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Age and Gender Predict the Outcome of Treatment for Graves’ Hyperthyroidism¹

Division of Medical Sciences and Department of Mathematics and Statistics (R.L.H.), University of Birmingham, Edgbaston, Birmingham, United Kingdom B15 2TH

Address all correspondence and requests for reprints to: Dr. A. Allahabadia, Division of Medical Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom B15 2TH. E-mail: j.a.franklyn{at}bham.ac.uk

The response to treatment in Graves’ hyperthyroidism is unpredictable, and factors postulated to predict outcome have not generally proved clinically useful or been widely adopted in clinical practice. We audited outcome in 536 patients with Graves’ hyperthyroidism presenting consecutively to determine whether simple clinical features predict disease presentation and response to treatment. At presentation males had slightly more severe biochemical hyperthyroidism [free T₄: males, 64.3 ± 3.0 pmol/L (mean ± SE); females, 61.3 ± 1.7 (P = 0.45); free T₃: males, 24.3 ± 1.5 pmol/L; females, 21.0 ± 0.6, (P = 0.04)]. Patients less than 40 yr at diagnosis had more severe hyperthyroidism than patients more than 40 yr old [free T₄: <40 yr, 64.3 ± 2.0; >40 yr, 56.7 ± 2.3 (P = 0.02); free T₃: <40 yr, 22.8 ± 0.8; >40 yr, 19.0 ± 0.9 (P = 0.003)]. Males had a lower remission rate than females after a course of antithyroid medication [19.6% vs. 40%; odds ratio, 0.37; 95% confidence interval (CI), 0.17–0.79; P < 0.01]. Similarly, patients aged less than 40 yr had a lower remission rate than older patients (32.6% vs. 47.8%; odds ratio, 0.53; 95% CI, 0.32–0.87; P = 0.01). One dose of radioiodine cured hyperthyroidism in fewer males than females (47% vs. 74%; P < 0.0001). Logistic regression analysis demonstrated male sex (odds ratio, 2.80; 95% CI, 1.31–5.98; P = 0.008), serum free T₄ concentration at diagnosis (odds ratio, 1.02; 95% CI, 1.0–1.04; P = 0.01), and dose of radioiodine administered (odds ratio, 0.99; 95% CI, 0.99–1.00; P = 0.001) were contributing factors associated with failure to respond to a single dose of radioiodine. As males and younger patients are more likely to fail to respond to medical treatment, and male patients are likewise less likely to respond to a single dose of radioiodine, we suggest that those groups with low remission rates should be offered definitive treatment with radioiodine or surgery soon after presentation and that the value of higher initial doses of radioiodine in males be evaluated

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