Graves' disease: persistent hyperthyroidism linked to reduced survival

  • Okosieme OE & al.
  • Lancet Diabetes Endocrinol
  • 28 Feb 2019

  • curated by Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • A retrospective study from the United Kingdom suggests that hyperthyroidism, indicated by low levels of thyroid-stimulated hormone (TSH), is associated with reduced survival of patients with Graves' disease, independent of treatment method.

Why this matters

  • The relative benefits of treatment modality and interactions with thyroid status are unclear.

Key results

  • Patients with Graves' disease experienced increased all-cause mortality (aHR, 1.23; P=.033) and major adverse cardiovascular events (MACEs; aHR, 2.47; P<.0001 compared with control subjects.>
  • Patients treated with radioiodine with resolved hyperthyroidism had reduced mortality (HR, 0.50; P=.012) and MACE risk (HR, 0.59; P=.021) compared with patients treated with antithyroid drugs.
  • Patients treated with radioiodine with unresolved hyperthyroidism had similar mortality (HR, 1.51; P=.079) but increased MACE risk (HR, 1.52; P=.042) compared with patients treated with antithyroid drugs.
  • In all patients with Graves' disease, persistently low TSH concentrations 1 year after diagnosis were associated with increased mortality (HR, 1.55; P=.019) and MACEs (HR, 1.54; P=.020).

Study design

  • 4189 patients with Graves' disease and 16,756 control subjects were analyzed for associations between treatment type, thyroid status, and mortality/MACE risk.
  • Funding: National Institute of Social Care and Health Research.

Limitations

  • Retrospective analysis of large database.