Clinical Spectrum and Outcome of Patients with Graves’ Disease: A Single-Center Experience from a Tertiary Care Institution in the Kashmir Valley, India

Abstract

ABSTRACT

Objective: Graves’ disease (GD) is a common autoimmune disorder with variable outcomes. We aim to study the clinical manifestations and treat-ment outcome of GD in the post-iodization scenario. Material and Met-hods: The present study was designed as a cross-sectional study, in which a total of 180 patients with GD (127 females and 53 males) attending our center were reviewed retrospectively. The demographic data, modes of tre-atment, comorbidities, remission, and recurrence rates were determined for the patients. All patients were initially treated with antithyroid drugs (ATDs), with the subsequent management depending on the course of the disease. Results: The mean (±SD) age at diagnosis was 38.30 (10.73) years and the lag period between the onset of symptoms and the diagno-sis was 5.12 (2.69) months, with the male patients having a significantly shorter duration of illness compared to females (4.36 vs. 5.44 months; P=0.015). Majority of the patients presented with the typical symptoms and signs associated with hyperthyroidism and/ or goiter, although the aty-pical presentations were not uncommon. ATDs were the most preferred treatment modality employed to achieve clinical and biochemical remis-sion. The mean duration of achieving euthyroidism and the normalization of TSH levels were 3.31±1.51 and 7.45±3.35 months, respectively. On fol-low-up at three months, 46.1% of the patients were euthyroid, with nor-malization of the TSH levels in 15.6% of them. Failure to achieve early remission/disease control was significantly higher in males (p=0.003) and smokers (p=0.036). Among the 72 patients who completed medical the-rapy, 49 patients achieved remission, of whom 20 patients relapsed with a first-year relapse rate of 20.4%. Disease relapse was significantly asso-ciated with higher initial 99 mTechnetium (99mTc) uptake (p=0.022) and higher grade of goiter (p=0.026) at presentation. The logistic regression analysis revealed male gender (p=0.048) and orbitopathy (p=0.036) as the independent risk factors predicting relapse of the GD. Conclusion: Graves’ disease manifests with varied clinical manifestations, including the atypical ones, warranting careful clinical assessment to ensure an accu-rate diagnosis. Gender and orbitopathy are the independent risk factors predicting the relapse of the disease.