Introduction

Graves’ Disease (GD) is an auto-immune disease characterized by an upregulated thyroid hormone (TH) production. GD is diagnosed by measuring thyroid-stimulating hormone (TSH), free thyroxine (fT4) and TSH-receptor antibodies (TBI). First line treatment of GD mainly involves a 1-2 year course of antithyroid drugs (ATD). After discontinuation of ATD, GD relapses in approximately 50% of patients. In 2016, Vos et al. developed the ‘Graves recurrent event after therapy +’ (GREAT+) score based on clinical and genetic markers to predict the likelihood of relapse after discontinuation of ATD, but this score is yet to be externally validated. The aim of this study was to investigate the need for this relapse prediction score (GREAT+) in GD amongst patients who are/were treated for GD and physicians treating GD.

Methods

A survey was sent to patients who are/were treated for GD and to physicians treating GD in June and July 2022.

Results

440 patients and 36 physicians completed the survey. 94% of the patients indicated interest in knowing the results of the GREAT+ score at start of treatment. Most patients valued the additional information the GREAT+ score could provide. Moreover, 56% of the patients would consider definite treatment (radioactive iodine or thyroid surgery) as a first line treatment option in case of a high relapse chance. Similarly, 97% of the physicians indicated the GREAT+ score may support communication with patients, especially with being confident in providing more definite answers. Furthermore, 83% may change their advice for first line treatment if a patient has a high relapse chance based on the GREAT+ score. 

Discussion

Based on this survey, both patients and physicians consider the GREAT+ score as a valuable addition to the current available information for treatment of GD. Moreover, information is particularly important for many patients who experience distress upon being diagnosed due to the unpredictabilty of GD relapse. Therefore, we plan to validate the GREAT+ score to improve clinical care for Graves’ patients.