• Healthcare Delivery

    What Patients and Doctors Should Know About Graves’ Disease

Graves’ disease is a disorder of the immune system that causes hyperthyroidism. This can cause sudden weight loss, rapid or irregular heartbeat, sweating, and nervousness or irritability. There are three treatment options for Graves’ disease: anti-thyroid medication, radioactive iodine or surgery. These all reduce or eliminate thyroid hormone production, but differ in effectiveness, potential side effects, and cost.

Juan Brito Campana, M.B.B.S, Mayo Clinic endocrinologist
Juan Brito Campana, M.B.B.S, Mayo Clinic endocrinologist

A research team led by Juan Brito Campana, M.B.B.S., is trying to gain a clearer understanding of the different therapies – both in prevalence and effectiveness. Building the evidence base surrounding Graves’ disease can lead to better information for patient decision making, as well as potentially better therapies.

An endocrinologist at Mayo Clinic, Dr. Brito Campana says that until now, the common understanding in the United States was that radioactive iodine was the preferred therapy (Burch, 2012). He and his team wondered if that was still the case, and further, whether that was the best choice for patients.

Using the OptumLabs™ Data Warehouse, they reviewed medical claims information for 8,217 adult patients diagnosed with Graves’ disease in the United States. They found that despite reported preference for radioactive iodine therapy, anti-thyroid medications were prescribed to 58 percent of the group. Radioactive iodine was used only 35 percent of the time, and 6 percent of patients received surgery. There were several unexpected variables, including gender, age, ethnicity (Hispanic versus non-Hispanic) and geography.

The researchers' findings are published online in Thyroid.

“These findings suggest that treatment availability, local expertise, and incentives shaping the nature and frequency of post-treatment follow-up, are playing a role in the providers’ choice of therapy,” says Dr. Brito Campana. “We don’t know how much patients are involved in the decision, and hope creating awareness and providing a tool to aid in understanding the options will be beneficial to the patient experience.”

He and his team plan to continue building the evidence base for the care options available to patients with Graves’ disease.

“We don’t know as much as we should about the effectiveness of the different anti-thyroid medications and their side effects,” he says. “We think we’ll be able to gain a clearer understanding of the comparative effectiveness of not only the two available anti-thyroid drugs (methimazole and propylthiouracil), but also radioactive iodine or surgery.”

In the face of multiple treatment options and remaining questions, Dr. Brito Campana encourages providers to remember: “the most important factor driving choice should be patient preference.”

In previous work (Brito, 2015), he and his colleagues developed a decision aid promoting patient-centered care and improving ability for shared decision making between patients and providers.

The current research was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

- Elizabeth Zimmerman Young, June 21, 2016