source: Thyroid: Official Journal of the American Thyroid Association
Nami Suzuki, Jaeduk Yoshimura Noh, Ran Yoshimura, Kentaro Mikura, Aya Kinoshita, Ai Suzuki, Takako Mitsumatsu, Ayako Hoshiyama, Miho Suzuki, Masako Matsumoto, Ai Yoshihara, Natsuko Watanabe, Kiminori Sugino, Koichi Ito
The prognosis of Graves’ disease (GD) is reportedly related to sex, age and genetic factors, although there is no consensus.
To investigate the relationship between severity and prognosis of GD and sex or age.
Subjects were patients newly diagnosed with GD between January 2005 and June 2019, and medical records were retrospectively reviewed. As prognostic research, patients diagnosed between January 2009 and December 2010 and followed-up for at least 12 months were enrolled. Patients were divided into nine age-stratified groups. Remission was defined as maintenance of a euthyroid state for >1 year after withdrawal of anti-thyroid drugs.
Participants comprised 21,633 patients (3,954 males, 17,679 females). Initial fT3 and fT4 levels significantly decreased with increasing age, including after sex-stratification. fT4 was significantly higher in males than females aged 20-39 years. Prognostic research in 2,191 patients treated with anti-thyroid drugs alone showed median durations until remission of 37.7 and 30.6 months in males and females, respectively. Remission and recurrence were observed in 1,391 patients (204 males, 1,187 females), and 262 patients (37 males, 225 females), respectively. According to Kaplan-Meyer analyses, males required significantly longer to achieve remission than females (p<0.0001), although there were no significant age-related differences (p=0.08). Cox proportional hazard modeling showed a 41% higher hazard ratio for remission in females than males (aHR [95% CI] = 1.41[1.21-1.64]), and each additional 10 years of age had a 14% lower rate of recurrence (age [per 10 years increase], aHR [95%CI] = 0.86 [0.78-0.94]); no significant relationship between recurrence rate and sex was identified.
Severity of hyperthyroidism in GD was significantly higher in males in their 20s and 30s, declining with advancing age in both sexes. Females were more likely to achieve remission than males, and younger patients had a higher risk of recurrence, although recurrence was unrelated to sex.
ITO Hospital, Japan