Vos et al reported equations for predicting recurrence of Graves' disease after a course of antithyroid drugs. The scores can be performed prior to the start of therapy. The authors are from the University of Amsterdam.
Patient selection: Graves' disease with hyperthyoidism
Outcome: recurrence after withdrawal of antithyroid drugs
Scores - Graves; Recurrent Events After Therapy (GREAT):
(1) GREAT: clinical markers only
(2) GREAT+: clinical markers plus genetic markers
Parameters:
(1) age in years
(2) serum free T4 in pmol/L (Delfia fluoroimmunoassay)
(3) serum TBII (thyrotropin-binding inhibitory immunoglobulin) in IU/L (TRAK human LIA, BRAHMS)
(4) goiter size (WHO classification)
(5) number of HLA polymorphisms (DQB1-02; DQA1-05; DRB1-03)
(6) PTPN22 genotype (wild type C/C vs C/T heterozygote)
|
Physical Exam |
Goiter Size Grade |
|
may be palpable; not visible |
0 |
|
easily palpable; visible with head normal or raised |
I |
|
easily visible with head in normal position |
II |
|
goiter visible at a distance |
III |
|
Parameter |
Finding |
Points |
|
age in years |
< 40 years |
1 |
|
|
>= 40 years |
0 |
|
serum free T4 |
< 40 pmol/L |
0 |
|
|
>= 40 pmol/L |
1 |
|
serum TBII |
< 6 |
0 |
|
|
6 to 19.9 |
1 |
|
|
>= 20 |
2 |
|
goiter size |
Class 0 or I |
0 |
|
|
II or III |
2 |
|
number of HLA polymorphisms |
none |
0 |
|
|
1 or 2 |
2 |
|
|
3 (linage disequilibrium) |
3 |
|
PTPN22 |
wild type |
0 |
|
|
C/T |
1 |
GREAT score =
= SUM(points for the first 4 parameter)
GREAT+ score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum GREAT score: 6
• maximum GREAT+ score: 10
• The higher the score the greater the risk of recurrence.
|
GREAT Score |
Class |
Recurrence |
|
0 or 1 |
I |
16% |
|
2 or 3 |
II |
44% |
|
4 to 6 |
III |
66% |
|
GREAT+ Score |
Class |
Recurrence |
|
0 to 2 |
I |
4% |
|
3 or 4 |
II |
21% |
|
5 or 6 |
III |
49% |
|
7 to 10 |
IV |
84% |
Specialty: Endocrinology, Pharmacology, clinical
