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The Long-Term Outco...
The Long-Term Outcome of Treatment for Graves' Hyperthyroidism
- Artikel/kapitelEngelska2019
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Mary Ann Liebert Inc,2019
Nummerbeteckningar
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LIBRIS-ID:oai:gup.ub.gu.se/287780
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https://gup.ub.gu.se/publication/287780URI
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https://doi.org/10.1089/thy.2019.0085DOI
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https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-76165URI
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-398569URI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:142289705URI
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Ämneskategori:art swepub-publicationtype
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Background: The treatment efficacy of antithyroid drug (ATD) therapy, radioactive iodine (I-131), or surgery for Graves' hyperthyroidism is well described. However, there are a few reports on the long-term total outcome of each treatment modality regarding how many require levothyroxine supplementation, the need of thyroid ablation, or the individual patient's estimation of their recovery. Methods: We conducted a pragmatic trial to determine the effectiveness and adverse outcome in a patient cohort newly diagnosed with Graves' hyperthyroidism between 2003 and 2005 (n = 2430). The patients were invited to participate in a longitudinal study spanning 8 +/- 0.9 years (mean +/- standard deviation) after diagnosis. We were able to follow 1186 (60%) patients who had been treated with ATD, I-131, or surgery. We determined the mode of treatment, remission rate, recurrence, quality of life, demographic data, comorbidities, and lifestyle factors through questionnaires and a review of the individual's medical history records. Results: At follow-up, the remission rate after first-line treatment choice with ATD was 45.3% (351/774), with I-131 therapy 81.5% (324/264), and with surgery 96.3% (52/54). Among those patients who had a second course of ATD, 29.4% achieved remission (vs. the 45.3% after the first course of ATD). The total number of patients who had undergone ablative treatment was 64.3% (763/1186), of whom 23% (278/1186) had received surgery, 43% (505/1186) had received I-131 therapy, including 2% (20/1186) who had received both surgery and I-131. Patients who received ATD as first-line treatment and possibly additional ATD had 49.7% risk (385/774) of having undergone ablative treatment at follow-up. Levothyroxine replacement was needed in 23% (81/351) of the initially ATD treated in remission, in 77.3% (204/264) of the I-131 treated, and in 96.2% (50/52) of the surgically treated patients. Taken together after 6-10 years, and all treatment considered, normal thyroid hormone status without thyroxine supplementation was only achieved in 35.7% (423/1186) of all patients and in only 40.3% of those initially treated with ATD. The proportion of patients that did not feel fully recovered at follow-up was 25.3%. Conclusion: A patient selecting ATD therapy as the initial approach in the treatment of Graves' hyperthyroidism should be informed that they have only a 50.3% chance of ultimately avoiding ablative treatment and only a 40% chance of eventually being euthyroid without thyroid medication. Surprisingly, 1 in 4 patients did not feel fully recovered after 6-10 years. The treatment for Graves' hyperthyroidism, thus, has unexpected long-term consequences for many patients.
Ämnesord och genrebeteckningar
Biuppslag (personer, institutioner, konferenser, titlar ...)
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Holmberg, Mats,1958Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institute of Medicine,Karolinska Universitetssjukhuset, ANOVA, Stockholm, Sweden,Univ Gothenburg, Sahlgrenska Acad, Inst Med, Gothenburg, Sweden;Karolinska Univ Hosp, ANOVA, Stockholm, Sweden(Swepub:gu)xhmats
(författare)
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T?rring, O.Karolinska Institutet
(författare)
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Byström, Kristina,1961-Örebro universitet,Institutionen för medicinska vetenskaper,Dept. of Medicine, Örebro University Hostpital, Örebro, Sweden,Orebro Univ, Dept Med, Orebro, Sweden;Univ Hosp, Orebro, Sweden(Swepub:oru)kbm
(författare)
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Khamisi, SelwanUppsala universitet,Endokrinologi och mineralmetabolism(Swepub:uu)selkh262
(författare)
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de Laval, D.Blekingesjukhuset i Karlskrona, Department of Medicine, Karlskrona, Sweden,Blekinge Hosp, Dept Med, Karlskrona, Sweden
(författare)
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Abraham-Nordling, M.Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Stockholm County, Sweden,Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden
(författare)
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Calissendorff, J.Karolinska Institutet
(författare)
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Lantz, M.Lund University, Lund, Sweden,Skane Univ Hosp, Dept Endocrinol, Malmo, Sweden;Lund Univ, Dept Clin Sci, Lund, Sweden
(författare)
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Hallengren, B.Lund University, Lund, Sweden,Skane Univ Hosp, Dept Endocrinol, Malmo, Sweden;Lund Univ, Dept Clin Sci, Lund, Sweden
(författare)
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Nyström, Helena Filipsson,1966Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institute of Medicine,Sahlgrenska Academy, Dept. of Endocrinology, Göteborg, Sweden,Univ Gothenburg, Sahlgrenska Acad, Inst Med, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Endocrinol, Gothenburg, Sweden(Swepub:gu)xfilih
(författare)
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Wallin, Göran,1952-Örebro universitet,Institutionen för medicinska vetenskaper,Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden,Orebro Univ, Fac Med & Hlth, Dept Surg, SE-70185 Orebro, Sweden;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden(Swepub:oru)gwn
(författare)
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Sjölin, Gabriel,1979-Örebro universitet,Institutionen för medicinska vetenskaper,Department of Surgery,Orebro Univ, Fac Med & Hlth, Dept Surg, SE-70185 Orebro, Sweden(Swepub:oru)glsn
(författare)
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Göteborgs universitetInstitutionen för medicin
(creator_code:org_t)
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Ingår i:Thyroid: Mary Ann Liebert Inc29:11, s. 1545-15571050-72561557-9077
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Sj?lin, G.
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Holmberg, Mats, ...
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T?rring, O.
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Byström, Kristin ...
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Khamisi, Selwan
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de Laval, D.
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Abraham-Nordling ...
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Calissendorff, J ...
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Lantz, M.
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Hallengren, B.
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Nyström, Helena ...
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Wallin, Göran, 1 ...
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Sjölin, Gabriel, ...
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Thyroid
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