Unveiling Risk Factors for Treatment Failure in Patients with Graves’ Disease: A Nationwide Cohort Study in Korea

• Published in: Endocrinology and metabolism (Seoul) Vol. 40; no. 1; pp. 125 - 134
• Main Authors: Kim, Jung A, Kim, Kyeong Jin, Choi, Jimi, Kim, Kyoung Jin, Song, Eyun, Yu, Ji Hee, Kim, Nam Hoon, Yoo, Hye Jin, Seo, Ji A, Kim, Nan Hee, Choi, Kyung Mook, Baik, Sei Hyun, Kim, Sin Gon
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Endocrine Society 01.02.2025; 대한내분비학회
• Subjects: Adult; Aged; Antithyroid Agents - therapeutic use; Cohort Studies; Female; Follow-Up Studies; graves disease; Graves Disease - drug therapy; Graves Disease - epidemiology; Graves Disease - therapy; Humans; Iodine Radioisotopes - therapeutic use; Male; Middle Aged; Original; Prognosis; Republic of Korea - epidemiology; Retrospective Studies; Risk Factors; Thyroidectomy - statistics & numerical data; Treatment Failure; Young Adult; 내과학; Republic of Korea; Graves disease; Treatment failure; Risk factors
• ISSN: 2093-596X; 2093-5978; 2093-5978
• DOI: 10.3803/EnM.2024.2093

Background: Antithyroid drug (ATD) treatment is the preferred initial treatment for Graves’ disease (GD) in South Korea, despite higher treatment failure rates than radioactive iodine (RAI) therapy or thyroidectomy. This study aimed to evaluate the incidence of treatment failure associated with the primary modalities for GD treatment in real-world practice.Methods: We included 452,001 patients diagnosed with GD between 2004 and 2020 from the Korean National Health Insurance Service-National Health Information Database. Treatment failure was defined as switching from ATD, RAI, or thyroidectomy treatments, and for ATD specifically, inability to discontinue medication for over 2 years.Results: Mean age was 46.2 years, with females constituting 70.8%. Initial treatments for GD included ATDs (98.0%), thyroidectomy (1.3%), and RAI (0.7%), with a noted increment in ATD application from 96.2% in 2004 to 98.8% in 2020. During a median follow- up of 8.5 years, the treatment failure rates were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Multivariate analysis indicated that the hazard ratio for treatment failure with ATD was 2.81 times higher than RAI. RAI treatments ≥10 mCi had 37% lower failure rates than doses <10 mCi.Conclusion: ATDs are the most commonly used for GD in South Korea, followed by thyroidectomy and RAI. Although the risk of treatment failure for ATD is higher than that of RAI therapy, initial RAI treatment in South Korea is relatively limited compared to that in Western countries. Further studies are required to evaluate the cause of low initial RAI treatment rates in South Korea.