Treatment of Graves’ disease in Brazil: results of a survey among endocrinologists

Villagelin, Danilo; Mazeto, Glaucia M. F. S.; Mesa Junior, Cléo Otaviano; Ramos, Helton Estrela; Scheffel, Rafael Selbach; Chiamolera, Maria Izabel; Perini, Nicolas; Ronconi, Thiago Luis; Texeira, Patricia

doi:10.20945/2359-3997000000657

Acessibilidade / Reportar erro

Brasil

Archives of Endocrinology and Metabolism

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Brief Report • Arch. Endocrinol. Metab. 67 (6) • 2023 • https://doi.org/10.20945/2359-3997000000657 copy

Treatment of Graves’ disease in Brazil: results of a survey among endocrinologists

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

The objective of the study was to determine how physicians in Brazil manage Graves’ disease in different scenarios including extrathyroidal manifestations.

Materials and methods:

This study was conducted via a digital survey. The respondents (n = 573) answered multiple-choice questions based on a clinical case and variations of the case regarding laboratory and imaging evaluation, treatment choice, and follow-up.

Results:

The preferred initial treatment chosen by 95% of the respondents was ATD with a preferred treatment duration of 18-24 months. For 5% of the respondents, RAI was the initial treatment of choice. None of the respondents chose thyroidectomy. When presented with a patient with a desire for pregnancy in the near future, most respondents (69%) opted for ATD as the initial treatment. For a patient with signs of mild to moderate Graves’ orbitopathy, ATD remained the initial therapy for 93.9% of the respondents. For patients initially treated with ATD with disease recurrence after ATD interruption, most respondents (60%) chose definitive treatment with RAI. A similar survey published in 2011 by Burch and cols. had results comparable to those of the present survey but with a higher proportion of respondents choosing RAI (45% in the 2011 survey versus 5% in the present survey).

Conclusion:

Brazilian endocrinologists choose ATD as the initial management of Graves’ disease, and most choose RAI as a definitive treatment for a patient with relapse after ATD therapy.

Keywords
Treatment; Graves' disease; hyperthyroidism treatment

Index case
ABC, a 36-year-old woman, presents with clinical signs of hyperthyroidism with a duration of 2 months. The patient denies the use of any medication, tobacco, or alcohol. She had two prior pregnancies, the last one 10 years before. This was her first episode of hyperthyroidism. On clinical evaluation, she presented goiter (two to three times the normal thyroid size), heart rate of 105 beats per minute, and no signs of orbitopathy. On laboratory evaluation, she had elevated serum free T4 (FT4; 3.6 ng/dL) and suppressed serum TSH (< 0.001 mIU/L) levels.
Variation 1
ABC, a 36-year-old woman, presents with clinical signs of hyperthyroidism with a duration of 2 months. The patient denies the use of any medication, tobacco, or alcohol. She had two prior pregnancies, the last one 10 years before. This was her first episode of hyperthyroidism. On clinical evaluation, she presented goiter (two to three times the normal thyroid size), heart rate of 105 beats per minute, and clinical activity score (CAS) of 3 (movement-induced pain, palpebral edema, and conjunctival hyperemia), proptosis of 23 mm in both eyes, and eyelid aperture of 10 mm, with no visual loss. On laboratory evaluation, she presented elevated serum FT4 (3.6 ng/dL) and suppressed serum TSH (< 0.001 mIU/L) levels.
Variation 2
DEF, a 50-year-old man, presents with clinical signs of hyperthyroidism with a duration of 2 months. He had a history of tobacco use and denied the use of any medication or alcohol. This was his first episode of hyperthyroidism. On clinical evaluation, he presented a goiter (two to three times the normal thyroid size), heart rate of 105 beats per minute, proptosis of 14 mm in both eyes, eyelid aperture of 7 mm, no signs of clinical orbitopathy, and no visual loss. On laboratory evaluation, he presented elevated serum FT4 (3.6 ng/dL) and suppressed serum TSH (< 0.001 mIU/L) levels.
Variation 3
Assuming the patient in the index case was initially treated with an antithyroid drug (ATD) for 18 months and presented with disease recurrence 6 months after discontinuing the ATD, what would be the treatment alternative?

Sociedade Brasileira de Endocrinologia e Metabologia Rua Botucatu, 572 - Conjuntos 81/83, 04023-061 São Paulo SP Brasil, Tel: (55 11) 5575-0311 - São Paulo - SP - Brazil
E-mail: aem.editorial.office@endocrino.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence to: Nicolas Perini, nicolas_perini@hotmail.com