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Management of Graves’ disease in Middle East, North Africa differs from Europe, North America
Physicians managing Graves’ disease in the Middle East and North Africa tended to use particular diagnostic and treatment modalities at rates falling in between those of North American and European practices, a survey of physicians in those regions found.
Researchers described the survey results as the first overview of Graves’ disease management for the region.
“Persistent and marked differences in [Graves’ disease] management throughout the world have been observed,” Salem A. Beshyah, PhD, FRCP, FACP, of the Sheikh Khalifa Medical City in Abu Dhabi, United Arab Emirates, and colleagues wrote. “Clinical practice patterns in the management of Graves’ disease have been monitored over the years in surveys of physicians in various parts of the world. … We are not aware of any studies published hitherto specifically on the management practices in the North Africa and the Middle East and North Africa region.”
Beshyah and colleagues carried out an electronic survey using an online questionnaire for practicing physicians throughout the North African and Middle Eastern regions. Most of the 352 physicians who responded were endocrinologists (n = 157) and internal medicine physicians (n = 116). The United Arab Emirates was the best represented of responding countries, with 120 respondents, followed by Pakistan and Iraq (n = 21 for both) and Saudi Arabia (n = 20).
Free thyroxine (80%) and serum thyroid-stimulating hormone assays (83%) were the most commonly requested measurements, the researchers reported. Total triiodothyronine (13%) and serum free T3 (62%) were less common. Physicians ordered serum antithyroid peroxidase antibody (50%) and thyroid-stimulating immunoglobin assessments (46%) more often than serum antithyroglobulin antibodies (36%). More than half of respondents requested thyroid ultrasounds (63.7%), whereas far fewer ordered nuclear medicine thyroid scans (33% for 99 m-Technetium; 7% for iodine-123) and radioactive iodine uptake (15% for iodine-131; 7% for iodine-123).
Most survey respondents preferred antithyroid drug therapy (52.7%), whereas 36.8% preferred radioactive iodine treatment, followed by beta-blockers only (6.9%) and thyroidectomy (3.2%). A small minority (1.3%) reported using no therapy. The most commonly used antithyroid drug during pregnancy was propylthiouracil in the first trimester and carbimazole afterward.
“The present study should set in motion local discussions and further [Middle East/North Africa]-based research,” the researchers wrote. “We would not predict that local or regional guidelines are produced de novo, but a commentary linking the findings of regional trends in management may put any new ‘international’ guidelines in a ‘regional’ perspective.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.