Goiter at Diagnosis Might Be Predicting Factor for Early Onset Intractable Graves’ Disease

Introduction: The clinical course of Graves’ disease (GD) treated with anti-thyroid drug (ATD) treatment were reviewed with the aim of establishing criteria able to predict intractable GD. Methods: The clinical course of 116 patients with GD who agreed to participate in this study between March 2009 and August 2019 in the pediatric endocrine clinic at Seoul St. Mary’s and St. Vincent’s Hospitals were reviewed. We defined an intractable as hyperthyroidism persistent over 2 years of ATD or relapsed after ATD withdrawal or had been treated ATD for at least 5 years [1-3]. Result: Of 116 patients diagnosed with GD, 37 patients (31.8%) had remission and 79 (68.2%) had intractable GD. Between intractable and remission GD group, there were no significant difference of female percentage, age at diagnosis, thyroid associated ophthalmopathy, serum levels of triiodothyronine (T3), free tetraiodothyronine (T4), Thyroid stimulating hormone (TSH) and positive rate of thyroid autoantibody (Thyroid peroxidase (TPO), Thyroglobulin (Tg), Thyroid stimulating hormone receptor (TSHR)). In intractable GD patients, the frequency of goiter at diagnosis is higher than remission group (89.9% [71/79] and 70.3% [26/37], P-value = 0.014). In correlation analysis, intractable GD showed positive correlation with goiter (R=0.247, P-value = 0.008). In multivariate logistic analyses, goiter is showed strong relationship with intractable GD (odds ratio, 3.793; 95% confidence interval, 1.367-10.524) after adjusting age and sex. Conclusion: Our study supported that goiter at initial presentation might be predicting factor for early onset intractable GD.