Struja Tristan, Kaeslin Marina, Boesiger Fabienne, Jutzi Rebecca, Imahorn Noemi, Kutz Alexander, Bernasconi Luca, Mundwiler Esther, Mueller Beat, Christ-Crain Mirjam, Meienberg Fabian, Ebrahimi Fahim, Henzen Christoph, Fischli Stefan, Kraenzlin Marius, Meier Christian, Schuetz Philipp
Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism.
Department of Laboratory MedicineKantonsspital Aarau, Aarau, Switzerland.
Eur J Endocrinol. 2017 Apr;176(4):413-419. doi: 10.1530/EJE-16-0986. Epub 2017 Jan 18.
First-line treatment in Graves' disease is often done with antithyroid agents (ATD), but relapse rates remain high making definite treatment necessary. Predictors for relapse risk help guiding initial treatment decisions.
We aimed to externally validate the prognostic accuracy of the recently proposed Graves' Recurrent Events After Therapy (GREAT) score to predict relapse risk in Graves' disease.
DESIGN, SETTING AND PARTICIPANTS: We retrospectively analyzed data (2004-2014) of patients with a first episode of Graves' hyperthyroidism from four Swiss endocrine outpatient clinics.
Relapse of hyperthyroidism analyzed by multivariate Cox regression.
Of the 741 included patients, 371 experienced a relapse (50.1%) after a mean follow-up of 25.6 months after ATD start. In univariate regression analysis, higher serum free T, higher thyrotropin-binding inhibitor immunoglobulin (TBII), younger age and larger goiter were associated with higher relapse risk. We found a strong increase in relapse risk with more points in the GREAT score from 33.8% in patients with GREAT class I (0-1 points), 59.4% in class II (2-3 points) with a hazard ratio of 1.79 (95% CI: 1.42-2.27, < 0.001) and 73.6% in class III (4-6 points) with a hazard ratio of 2.24 (95% CI: 1.64-3.06, < 0.001).
Based on this retrospective analysis within a large patient population from a multicenter study, the GREAT score shows good external validity and can be used for assessing the risk for relapse in Graves' disease, which influence the initial treatment decisions.
格雷夫斯病的一线治疗通常使用抗甲状腺药物（ATD），但复发率仍然很高，因此有必要进行确定性治疗。复发风险的预测因素有助于指导初始治疗决策。
我们旨在外部验证最近提出的格雷夫斯病治疗后复发事件（GREAT）评分预测格雷夫斯病复发风险的预后准确性。
设计、设置和参与者：我们回顾性分析了来自瑞士四个内分泌门诊诊所的首次发作格雷夫斯病甲亢患者的数据（2004 - 2014年）。
通过多变量Cox回归分析甲亢复发情况。
在纳入的741例患者中，371例（50.1%）在开始使用抗甲状腺药物后平均随访25.6个月出现复发。在单变量回归分析中，较高的血清游离T、较高的促甲状腺素结合抑制免疫球蛋白（TBII）、较年轻的年龄和较大的甲状腺肿与较高的复发风险相关。我们发现GREAT评分得分越高，复发风险显著增加，GREAT I类（0 - 1分）患者的复发风险为33.8%，II类（2 - 3分）患者为59.4%，风险比为1.79（95% CI：1.42 - 2.27，<0.001），III类（4 - 6分）患者为73.6%，风险比为2.24（95% CI：1.64 - 3.06，<0.001）。
基于这项来自多中心研究的大量患者群体的回顾性分析，GREAT评分显示出良好的外部有效性，可用于评估格雷夫斯病的复发风险，这会影响初始治疗决策。
