A Predictive Model for Graves' Disease Recurrence After Antithyroid Drug Therapy: A Retrospective Multi-Center Cohort Study.

El Kawkgi O, Toro-Tobon D, Toloza FJK, Vallejo S, Jacome CS, Ayala IN, Vallejo BA, Wenczenovicz C, Tzeng O, Spencer HJ, Thostenson JD, Li D, Kohlenberg J, Lincango E, Mohan S, Castellanos-Diaz J, Maraka S, Ospina NS, Brito JP. A Predictive Model for Graves' Disease Recurrence After Antithyroid Drug Therapy: A Retrospective Multi-Center Cohort Study. Endocrine Practice : Official Journal of The American College of Endocrinology and The American Association of Clinical Endocrinologists. 2024 Dec 16.

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Abstract:

OBJECTIVES: Predicting recurrence after antithyroid drug (ATD) cessation is crucial for optimal treatment decision-making in patients with Graves' disease (GD). We aimed to identify factors associated with GD recurrence and to develop a model using routine pretherapeutic clinical parameters to predict GD recurrence risk during the first year following ATD discontinuation. METHODS: This electronic health records-based observational cohort study analyzed patients with GD treated with ATDs at three U.S. academic centers. Demographic, clinical characteristics and GD recurrence within one year following ATD discontinuation were assessed. Univariable and multivariable analyses were performed. A predictive model for GD recurrence was developed and visualized as a nomogram. RESULTS: Among the 523 patients included in the study, 211 (40.34%) discontinued treatment. Of these, the 142 (67.29%) that had a follow-up period exceeding 12 months after stopping ATD were used for the development of the predictive model. Among the patients included in the model, the majority were women (n = 111, 78.16%), with a mean age of 49.29 years (SD 16.31) and baseline free T4 (FT4) levels averaging 3.39 ng/dl (SD 2.25). Additionally, 79/211 patients (37.44%) experienced recurrence within one year. Multivariable analysis indicated a 31% increased risk of GD recurrence per additional decade of age (OR 1.31, 95% CI 1.03-1.66, p = 0.0258), and a 65% increased risk of GD recurrence for every 2.0 ng/dL rise in baseline FT4 (OR 1.65, 95% CI 1.08-2.50, p = 0.0192). The recurrence predictive model's AUC was 0.69 in the derivation dataset and 0.65 in cross-validation. CONCLUSIONS: This study introduced a practical model that can be used during the initial therapeutic decision-making process. It utilizes easily accessible baseline clinical data to predict the likelihood of GD recurrence after one year of ATD therapy. Further research is needed to identify other factors affecting risk of recurrence and develop more precise predictive models.