A 2023 International Survey of Clinical Practice Patterns in the Management of Graves' Disease: A Decade of Change.

ABSTRACT

CONTEXT Over the past several decades, there have been indications of potential shifts in the diagnostic strategies, treatment, and monitoring of patients with Graves´ disease (GD). OBJECTIVE: To evaluate current practices in managing GD and compare them to previous surveys. DESIGN: We used a global survey of endocrinologists to assess diagnosis, monitoring and treatment in a typical patient with GD, as well as treatment variation in five different clinical scenarios. SETTING: Online survey. PARTICIPANTS: Members of various endocrine societies worldwide. INTERVENTION None. MAIN OUTCOME: Shifts in the management of GD. RESULTS: 1252 respondents from 85 countries completed the survey. Methods used to diagnose an uncomplicated GD case have changed over the past decade, reflecting increased use of TRAb and reciprocal decreases in nuclear medicine studies. The preferred mode of therapy for uncomplicated GD was antithyroid drugs (ATDs) by 91.5% of respondents, radioactive iodine (RAI) therapy by 7%, and thyroidectomy by 1.5%. Compared with previous surveys, the use of RAI as a first-line choice decreased in all geographic regions. The U.S. had the sharpest decline in the selection of initial therapy with RAI, decreasing from 69% in 1990 to 11.1% in 2023. In patients with persistent TRAb positivity after 18 months, 68.7% of respondents would continue the use of ATDs. After a relapse of GD, resumption of ATDs was selected by 59.9% of respondents. In patients with active TED or planning pregnancy, ATDs were the first choice (67.5% and 72.8%, respectively), and thyroidectomy emerged as the second choice (22.9% and 15.6%, respectively). CONCLUSIONS: Paradigm shifts have occurred in the management of uncomplicated GD and its variants, as well as the response to persistent and recurrent hyperthyroidism.