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Article: Outcomes of Graves’ Disease Patients Following AntiThyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-Line Treatment
Title | Outcomes of Graves’ Disease Patients Following AntiThyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-Line Treatment |
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Authors | |
Keywords | antithyroid drugs Graves’ disease population based cohort radioactive iodine thyroidectomy |
Issue Date | 2021 |
Publisher | Lippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com |
Citation | Annals of Surgery, 2021, v. 273 n. 6, p. 1197-1206 How to Cite? |
Abstract | Background: The long-term outcomes of first-line choice among anti-thyroid drug (ATD), radioactive iodine (RAI) and thyroidectomy for Graves’ disease (GD) patients remain unclear. Objective: To compare the long-term morbidity, mortality, relapse, and costs of GD patients receiving first-line treatment. Methods: A population-based retrospective cohort of GD patients initiating first-line treatment with ATD, RAI, or thyroidectomy as a first-line primary treatment between 2006 and 2018 from Hong Kong Hospital Authority was analyzed. Risks of all-cause mortality, cardiovascular diseases (CVD), atrial fibrillation (AF), psychological disease, diabetes, and hypertension were estimated using Cox proportional hazards regression models. The 10-year healthcare costs, change of comorbidities, and risk of relapse were compared across treatments. Results: Over a median follow-up of 90 months with 47,470 person-years, 6385 patients (ATD, 74.93%; RAI, 19.95%; thyroidectomy, 5.12%) who received first-line treatment for GD were analyzed. Compared with ATD group, patients who had undergone surgery had significantly lower risks of all-cause mortality (HR = 0.363, 95%CI = 0.332–0.396), CVD (HR = 0.216, 95%CI = 0.195–0.239), AF (HR = 0.103, 95%CI = 0.085–0.124), psychological disease (HR = 0.279, 95%CI = 0.258–0.301), diabetes (HR = 0.341, 95%CI = 0.305–0.381) and hypertension (HR = 0.673, 95%CI = 0.632–0.718). Meanwhile, RAI group was also associated with decreased risks of all-cause mortality (HR = 0.931, 95%CI = 0.882–0.982), CVD (HR = 0.784, 95%CI = 0.742–0.828), AF (HR = 0.622, 95%CI = 0.578–0.67) and psychological disease (HR = 0.895, 95%CI = 0.855–0.937). The relapse rate was 2.41% in surgery, 75.60% in ATD, and 19.53% in RAI group. The surgery group was observed with a significant lower CCI score than the other two groups at the tenth-year follow-up. The mean 10-year cumulative healthcare costs in ATD, RAI, and surgery group was US$23915, US$24260, and US$20202, respectively. Conclusions: GD patients who received surgery as an initial treatment appeared to have lower chances of all-cause mortality, CVD, AF, psychological disease, diabetes and hypertension in the long-term when compared to those treated with ATD or RAI. The surgery group had the lowest relapse and direct healthcare costs among the three treatment modalities. This long-term cohort study suggested surgery may have a larger role to play as an initial treatment for GD patients. |
Description | Hybrid open access |
Persistent Identifier | http://hdl.handle.net/10722/297218 |
ISSN | 2023 Impact Factor: 7.5 2023 SCImago Journal Rankings: 2.729 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | LIU, X | - |
dc.contributor.author | Wong, CKH | - |
dc.contributor.author | Chan, WWL | - |
dc.contributor.author | Tang, EHM | - |
dc.contributor.author | Woo, YC | - |
dc.contributor.author | Lam, CLK | - |
dc.contributor.author | Lang, BHH | - |
dc.date.accessioned | 2021-03-08T07:15:50Z | - |
dc.date.available | 2021-03-08T07:15:50Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | Annals of Surgery, 2021, v. 273 n. 6, p. 1197-1206 | - |
dc.identifier.issn | 0003-4932 | - |
dc.identifier.uri | http://hdl.handle.net/10722/297218 | - |
dc.description | Hybrid open access | - |
dc.description.abstract | Background: The long-term outcomes of first-line choice among anti-thyroid drug (ATD), radioactive iodine (RAI) and thyroidectomy for Graves’ disease (GD) patients remain unclear. Objective: To compare the long-term morbidity, mortality, relapse, and costs of GD patients receiving first-line treatment. Methods: A population-based retrospective cohort of GD patients initiating first-line treatment with ATD, RAI, or thyroidectomy as a first-line primary treatment between 2006 and 2018 from Hong Kong Hospital Authority was analyzed. Risks of all-cause mortality, cardiovascular diseases (CVD), atrial fibrillation (AF), psychological disease, diabetes, and hypertension were estimated using Cox proportional hazards regression models. The 10-year healthcare costs, change of comorbidities, and risk of relapse were compared across treatments. Results: Over a median follow-up of 90 months with 47,470 person-years, 6385 patients (ATD, 74.93%; RAI, 19.95%; thyroidectomy, 5.12%) who received first-line treatment for GD were analyzed. Compared with ATD group, patients who had undergone surgery had significantly lower risks of all-cause mortality (HR = 0.363, 95%CI = 0.332–0.396), CVD (HR = 0.216, 95%CI = 0.195–0.239), AF (HR = 0.103, 95%CI = 0.085–0.124), psychological disease (HR = 0.279, 95%CI = 0.258–0.301), diabetes (HR = 0.341, 95%CI = 0.305–0.381) and hypertension (HR = 0.673, 95%CI = 0.632–0.718). Meanwhile, RAI group was also associated with decreased risks of all-cause mortality (HR = 0.931, 95%CI = 0.882–0.982), CVD (HR = 0.784, 95%CI = 0.742–0.828), AF (HR = 0.622, 95%CI = 0.578–0.67) and psychological disease (HR = 0.895, 95%CI = 0.855–0.937). The relapse rate was 2.41% in surgery, 75.60% in ATD, and 19.53% in RAI group. The surgery group was observed with a significant lower CCI score than the other two groups at the tenth-year follow-up. The mean 10-year cumulative healthcare costs in ATD, RAI, and surgery group was US$23915, US$24260, and US$20202, respectively. Conclusions: GD patients who received surgery as an initial treatment appeared to have lower chances of all-cause mortality, CVD, AF, psychological disease, diabetes and hypertension in the long-term when compared to those treated with ATD or RAI. The surgery group had the lowest relapse and direct healthcare costs among the three treatment modalities. This long-term cohort study suggested surgery may have a larger role to play as an initial treatment for GD patients. | - |
dc.language | eng | - |
dc.publisher | Lippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com | - |
dc.relation.ispartof | Annals of Surgery | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | antithyroid drugs | - |
dc.subject | Graves’ disease | - |
dc.subject | population based cohort | - |
dc.subject | radioactive iodine | - |
dc.subject | thyroidectomy | - |
dc.title | Outcomes of Graves’ Disease Patients Following AntiThyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-Line Treatment | - |
dc.type | Article | - |
dc.identifier.email | Wong, CKH: carlosho@hku.hk | - |
dc.identifier.email | Chan, WWL: winglok@hku.hk | - |
dc.identifier.email | Tang, EHM: erichm@hku.hk | - |
dc.identifier.email | Woo, YC: wooyucho@hku.hk | - |
dc.identifier.email | Lam, CLK: clklam@hku.hk | - |
dc.identifier.email | Lang, BHH: Blang@hku.hk | - |
dc.identifier.authority | Wong, CKH=rp01931 | - |
dc.identifier.authority | Chan, WWL=rp02541 | - |
dc.identifier.authority | Lam, CLK=rp00350 | - |
dc.identifier.authority | Lang, BHH=rp01828 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.1097/SLA.0000000000004828 | - |
dc.identifier.pmid | 33914484 | - |
dc.identifier.scopus | eid_2-s2.0-85106543108 | - |
dc.identifier.hkuros | 321707 | - |
dc.identifier.hkuros | 322665 | - |
dc.identifier.volume | 273 | - |
dc.identifier.issue | 6 | - |
dc.identifier.spage | 1197 | - |
dc.identifier.epage | 1206 | - |
dc.identifier.isi | WOS:000662304000044 | - |
dc.publisher.place | United States | - |