Identifying Key Predictors of Long-term Remission in Graves Disease After Antithyroid Drug Treatment

Introduction: Treatment of Graves' disease (GD) is based on the triad of antithyroid drugs (ATD), radioactive iodine and surgery (total or subtotal thyroidectomy). ATD remains the first-line treatment. Aim: To determine predictors of GD remission after treatment with ATD. Methods: Cross-sectional study for analytical purposes including 105 patients followed for GD treated with ATD for 12 to 18 months. The collection of clinical and biological data was done through the consultation of medical records. Patients were divided to two groups according to their outcome. The "Remission" group included patients with durable euthyroidism after treatment withdrawal. The "Failure" group included patients who did not achieve euthyroidism at the end of treatment or who had relapsed after treatment withdrawal. Results were compared using Chi-Square test and t-test and logistic regression model with significance at p Results: Patients in the "Remission" group were 43 (40.95%) and patients in the "Failure" group were 62 (59.05%). Factors that were significantly associated with remission at univariate analysis were: a shorter duration of symptom progression, a shorter duration of treatment, a lower initial anti-TSH receptor antibodies level, methimazole use compared to Benzylthiouracil use and better therapeutic adherence. Multivariate analysis showed that only shorter treatment duration (p = 0.01, OR = 0.90, IC95% [0.87 0.97]), lower initial anti-TSH receptor antibodies level (p = 0.016; = 0.93, IC95% [0.87-0.98]) and methimazole use (p = 0.048, OR = 2.4, IC95% [1.00-5.74]) were significant predictors of remission. Conclusion: A lower initial level of anti-TSH receptor antibodies, the use of methimazole compared to Benzylthiouracil as well as a shorter duration of treatment are factors of better prognosis in the outcome of Graves’ disease after Antithyroid drug treatment.