Fig. 1Hypothetical curves reflecting the natural history of Graves' hyperthyroidism. A minority of patients (green line) have a single episode of hyperthyroidism. The majority (blue line) has a prolonged course following a relapsing and remitting course over many years. In some patients (red line) the disease never remits but continues to express herself clinically. In the long-term the natural course along the green and blue curves could evolve towards spontaneous development of hypothyroidism.
Fig. 2Chance of remission of Graves' hyperthyroidism after a course of antithyroid drugs. ATD, antithyroid drug.
Table 1A Predictive Score (Called the GREAT Score) for the Outcome of Therapy with Antithyroid Drugs in Graves' Hyperthyroidism Based on Four Baseline Characteristics [23]
Marker |
GREAT score |
Recurrence risk |
Age, yr |
|
|
≥40 |
0 |
|
<40 |
1 |
|
Serum FT4, pmol/L |
|
|
<40 |
0 |
|
≥40 |
1 |
|
Serum TBII, U/L |
|
|
<6 |
0 |
|
6–19.9 |
1 |
|
≥20 |
2 |
|
Goiter sizea
|
|
|
Grade 0–I |
0 |
|
Grade II–III |
2 |
|
Risk stratification |
GREAT score 0–1=class I |
Recurrences 16% |
GREAT score 2–3=class II |
Recurrences 44% |
GREAT score 4–6=class III |
Recurrences 68% |
Table 2Long-Term Follow-up Studies in Patients with Graves' Hyperthyroidism Who Were in Stable Remission after a Course of Antithyroid Drugs
|
UK 1977 [48] |
USA 1979 [49] |
Japan 1986 [50] |
Combined [484950] |
In remission for |
7.6±0.6 yr |
20–27 yr |
>10 yr |
About 20 yr |
ΔTSH-TRH ↓ (subclinical hyperthyroidism) |
17 (16) |
0 |
10 (23) |
27 (16) |
ΔTSH-TRH N (euthyroid) |
65 (59) |
9 (60) |
28 (62) |
102 (60) |
ΔTSH-TRH ↑ (subclinical hypothyroidism) |
21 (19) |
5 (33) |
5 (11) |
31 (18) |
Hypothyroid |
7 (6) |
1 (7) |
2 (4) |
10 (6) |
Total |
110 |
15 |
45 |
170 (100) |