Presentation and management of Graves disease-Experience from a tertiary care center in Eastern India
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 10
Abstract
Graves’ disease has varied presentation and preference for therapeutic modality varies from country to country. We report the presentation and mode of therapy we perform in a tertiary care center in Eastern India. This is a retrospective data of 60 patients with Graves’ disease evaluated and treated at Institute of Post-graduate Medical Education and Research (IPGMER), Kolkata. Patients were recruited consecutively between March 2017 and May 2017. Baseline characteristics revealed median (±IQR) age of presentation 33.1±10.1 years, F:M ratio 2.3:1, median duration 7.7±6.8 months, 28% were overweight and 20 % were smoker. Most common mode of presentation was tremor (93%), followed by palpitation (86.6%), weight loss (85%) and hyperdefecation (25%). Overall 31 (51.6%) patients had eye signs and active eye disease was present in 5 (8.3%) patients. Only 30 patients were screened for glycemic status at disease onset and 12 (40%) were found to have dysglycemia. Diagnosis of Graves’ was mostly done by clinical examination (57%), followed by Isotope studies (38%) and only 3 (5%) patients by Anti TSH receptor antibodies (TRAb). Majority of the patients (70%) underwent medical therapy alone, followed by radioiodine ablation (21.6%) and surgery done in 5 (8.3%) patients only. Average radioiodine dose was 11.9 ± 2.1 mCi and only 2 (13.3%) patient needed repeat dose. 2 patients out of 5 who underwent total thyroidectomy developed permanent hypoparathyroidism. A comprehensive overview of management of Graves’ disease in Eastern India is described. There is high prevalence of dysglycemia but often not screened. Requirement of usage of TRAb is still minimal and restricted to special cases only.
Authors and Affiliations
Subhodip Pramanik, Rana Bhattacharjee, Subhankar Chowdhury
Keywords
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