Clinical Manifestations, TSH and FT4 Levels During Initiation and Maintenance Therapy in Patients with Graves’ Disease at Dr. M. Djamil General Hospital, Padang, 2017–2022
DOI:
https://doi.org/10.53366/jimki.v12i2.996Keywords:
Graves’ disease, Hyperthyroidism, Thyroid function, Clinical ManifestationAbstract
Background: Graves’ disease is an autoimmune cause of hyperthyroidism marked by characteristic symptoms and abnormalities in TSH and FT4 levels. Management consists of an initial treatment phase followed by long-term maintenance, and variability in immune responsiveness may influence therapeutic outcomes. This study aimed to describe clinical manifestations and thyroid hormone profiles during initial and maintenance therapy among patients treated at Dr. M. Djamil General Hospital, Padang, from 2017 to 2022. Method: A descriptive cross-sectional design with total sampling was applied. Forty patients diagnosed with Graves’ disease were included. Clinical and laboratory variables were extracted from medical records, and univariate analysis was performed using SPSS v26. Results: The majority of patients were women aged 40–60 years. Palpitations were the most frequent symptom in both treatment phases, followed by excessive sweating, tremor, and exophthalmos. Treatment duration exceeded 24 months for the majority. Mean TSH increased from 0.11±0.17 µIU/mL in the initial phase to 0.62±1.03 µIU/mL during maintenance, while mean FT4 decreased from 47.09±32.79 pmol/L to 21.73±13.10 pmol/L. Discussion: The observed rise in TSH and decline in FT4 indicate biochemical improvement consistent with antithyroid drug responsiveness. The reduction in symptom frequency parallels hormonal stabilization, supporting the clinical utility of long-term therapy. The extended duration of treatment aligns with standard recommendations that emphasize sustained disease control to minimize the risk of relapse. Conclusion: Transition from initial to maintenance therapy was associated with symptomatic improvement and progressive normalization of thyroid function, emphasizing the importance of prolonged and well-supervised treatment in Graves’ disease.
References
1. Leo S De, Lee SY, Braverman LE, Unit E, Sciences C. Hyperthyroidism: Lancet review. Lencet. 2016;3,88:906-18.
2. Hussain YS, Hookham JC, Allahabadia A, Balasubramanian SP. Epidemiology, management and outcomes of Graves' disease-real life data. Endocrine. 2017 Jun;56(3):568-578. doi: 10.1007/s12020-017-1306-5.
3. Bhusal BPK. Graves Disease In StatPearls Publishing. Treasure Island. 2023
4. Mihardja L, Karyana M. Hyperthyroidism in Indonesian community: a mini review. Endocrinol Int J. 2019;7:52–3.
5. Kementerian Kesehatan RI. Infodatin: Situasi dan Analisis Penyakit Tiroid. Pusat Data dan Informasi Kementerian Kesehatan RI.Jakarta: Menteri Kesehatan RI; 2015:1-8.
6. Erza. Gambaran frekuensi dan karakteristik kelainan tiroid di RSUP Dr M. Djamil padang periode Januari 2017 – Desember 2017. J Kedokt dan Kesehat. 2019;44.
7. Chung JH. Antithyroid drug treatment in graves’ disease. Endocrinol Metab. 2021;36:491–9.
8. Price S, Wilson L. Patofisiologi: Konsep Klinis Proses- Proses Penyakit, edisi 6. Jakarta: EGC; 2006: 1225– 36.
9. Wang PW, Chen IY, Juo SH, Hsi E, Liu RT, Hsieh CJ. Genotype and phenotype predictors of relapse of Graves' disease after antithyroid drug withdrawal. European Thyroid Journal. 2012; 1: 251–8.
10. Laurberg P, Nygaard B, Andersen S, Carle A, Karmisholt J, Kerjbjerg A, et al. Association between TSH-receptor autoimmunity, hyperthyroidism, goitre, and orbitopathy in 208 patients included in the remission induction and sustenance in the remission induction and sustenance in graves disease study.2024;1-6
11. Buly L, Utama F, Robikhul Ikhsan M, Yanti V. Hubungan Antara Tanda Dan Gejala Klinis Hipertiroid Dengan Hormon Tiroid Pada Penderita Hipertiroid. ETD UGM. 2020.
12. Kelompok Studi Tiroidologi Indonesia. Pedoman pengelolaan penyakit hipertiroid. Bandung; 2017:1- 39.
13. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. American association of Clinical Endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. Endocr Pract. 2016;22:1–60.
14. Kahaly GJ, Bartalena L, Hegedüs L, Leenhardt L, Poppe K, Pearce SH. 2018 European thyroid association guideline for the management of graves’ hyperthyroidism. Eur Thyroid J. 2018;7:167–86.
15. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26:1343–421.
16. Vargatu I. Williams Textbook of Endocrinology. Vol. 12, Acta Endocrinologica. 2016. 113–39.
17. Decroli E, Manaf A, Syahbuddin S. Immunologic and hormonal effects of propylthiouracil treatment using maintenance dose in Graves' disease. Acta Medica Indonesiana. 2014; 46(4): 14–9.
18. Diagne N, Faye A, Ndao AC, Djiba B, Kane BS, Ndongo S, et al. Epidemiological, clinical, therapeutic and evolutive aspects of Basedow-Graves disease in the Depatment of Internal Medicine at CHU Aristide Le Dantec, Dakar. Pan Afr Med J. 2016;25:6.
19. García-Mayor RV, Álvarez-Vázquez P, Fluiters E, Valverde D, Andrade A. Long-term remission following antithyroid drug withdrawal in patients with Graves' hyperthyroidism: parameters with prognostic value. Endocrine. 2019 Feb;63(2):316-322. doi: 10.1007/s12020-018-1785-z.
20. Boundia D, Demba D, Djiby S, Assane NM, Mané DI, Limane BA, et al. Evolution of Graves’s Disease: Impact of Socio-Demographic and Clinical Factors in Senegalese Subject. Open J Intern Med. 2020;10:160– 70.
21. Song E, Kim M, Park S, Park MJ, Kim JA, Roh E, et al. Treatment Modality and Risk of Heart Failure in Patients With Long-Standing Graves’ Disease: A Nationwide Population-Based Cohort Study. Front Endocrinol. 2021;12:1–8.
22. Clinical I, Guidelines P. Indonesian Clinical Practice Guidelines for Hyperthyroidism The Indonesian Society of Endocrinology Diseases, Task Force on Thyroid. J ASEAN Fed Endocr Soc. 2012;27(1):34–9.
23. Kanokwongnuwat W, Penpong N, Sangsri C. Incidence and treatment outcomes of Graves' disease in Thailand: a single-center retrospective observational study. Thyroid Res. 2022 Dec 19;15(1):24. doi: 10.1186/s13044-022-00142-4.
24. Ahmed MMA. Outcomes of Long-Term Follow-up of Patients Receiving Antithyroid Medication for Hyperthyroidism due to Graves' Disease. SJMS 2023; 2 (2): 54-63.
25. Ortona, Elena Pierdominici, Marina Maselli, Angela Veroni, Caterina Aloisi F, Shoenfeld and Y. Sex-based differences in autoimmune diseases. 2016;2:205- 212.
26. Magri F, Zerbini F, Gaiti M, Capelli V, Ragni A, Rotondi M, et al. Gender influences the clinical presentation and long-term outcome of graves disease. Endocr Pract. 2016;22(11):1336–42.
27. Santin AP, Furlanetto TW. Role of estrogen in thyroid function and growth regulation. J Thyroid Res. 2011;2011:875125. doi: 10.4061/2011/875125.
28. Sarr A, Diédhiou D, Ndour-Mbaye NM, Sow D, Diallo IM, Alaoui S El, et al. Graves’ Disease in Senegal: Clinical and Evolutionary Aspects. Open J Intern Med. 2016;06:77–82
29. Bawand R, Borzouei S, Salimbahrami SA, Sheikh V. Comparison of clinical efficacy of antithyroid drugs, radioactive iodine, and thyroidectomy for treatment of patients with graves’ disease, toxic thyroid adenoma, and toxic multinodular goiter. Biomed Biotechnol Res J. 2022;6(4):569–75.
30. Barrett K, Barman S, Boitano S BH. Ganong’s Review of Medical Physiology. Review of Medical 25e. New York, NY McGraw-Hil; 2016;4:301-314.
31. Guyton AC HJ. Buku Ajar Fisiologi Kedokteran. 12th ed. EGC, editor. Jakarta; 2014;865-66.
32. Azizi F, Abdi H, Amouzegar A. Control of Graves’ hyperthyroidism with very long-term methimazole treatment: a clinical trial. BMC Endocr Disord. 2021;21:1–7.
33. Konishi T, Okamoto Y, Ueda M, Fukuda Y, Harusato I, Tsukamoto Y, et al. Drug discontinuation after treatment with minimum maintenance dose of an antithyroid drug in graves’ disease: A retrospective study on effects of treatment duration with minimum maintenance dose on lasting remission. Endocr J. 2011;58(2):95–100.
34. Abdi H, Amouzegar A, Azizi F. Antithyroid drugs. Iran J Pharm Res. 2019;18:1–12
35. Eliana F, Suwondo P, Asmarinah A, Harahap A, Djauzi S, Prihartono J, et al. The Role of Cytotoxic T-lymphocyte-associated Protein 4 (CTLA-4) Gene, Thyroid Stimulating Hormone Receptor (TSHR) Gene and Regulatory T-cells as Risk Factors for Relapse in Patients with Graves Disease. Acta Med Indones. 2017;49:195–204
36. Rajput R, Goel V. Indefinite antithyroid drug therapy in toxic Graves′ disease: What are the cons. Indian J Endocrinol Metab. 2013;17:88.
37. Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Törring O. TSH-receptor autoimmunity in Graves’ disease after therapy with anti-thyroid drugs, surgery, or radioiodine: A 5-year prospective randomized study. Eur J Endocrinol. 2008;158:69– 75.
38. El-shareif HJ. Clinical Profile and Long-Term Remission in Patients with Graves ’ Disease: The Tripoli Medical Centre Experience. 2018;6:1–6.
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