the GD cohort seen at Cairns Hospital. Treatment failure was defined as either relapse following remission after at least 12 months of ATD, on-going ATD requirement after more than 24 months or the requirement of definitive therapy after initial treatment with ATD. Pre-treatment factors which may be predictive of ATD failure were also reviewed.
We conducted a retrospective cohort study of patients with GD who were evaluated, managed initially with ATD and followed up at the Cairns Hospital Endocrinology clinic between 2006-2016.
118 patients fulfilled criteria for inclusion in our study. Of these patients 86 (73%) failed ATD. Baseline characteristics including age, ethnicity, gender, smoking status, baseline thyroid function tests and thyrotropin stimulating hormone receptor antibody (TSHRAb) levels, ophthalmopathy, presence and size of goitre, were collected to determine whether these factors have significant association with ATD failure.
In our cohort, the high rate of ADT failure was confirmed and reported at 73%. Univariate analysis of baseline characteristics revealed Indigenous ethnicity and large goitre size have a significant association with ATD failure. Previous studies have reported an association with goitre size and ATD failure, however the link with Indigenous ethnicity has not previously been reported.1