Goiter size as a parameter for predicting remission in patients suffering from Graves disease treated by thyrosupressive drug therapy

Graves' disease is defined as hyperthyroidism with diffuse goiter caused by immune disorders. Efforts to identify factors that may indicate the likelihood of achieving remission or relapse upon cessation of thyrosupressive drug therapy are continuously ongoing. Reports on the achievement of long-term remission range between 14-80% in the treated, and the overall rate of recurrence after withdrawal of treatment is about 30- 50%. Determination of the early prognostic factors for the outcome of thyrosupressive drug therapy could allow the differentiation between patients who respond and do not respond to therapy and timely selection of ablative therapy. The aim of this study was to determine the effect of goiter size as a predictor of remission during thyrosupressive drug therapy. The study was conducted in a prospective manner including 106 consecutive patients with newly diagnosed autoimmune hyperethyroidism who were given thyrosupressive drug therapy. After the diagnosis of the disease by anamnestic, clinical and biochemical examination at the beginning and 12 months after the initiation of thyrosupressive drug therapy, the presence and goiter size were followed by palpation and by echosonographic volumetry. In the majority of the patients (90%) at the beginning of the disease goiter was small or absent (grade 0A, 0B, 0-I). During the MTT the presence and goiter size did not change significantly. The average thyroid volume at the beginning of the disease in our patients was about 21 ml. During MTT and twelve months after the start of MTT, significant changes in the size of thyroid were not observed. It was observed that there was no significant difference in the presence and goiter site, whether it was determined by palpation, or measured echosonographically among patients in remission, and in those who had no remission. The results indicate that the presence and goiter size at the onset of the disease are not relevant for the prediction of remission in patients with Graves' disease treated by the thyrosupressive drug therapy.