Erschienen in:
21.09.2022 | Original Article
2021 Asia-Pacific Graves’ Disease Consortium Survey of Clinical Practice Patterns in the Management of Graves’ Disease
verfasst von:
Rajeev Parameswaran, Mechteld Christine de Jong, James Lee Wai Kit, Kathleen Sek, Tran Quang Nam, Tran Viet Thang, Nguyen Thy Khue, Than Than Aye, Phone Myint Tun, Timothy Cole, Julie A. Miller, Michael Villa, Benjapa Khiewvan, Sirinart Sirinvaravong, Yong Lit Sin, Rohaizak Muhammad, Tjin Shing Jap, Amit Agrawal, Rajesh Rajput, Ranil Fernando, Manilka Sumanatilleke, Ketut Suastika, Young Kee Shong, Brian Lang, Luigi Bartalena, Samantha Peiling Yang, on behalf of the Asian Graves Consortium Study
Erschienen in:
Endocrine
|
Ausgabe 1/2023
Einloggen, um Zugang zu erhalten
Abstract
Aim
Although Graves’ disease (GD) is common in endocrine practices worldwide, global differences in diagnosis and management remain. We sought to assess the current practices for GD in countries across Asia and the Pacific (APAC), and to compare these with previously published surveys from North America and Europe.
Methods
A web-based survey on GD management was conducted on practicing clinicians. Responses from 542 clinicians were received and subsequently analysed and compared to outcomes from similar surveys from other regions.
Results
A total of 542 respondents participated in the survey, 515 (95%) of whom completed all sections. Of these, 86% were medical specialists, 11% surgeons, and 3% nuclear medicine physicians. In addition to serum thyroid-stimulating hormone (TSH) and free thyroxine assays, most respondents would request TSH-receptor autoantibody (TRAb) measurement (68%) during initial work-up. Thyroid ultrasound is requested by about half of respondents (53%), while the use of nuclear medicine scans is limited. The preferred first-line treatment is anti-thyroid drug (ATD) therapy (79%) with methimazole (MMI) or carbimazole (CBZ), followed by radioiodine (RAI; 19%) and surgery (2%). In case of surgery, one-third of respondents would opt for a subtotal rather than a total thyroidectomy. In case of mild Graves orbitopathy (GO), ATDs (67%) remains the preferred treatment, but a larger proportion of clinicians prefer surgery (20%). For a patient with intention to conceive, the preferred treatment pattern remained unchanged, although propylthiouracil (PTU) became the preferred ATD-agent during the first trimester. In comparison to European and American practices, marked differences were noted in the relatively infrequent usage of nuclear medicine scans and the overall higher use of a ATDs and β-blockers and adjunctive ATD-treatment during RAI in the APAC-group.
Conclusion
Although regional differences regarding the diagnosis and management of GD are apparent in this first pan-Asia-Pacific survey, this study reveals the overall approach to the management of this disease in Asia-Pacific generally tends to fall between the trends appreciated in the American and European cohorts.