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The management of Graves' disease by Indian thyroidologists
1Centre for Endocrine Sciences, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Background:
Although effective modes for treating Graves' disease are available, there is controversy over their choice. We conducted a nation-wide survey to determine trends in the diagnosis and management of Graves' disease in India.
Methods:
A proforma was mailed to 45 practising thyroidologists who were members of the Endocrine Society of India or the Thyroid Association of India. One index case and 5 variations were provided, and the members were asked to indicate the investigations of choice, therapeutic modality and details about its implementation.
Results:
The overall response rate was 71% (32). For diagnosis, serum T3, T4, TSH, sensitive TSH, free T3, and free T4 were asked for by 24, 25, 6, 13, 5, and 10 responders respectively. Radioactive iodine uptake with or without a scan was obtained by 19 of the responders. Antithyroid drugs were the choice of the majority in most situations (index case: 40-year-old female with first episode of typical Graves' disease--23; 40-year-old male--20; 16-year-old male--32; 40-year-old female without goitre--25), except for the patient with relapse and the 65-year-old female where radioiodine was the choice of the majority (20 and 23 respectively).
Conclusion:
Antithyroid drugs are the mainstay of treatment of Graves' disease in India. The predominant use of these drugs was similar to European data, but different from the practice in the USA, where radioiodine is used much more liberally.