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ANTITHYROID DRUGS IN THE TREATMENT OF HYPERTHYROIDISM OF Graves' DISEASE: LONG‐TERM FOLLOW‐UP OF 434 PATIENTS
Author(s) -
HEDLEY A. J.,
YOUNG R. E.,
JONES S. J.,
ALEXANDER W. D.,
BEWSHER P. D.
Publication year - 1989
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.1989.tb01244.x
Subject(s) - carbimazole , medicine , graves' disease , antithyroid drugs , triiodothyronine , pediatrics , disease , antithyroid agent , endocrinology , thyroid
SUMMARY A study of antithyroid drug (ATD) therapy with a mean follow‐up period of 10 years (range 2–25) in 434 patients with Graves' disease has been made by linking hospital records with those of a central follow‐up register. The majority (89%) were treated with carbimazole and 87% received combined therapy with triiodothyronine (T3) (73%) or thyroxine (T4) (14%). Sixty‐one per cent were assessed for T3 suppression tests on completion of treatment, of whom 61% (95% CL, 55‐67%) suppressed. The overall 5‐year cumulative proportion developing recurrent hyperthyroidism was 54‐62% with rates of 26‐44% in suppressed patients and 65‐79% in those not suppressed. In unsuppressed patients, most (72%) of the recurrences occurred within 1 year with only an additional 10% predicted up to 10 years. In suppressed patients 30% of recurrences occurred in the first year, 60% between 1 and 5 years and a further 10% between 5 and 10 years. Suppression with T3 is probably the best and cheapest predictor of outcome but has an accuracy of only 70% for both positive and negative tests which limits its usefulness in planning long‐term follow‐up and surveillance. A standard format should be adopted for the analysis and reporting of follow‐up studies, based on actuarial methods of estimating the cumulative proportion with recurrences or other events, to facilitate comparisons between different centres.