Parameswaran Rajeev, de Jong Mechteld Christine, Kit James Lee Wai, Sek Kathleen, Nam Tran Quang, Thang Tran Viet, Khue Nguyen Thy, Aye Than Than, Tun Phone Myint, Cole Timothy, Miller Julie A, Villa Michael, Khiewvan Benjapa, Sirinvaravong Sirinart, Sin Yong Lit, Muhammad Rohaizak, Jap Tjin Shing, Agrawal Amit, Rajput Rajesh, Fernando Ranil, Sumanatilleke Manilka, Suastika Ketut, Shong Young Kee, Lang Brian, Bartalena Luigi, Yang Samantha Peiling
Department of Endocrine Surgery, National University Hospital, Singapore, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Endocrine. 2023 Jan;79(1):135-142. doi: 10.1007/s12020-022-03193-7. Epub 2022 Sep 21.
Although Graves' disease (GD) is common in endocrine practices worldwide, global differences in diagnosis and management remain. We sought to assess the current practices for GD in countries across Asia and the Pacific (APAC), and to compare these with previously published surveys from North America and Europe.
A web-based survey on GD management was conducted on practicing clinicians. Responses from 542 clinicians were received and subsequently analysed and compared to outcomes from similar surveys from other regions.
A total of 542 respondents participated in the survey, 515 (95%) of whom completed all sections. Of these, 86% were medical specialists, 11% surgeons, and 3% nuclear medicine physicians. In addition to serum thyroid-stimulating hormone (TSH) and free thyroxine assays, most respondents would request TSH-receptor autoantibody (TRAb) measurement (68%) during initial work-up. Thyroid ultrasound is requested by about half of respondents (53%), while the use of nuclear medicine scans is limited. The preferred first-line treatment is anti-thyroid drug (ATD) therapy (79%) with methimazole (MMI) or carbimazole (CBZ), followed by radioiodine (RAI; 19%) and surgery (2%). In case of surgery, one-third of respondents would opt for a subtotal rather than a total thyroidectomy. In case of mild Graves orbitopathy (GO), ATDs (67%) remains the preferred treatment, but a larger proportion of clinicians prefer surgery (20%). For a patient with intention to conceive, the preferred treatment pattern remained unchanged, although propylthiouracil (PTU) became the preferred ATD-agent during the first trimester. In comparison to European and American practices, marked differences were noted in the relatively infrequent usage of nuclear medicine scans and the overall higher use of a ATDs and β-blockers and adjunctive ATD-treatment during RAI in the APAC-group.
Although regional differences regarding the diagnosis and management of GD are apparent in this first pan-Asia-Pacific survey, this study reveals the overall approach to the management of this disease in Asia-Pacific generally tends to fall between the trends appreciated in the American and European cohorts.
尽管格雷夫斯病（GD）在全球内分泌诊疗中很常见，但在诊断和管理方面仍存在全球差异。我们试图评估亚太地区各国目前对GD的诊疗实践，并将其与之前北美和欧洲发表的调查结果进行比较。
对执业临床医生进行了一项关于GD管理的网络调查。收到了542名临床医生的回复，随后对其进行分析，并与其他地区类似调查的结果进行比较。
共有542名受访者参与了调查，其中515名（95%）完成了所有部分。其中，86%是医学专家，11%是外科医生，3%是核医学医生。除血清促甲状腺激素（TSH）和游离甲状腺素检测外，大多数受访者在初次检查时会要求检测促甲状腺激素受体自身抗体（TRAb）（68%）。约一半的受访者（53%）会要求进行甲状腺超声检查，而核医学扫描的使用有限。首选的一线治疗是抗甲状腺药物（ATD）治疗（79%），使用甲巯咪唑（MMI）或卡比马唑（CBZ），其次是放射性碘（RAI；19%）和手术（2%）。在手术治疗的情况下，三分之一的受访者会选择次全甲状腺切除术而不是全甲状腺切除术。对于轻度格雷夫斯眼眶病（GO），ATD（67%）仍然是首选治疗方法，但有更大比例的临床医生更喜欢手术（20%）。对于有怀孕意愿的患者，首选的治疗模式保持不变，尽管丙硫氧嘧啶（PTU）在孕早期成为首选的ATD药物。与欧美诊疗实践相比，亚太地区组在核医学扫描使用相对较少、ATD和β受体阻滞剂总体使用较多以及放射性碘治疗期间辅助使用ATD治疗方面存在明显差异。
尽管在这项首次泛亚太地区调查中，GD的诊断和管理存在明显的地区差异，但本研究表明，亚太地区对这种疾病的总体管理方法通常介于美国和欧洲队列所呈现的趋势之间。
