Comparative Effectiveness of Treatment Choices for Graves' Disease in the Elderly Population: Experience of a Tertiary Referral Center

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 432-458-Thyroid Autoimmunity
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-443
Vishnu Sundaresh*1, Juan Pablo Brito2, Marius Stan2 and Rebecca S Bahn2
1LSUHSC, Shreveport, LA, 2Mayo Clinic, Rochester, MN
Introduction: Hyperthyroidism due to Graves’ disease (GD) is more common in adults in the US between 30-60 years, whereas toxic nodular goiter has a higher prevalence in the elderly population. Studies regarding management of Graves’ disease in the elderly are limited. This cohort study aimed to provide practical information regarding the benefits and risks of radioactive iodine (RAI), antithyroid drugs (ATDs), and thyroidectomy in individuals treated at a tertiary care medical center.

Methods: Our cohort included adults aged 60 years and above diagnosed with Graves’ hyperthyroidism from January 1, 2002 to December 31, 2008, who had complete follow up after treatment at the Mayo Clinic, Minnesota. Data on different treatment modalities, their failure rates and adverse effects were extracted manually and electronically from the electronic medical records. Kaplan Meier analyses were performed to evaluate the association of treatments with relapse free survival.

Results: Our cohort of 172 subjects had a mean age of 69.2 years (range: 60-87), mean follow up of 2 years, 66.3% women and 11.6% smokers. The initial therapy was RAI in 75%, ATDs in 15% and thyroidectomy in 1.7%; 8.1% were observed. For the duration of follow up, ATDs had an overall failure rate of 67.4% compared with 10.8% for RAI (HR: 3.5, p=0.0001). Surgery had a 100% remission rate. Adverse effects developed in 12 patients treated with ATDs which included nausea/gastric distress (1.5%), dysgeusia (4.5%), rash (4.5%), pruritus (3%), antithyroid arthritis syndrome (1.5%), elevated liver enzymes (1.5%), cholestasis (1.5%). One patient treated with RAI experienced radiation thyroiditis (<1%) and 1 case of post-operative hematoma occurred. Compared to a parallel cohort under the age of 60 years, fewer patients opted for surgery as initial therapy (1.7% vs 2.9%). Failure rates were higher for ATDs (67.4% vs 59.3%) and RAI (10.8% vs 7.7%).  Dermatological reactions were higher while GI adverse effects and radiation thyroiditis were lower.

Conclusions: RAI was the most commonly chosen therapy in our cohort demonstrating a good efficacy and safety profile. As in younger patients, surgery was also very effective and safe in the hands of high volume thyroid surgeons. Although ATDs preserve endogenous thyroid function, a high relapse rate combined with a significant adverse effect profile was observed. These data can aid discussion between physician and patient regarding therapeutic choices for GD.


Nothing to Disclose: VS, JPB, MS, RSB

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