External Validation of the GREAT Score in Turkish Patients with Gravesʼ Hyperthyroidism Treated with the Titration Regimen Method of Antithyroid Drugs: A Multicenter Study

Sayid Shafi Zuhur; Gulsah Elbuken; Ismail Yildiz; Pinar Kadioglu; Selvinaz Erol; Serdar Sahin; Faruk Kilinc; Gulhan Akbaba; Birol Topcu; Yuksel Altuntas

doi:10.1055/a-0974-3991

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2019; 51(10): 627-633
DOI: 10.1055/a-0974-3991

Endocrine Care

External Validation of the GREAT Score in Turkish Patients with Gravesʼ Hyperthyroidism Treated with the Titration Regimen Method of Antithyroid Drugs: A Multicenter Study

Sayid Shafi Zuhur

¹Department of Endocrinology and Metabolism, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey

,

Gulsah Elbuken

¹Department of Endocrinology and Metabolism, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey

,

Ismail Yildiz

¹Department of Endocrinology and Metabolism, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey

,

Pinar Kadioglu

²Department of Endocrinology and Metabolism, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey

,

Selvinaz Erol

³Department of Endocrinology and Metabolism, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

,

Serdar Sahin

²Department of Endocrinology and Metabolism, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey

,

Faruk Kilinc

⁴Department of Endocrinology and Metabolism, Faculty of Medicine, Firat University, Elazig, Turkey

,

Gulhan Akbaba

⁵Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey

,

Birol Topcu

⁶Department of Biostatistics, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey

,

Yuksel Altuntas

³Department of Endocrinology and Metabolism, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

› Author Affiliations

Abstract

Recently, the Gravesʼ Recurrent Events After Therapy score (GREAT) was proposed as a useful tool to predict relapse before starting antithyroid drugs (ATD) in patients with Gravesʼ disease (GD). Therefore, we intended to assess the validity of the GREAT score in Turkish patients with GD, including patients who experienced a poorly controlled disease (multiple episodes of hyperthyroidism followed by euthyroidism or rarely hypothyroidism) during ATD dose titration. This is a retrospective multicenter study including 517 patients with the first episode of GD who were treated for at least 12 months. The patients were classified as relapse+poorly controlled disease (non-remission) and remission groups. During a median follow-up time of 35 months (12–144 months), 191 (37%) patients experienced a relapse, 136 (26.3%) a poorly controlled disease, and 190 (36.7%) remained in remission. Patients with non-remission disease tended to have significantly higher serum levels of TRAb, fT4, and fT3, and have larger goiter sizes on palpation at baseline, as compared with the remission group. Non-remission disease occurred in 12, 35, and, 53% of the patients falling into GREAT class I, II, and III, respectively (hazard ratio 2.56, 95% CI 2.02–3.51, p=0.012, and hazard ratio 3.54, 95% CI 2.12–5.91, p<0.001, for GREAT class II and III against class I, respectively). According to our study, the GREAT score is a useful tool to predict the risk of relapse as well as the occurrence of poorly controlled disease before starting treatment with ATDs.

Key words

Gravesʼ disease - relapse - antithyroid drugs - GREAT score

Full Text

References

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