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Article: Outcomes of Graves’ Disease Patients Following AntiThyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-Line Treatment

TitleOutcomes of Graves’ Disease Patients Following AntiThyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-Line Treatment
Authors
Keywordsantithyroid drugs
Graves’ disease
population based cohort
radioactive iodine
thyroidectomy
Issue Date2021
PublisherLippincott 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?
AbstractBackground: 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.
DescriptionHybrid open access
Persistent Identifierhttp://hdl.handle.net/10722/297218
ISSN
2020 Impact Factor: 12.969
2020 SCImago Journal Rankings: 4.153
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLIU, X-
dc.contributor.authorWong, CKH-
dc.contributor.authorChan, WWL-
dc.contributor.authorTang, EHM-
dc.contributor.authorWoo, YC-
dc.contributor.authorLam, CLK-
dc.contributor.authorLang, BHH-
dc.date.accessioned2021-03-08T07:15:50Z-
dc.date.available2021-03-08T07:15:50Z-
dc.date.issued2021-
dc.identifier.citationAnnals of Surgery, 2021, v. 273 n. 6, p. 1197-1206-
dc.identifier.issn0003-4932-
dc.identifier.urihttp://hdl.handle.net/10722/297218-
dc.descriptionHybrid open access-
dc.description.abstractBackground: 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.languageeng-
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com-
dc.relation.ispartofAnnals of Surgery-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectantithyroid drugs-
dc.subjectGraves’ disease-
dc.subjectpopulation based cohort-
dc.subjectradioactive iodine-
dc.subjectthyroidectomy-
dc.titleOutcomes of Graves’ Disease Patients Following AntiThyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-Line Treatment-
dc.typeArticle-
dc.identifier.emailWong, CKH: carlosho@hku.hk-
dc.identifier.emailChan, WWL: winglok@hku.hk-
dc.identifier.emailTang, EHM: erichm@hku.hk-
dc.identifier.emailWoo, YC: wooyucho@hku.hk-
dc.identifier.emailLam, CLK: clklam@hku.hk-
dc.identifier.emailLang, BHH: Blang@hku.hk-
dc.identifier.authorityWong, CKH=rp01931-
dc.identifier.authorityChan, WWL=rp02541-
dc.identifier.authorityLam, CLK=rp00350-
dc.identifier.authorityLang, BHH=rp01828-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1097/SLA.0000000000004828-
dc.identifier.pmid33914484-
dc.identifier.scopuseid_2-s2.0-85106543108-
dc.identifier.hkuros321707-
dc.identifier.hkuros322665-
dc.identifier.volume273-
dc.identifier.issue6-
dc.identifier.spage1197-
dc.identifier.epage1206-
dc.identifier.isiWOS:000662304000044-
dc.publisher.placeUnited States-

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