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Inequitable outcomes after Graves’ disease treatment for indigenous population, Europeans
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Indigenous people of New Zealand are more than twice as likely as adults of European descent to have hypothyroidism after definitive treatment for Graves’ disease and three times more likely to have persistent thyrotoxicosis at 1 year after radioactive iodine therapy vs. white patients, according to findings published in the Journal of the Endocrine Society.
“Euthyroid rates following definitive therapy — both radioiodine and surgery — for Graves’ disease were lower than expected, particularly for Mori, the indigenous people of New Zealand,” Marianne Elston, MBChB, FRACP, PhD, a consultant endocrinologist at Waikato Hospital in Hamilton, New Zealand, and a senior lecturer at the University of Auckland, told Endocrine Today. “This inequity continued out to 10 years of follow-up and was irrespective of definitive treatment option received.”
In a retrospective chart review, Elston and colleagues analyzed data from 798 patients who underwent radioactive iodine therapy (n = 589) or thyroidectomy (n = 209) for Graves’ disease between December 2001 and March 2013 at Waikato Hospital (28.7% Mori; 58.3% European ethnicity). Primary outcome was thyroid state after treatment, ascertained by thyroid-stimulating hormone levels at 1, 2, 5 and 10 years after treatment.
At 1 year, 47.7% of patients were euthyroid and 26.3% were hyperthyroid. At 10 years, 63.5% of patients were euthyroid, 10.7% were hyperthyroid and 25.8% were hypothyroid, with data available for 318 patients.
Researchers found that Mori patients were younger than European patients (median age, 43 years vs. 50 years; P < .0005) and were more likely to undergo radioactive iodine therapy vs. surgery (79.5% vs. 20.5%; P = .041) and receive more than one dose of radioactive iodine vs. Europeans (30.2% vs. 14.2%; P < .0005). Mori were less likely to be euthyroid when compared with Europeans at 1 year (29.7% vs. 57.3%) and 10 years (52.2% vs. 70.9%; P < .0005). Mori patients were also three times more likely to have persistent thyrotoxicosis at 1 year after radioactive iodine therapy vs. European patients (25.8% vs. 8.3%; P < .0005); however, the excess rate among Mori patients resolved by 5 years, according to researchers. At 5 years, Mori patients were more than twice as likely to be hypothyroid vs. European patients (54.1% vs. 20%; P < .0005).
The researchers noted that euthyroid rates were low overall, indicating the need for improvement in care, particularly for indigenous people.
“Definitive therapy for Graves’ [disease] should be able to render patients euthyroid, either endogenously euthyroid or, for those hypothyroid, due to optimal levothyroxine replacement,” Jade Tamatea (Ngti Maniapoto, Ngti Kahungunu), BHB, MBChB, PhD, a senior lecturer at the University of Auckland and consultant endocrinologist with the Waikato District Health Board, told Endocrine Today. “Appropriate long-term care of Graves’ disease is important, as being either hyperthyroid or hypothyroid is associated with long-term morbidity and increased mortality. Ethnic differences in health care outcomes, as demonstrated in this study, indicate a need for improvements that focus on achieving equity for indigenous populations. Such approaches are likely to improve care for all receiving definitive therapy for Graves’ disease.” – by Regina Schaffer
For more information:
Marianne Elston, MBChB, FRACP, PhD, can be reached at Waikato Hospital, Private Bag 3200, Hamilton, New Zealand; email: marianne.elston@waikatohb.health.nz.
Disclosures: The authors report no relevant financial disclosures.
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