DISEASE PRESENTATION AND REMISSION RATE IN GRAVES' DISEASE TREATED WITH ANTI-THYROID DRUGS: IS GENDER REALLY A FACTOR?

OBJECTIVE: Male gender is considered an adverse prognostic factor for remission of Graves' disease treatment with anti-thyroid drugs (ATD), though published data is conflicting. This often results in early consideration of radioiodine treatment and surgery for men. Our objective was to compare disease presentation and outcome in men versus women treated with ATDs.

METHODS: Retrospective study of 235 patients (64 men, 171 women) with Graves' disease who were evaluated for features at presentation and outcome at the end of follow-up between 2010 and 2015.

RESULTS: Disease presentation was similar in men and women for age at diagnosis (41.4±14 vs. 40±15 years), duration of follow up (6.6±7 vs. 7.7±6 years), rates of co-morbid autoimmune diseases, and rate of Graves' ophthalmopathy. Smoking was more prevalent in males (31% vs. 15%, p=0.009). Free T4 and T3 levels were comparable. ATDs were first line treatment in all males and in 168 of 171 females, for a median duration of 24 and 20 months, respectively (p=0.55). Remission rates were 47% in men and 58% in women (p=0.14). Males had less adverse events (9% vs. 18%) and treatment discontinuation (5% vs. 16%). Disease recurrence was comparable (14% vs. 20%, p=0.32), as was requirement for second line treatment, either radioiodine therapy or thyroidectomy.

CONCLUSION: Graves' disease presentation is similar in men and women. Men treated with ATDs have high remission rates and similar recurrence rates compared to women, with less adverse events and less discontinuation of treatment. ATDs are an attractive first line treatment for both genders.

ABBREVIATIONS: ATD = anti-thyroid drugs, GO = Graves' ophthalmopathy, ATA = American thyroid association, EUGOGO = European group on Graves' orbitopathy, MRI = magnetic resonance imaging.