Skip to main content
main-content

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

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.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat G.A. Brent, Clinical practice. Graves’ disease. N. Engl J. Med. 358, 2594–2605 (2008) CrossRef G.A. Brent, Clinical practice. Graves’ disease. N. Engl J. Med. 358, 2594–2605 (2008) CrossRef
2.
Zurück zum Zitat L. Bartalena, H.B. Burch, K.D. Burman, G.J. Kahaly, A 2013 European survey of clinical practice patterns in the management of Graves’ disease. Clin. Endocrinol. 84, 115–120 (2016) CrossRef L. Bartalena, H.B. Burch, K.D. Burman, G.J. Kahaly, A 2013 European survey of clinical practice patterns in the management of Graves’ disease. Clin. Endocrinol. 84, 115–120 (2016) CrossRef
3.
Zurück zum Zitat H.B. Burch, K.D. Burman, D.S. Cooper, A 2011 survey of clinical practice patterns in the management of Graves’ disease. J. Clin. Endocrinol. Metab. 97, 4549–4558 (2012) CrossRef H.B. Burch, K.D. Burman, D.S. Cooper, A 2011 survey of clinical practice patterns in the management of Graves’ disease. J. Clin. Endocrinol. Metab. 97, 4549–4558 (2012) CrossRef
4.
Zurück zum Zitat C. Sriphrapradang, Diagnosis and Management of Graves’ Disease in Thailand: a survey of current practice. J. Thyroid Res. 2020, 8175712 (2020) CrossRef C. Sriphrapradang, Diagnosis and Management of Graves’ Disease in Thailand: a survey of current practice. J. Thyroid Res. 2020, 8175712 (2020) CrossRef
5.
Zurück zum Zitat A. Mithal, A. Shah, S. Kumar, The management of Graves’ disease by Indian thyroidologists. Natl Med. J. India 6, 163–166 (1993) PubMed A. Mithal, A. Shah, S. Kumar, The management of Graves’ disease by Indian thyroidologists. Natl Med. J. India 6, 163–166 (1993) PubMed
6.
Zurück zum Zitat T. Tominaga, N. Yokoyama, S. Nagataki, B.Y. Cho, C.S. Koh, J.L. Chen, Y. Shi, International differences in approaches to 131I therapy for Graves’ disease: case selection and restrictions recommended to patients in Japan, Korea, and China. Thyroid 7, 217–220 (1997) CrossRef T. Tominaga, N. Yokoyama, S. Nagataki, B.Y. Cho, C.S. Koh, J.L. Chen, Y. Shi, International differences in approaches to 131I therapy for Graves’ disease: case selection and restrictions recommended to patients in Japan, Korea, and China. Thyroid 7, 217–220 (1997) CrossRef
7.
Zurück zum Zitat J.H. Moon, K.H. Yi, The diagnosis and management of hyperthyroidism in Korea: consensus report of the korean thyroid association. Endocrinol. Metab. 28, 275–279 (2013) CrossRef J.H. Moon, K.H. Yi, The diagnosis and management of hyperthyroidism in Korea: consensus report of the korean thyroid association. Endocrinol. Metab. 28, 275–279 (2013) CrossRef
8.
Zurück zum Zitat X. Wang, X. Teng, C. Li, Y. Li, J. Li, W. Teng, Z. Shan, Y. Lai, A Chinese survey on clinical practice in hyperthyroidism management: comparison with recent studies and guidelines. Endocr. Connect. 10, 1091–1100 (2021) CrossRef X. Wang, X. Teng, C. Li, Y. Li, J. Li, W. Teng, Z. Shan, Y. Lai, A Chinese survey on clinical practice in hyperthyroidism management: comparison with recent studies and guidelines. Endocr. Connect. 10, 1091–1100 (2021) CrossRef
9.
Zurück zum Zitat J. Kim, M.S. Choi, J. Park, H. Park, H.W. Jang, J.H. Choe, J.H. Kim, J.S. Kim, Y.S. Cho, J.Y. Choi, T.H. Kim, J.H. Chung, S.W. Kim, Changes in thyrotropin receptor antibody levels following total thyroidectomy or radioiodine therapy in patients with refractory Graves’ Disease. Thyroid 31, 1264–1271 (2021) CrossRef J. Kim, M.S. Choi, J. Park, H. Park, H.W. Jang, J.H. Choe, J.H. Kim, J.S. Kim, Y.S. Cho, J.Y. Choi, T.H. Kim, J.H. Chung, S.W. Kim, Changes in thyrotropin receptor antibody levels following total thyroidectomy or radioiodine therapy in patients with refractory Graves’ Disease. Thyroid 31, 1264–1271 (2021) CrossRef
10.
Zurück zum Zitat T.F. Davies, P.P. Yeo, D.C. Evered, F. Clark, B.R. Smith, R. Hall, Value of thyroid-stimulating-antibody determinations in predicting short-term thyrotoxic relapse in Graves’ disease. Lancet 1, 1181–1182 (1977) CrossRef T.F. Davies, P.P. Yeo, D.C. Evered, F. Clark, B.R. Smith, R. Hall, Value of thyroid-stimulating-antibody determinations in predicting short-term thyrotoxic relapse in Graves’ disease. Lancet 1, 1181–1182 (1977) CrossRef
11.
Zurück zum Zitat D.S. Ross, H.B. Burch, D.S. Cooper, M.C. Greenlee, P. Laurberg, A.L. Maia, S.A. Rivkees, M. Samuels, J.A. Sosa, M.N. Stan, M.A. Walter, 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 26, 1343–1421 (2016) CrossRef D.S. Ross, H.B. Burch, D.S. Cooper, M.C. Greenlee, P. Laurberg, A.L. Maia, S.A. Rivkees, M. Samuels, J.A. Sosa, M.N. Stan, M.A. Walter, 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 26, 1343–1421 (2016) CrossRef
12.
Zurück zum Zitat J.P. Brito, S. Schilz, N. Singh Ospina, R. Rodriguez-Gutierrez, S. Maraka, L.R. Sangaralingham, V.M. Montori, Antithyroid drugs—the most common treatment for Graves’ Disease in the United States: a nationwide population-based study. Thyroid 26, 1144–1145 (2016) CrossRef J.P. Brito, S. Schilz, N. Singh Ospina, R. Rodriguez-Gutierrez, S. Maraka, L.R. Sangaralingham, V.M. Montori, Antithyroid drugs—the most common treatment for Graves’ Disease in the United States: a nationwide population-based study. Thyroid 26, 1144–1145 (2016) CrossRef
13.
Zurück zum Zitat F. Azizi, R. Malboosbaf, Safety of long-term antithyroid drug treatment? A systematic review. J. Endocrinol. Investig. 42, 1273–1283 (2019) CrossRef F. Azizi, R. Malboosbaf, Safety of long-term antithyroid drug treatment? A systematic review. J. Endocrinol. Investig. 42, 1273–1283 (2019) CrossRef
14.
Zurück zum Zitat J. Jin, V. Sandoval, M.E. Lawless, A.R. Sehgal, C.R. McHenry, Disparity in the management of Graves’ disease observed at an urban county hospital: a decade-long experience. Am. J. Surg. 204, 199–202 (2012) CrossRef J. Jin, V. Sandoval, M.E. Lawless, A.R. Sehgal, C.R. McHenry, Disparity in the management of Graves’ disease observed at an urban county hospital: a decade-long experience. Am. J. Surg. 204, 199–202 (2012) CrossRef
15.
Zurück zum Zitat P.V. Pradeep, A. Agarwal, M. Baxi, G. Agarwal, S.K. Gupta, S.K. Mishra, Safety and efficacy of surgical management of hyperthyroidism: 15-year experience from a tertiary care center in a developing country. World J. Surg. 31, 306–312 (2007). CrossRef P.V. Pradeep, A. Agarwal, M. Baxi, G. Agarwal, S.K. Gupta, S.K. Mishra, Safety and efficacy of surgical management of hyperthyroidism: 15-year experience from a tertiary care center in a developing country. World J. Surg. 31, 306–312 (2007). CrossRef
16.
Zurück zum Zitat D.M. Elfenbein, D.F. Schneider, J. Havlena, H. Chen, R.S. Sippel, Clinical and socioeconomic factors influence treatment decisions in Graves’ disease. Ann. Surg. Oncol. 22, 1196–1199 (2015) CrossRef D.M. Elfenbein, D.F. Schneider, J. Havlena, H. Chen, R.S. Sippel, Clinical and socioeconomic factors influence treatment decisions in Graves’ disease. Ann. Surg. Oncol. 22, 1196–1199 (2015) CrossRef
17.
Zurück zum Zitat G.J. Kahaly, L. Bartalena, L. Hegedüs, L. Leenhardt, K. Poppe, S.H. Pearce, 2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism. Eur. Thyroid J. 7, 167–186 (2018) CrossRef G.J. Kahaly, L. Bartalena, L. Hegedüs, L. Leenhardt, K. Poppe, S.H. Pearce, 2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism. Eur. Thyroid J. 7, 167–186 (2018) CrossRef
Metadaten
Titel
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
Publikationsdatum
21.09.2022
Verlag
Springer US
Erschienen in
Endocrine
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-022-03193-7

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Innere Medizin und bleiben Sie gut informiert – ganz bequem per eMail.