A letter to the editor in the August 2008 issue of The Thyroid cautions that Graves’ disease can be lethal in young adults. The author describes a Japanese data review study, which evaluated the cause of death in 52 patients with Graves’ disease who died between 1997 and 2006. Most of the deaths (40) were not related to their thyroid conditions.
However, when death was related to Graves’ disease, death was usually sudden. The primary causes were noncompliance with anti-thyroid drug medications and consequences of radioiodine ablation.
Gender Differences
The 12 patients under 60 years of age whose deaths were related to Graves’ disease included 7 males and 5 females. Although women are 8 times as likely to develop Graves’ disease, men tend to have a more serious disease course. This is generally thought to be because men are more likely to be diagnosed with Graves’ disease late in the disease course when their condition is severe.
Causes of Death
Five patients died because of severe thyrotoxicosis and noncompliance with anti-thyroid drugs. Four patients died either before or after radioiodine ablation. Two deaths were attributed to co-existing autoimmune heart disease and in one case the patient had normal thyroid function and it’s uncertain whether his death was related to Graves’ disease.
Risk Factors
The authors note that poor compliance with medications and radioiodine ablation are major risk factors for mortality in patients with Graves’ disease.
The authors believe that reasons for noncompliance include: lack of understanding by young patients with severe thyrotoxicosis that treatment is needed and economic reasons that prevent them from continuing with treatment. The authors also note that, because of its risk of causing death, doctors need to be very careful in prescribing radioiodine ablation for patients with Graves’ disease.
Resource:
Surnihisa Kubato, Shuji Fukata, Nobuyuki Amino and Akira Miyauchi; Kuma Hospital, Kobe, Japan, Graves’ Disease can be a Lethal Disorder in Young Adults, The Thyroid, Aug 2008, 18(8): 915-916. Contact kubota@kuma-h.or.jp