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A Prognostic Model for Predicting the Probability of Remission of Toxic Diffuse Goiter

DOI:10.31550/1727-2378-2020-19-2-40-44
Bibliography link: Volkova A.R., Dora S.V., Allamova G.G., Abramova I.M., Panchoyan S.M. A Prognostic Model for Predicting the Probability of Remission of Toxic Diffuse Goiter. Doctor.Ru. 2020; 19(2): 40–44. (in Russian) DOI: 10.31550/1727-2378-2020-19-2-40-44
A Prognostic Model for Predicting the Probability of Remission of Toxic Diffuse Goiter
22 April 09:25

Objective of the Study: To develop an assessment scale for predicting the probability of remission of toxic diffuse goiter (TDG), to optimize treatment approaches.

Study Design: This investigation included retrospective analysis and a prospective, open-label, nonrandomized, noncontrolled study.

Materials and Methods: The investigation had two parts— retrospective analysis and a prospective study. The retrospective analysis was done on data collected from 515 patients with TDG (404 [78.5%] women and 111 [21.5%] men), who had been diagnosed between 1970 and 2010. The mean age of the enrolled patients was 41.96 ± 0.60 (41.15 ± 0.66 for the women and 45.25 ± 0.60 for the men; р=0.01). All patients had received thyroid-suppressing agents for 12-18 months. After discontinuation of these agents, patients were followed up every six months for five years. Stepwise regression analysis was performed to create a mathematical model for assessing the probability of TDG remission in patients receiving conventional thyroid suppression therapy. Based on the results of this analysis, a discriminant function (D) was developed to divide the patients into two groups. Group 1 included patients with a D value below 3.26, and Group 2 was made up of patients with a D value of 3.26 or higher.

Two hundred patients (108 [54%] women and 92 [46%] men) with newly diagnosed TDG were enrolled in the prospective study and followed up for four years. Their mean age at diagnosis was 42.96 ± 0.60 (44.17 ± 0.66 for the women and 46.25 ± 0.71 for the men). All patients received conventional thyroid suppression therapy for 12-18 months. Based on the proposed prognostic criteria, the patients were divided into groups, depending on their D values: Group 1 consisted of patients with a D value below 3.26 (low risk of recurrence of hyperthyroidism), and Group 2 was made up of patients with a D value of 3.26 or higher (high risk of recurrence of hyperthyroidism).

Study Results: Six significant discriminant variables were identified that influence the probability of TDG remission: initial volume of the thyroid gland (cm3), ophthalmopathy, age of disease onset (years), ratio of free triiodothyronine to free thyroxine, initial levels of anti-thyroid-stimulating hormone receptor antibodies, and tobacco smoking. The most informative parameters were selected to create a discriminant function D (equation). If the D value is below 3.26, the probability of remission is high, while D≥3.26 corresponds to a low probability of remission. The prospective study showed that this predictive model for assessing the probability of TDG remission is highly sensitive (86%) and specific (84%).

Conclusion: The proposed assessment scale for predicting the probability of TDG remission helps forecast disease course at diagnosis and optimize treatment approaches.

Contribution: Abramova, I.M. — study design, review of relevant publications, and writing the final manuscript; Allamova, G.G. — data processing analysis and interpretation; Panchoyan, S.M. — assistance with patient selection and statistical analysis of the study data; Dora, S.V. — review of critically important material, thematic publications reviewing. Volkova, A.R. — review of critically important material, approval of the manuscript for publication.

Conflict of interest: The authors declare that they do not have any conflict of interests.

A.R. Volkova — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. eLIBRARY.RU SPIN: 4007-1288. E-mail: volkovaa@mail.ru

S.V. Dora (Corresponding author) — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. eLIBRARY.RU SPIN: 9845-0065. E-mail: doras2001@mail.ru

G.G. Allamova — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. E-mail: gulbahara1991@mail.ru

I.M. Abramova — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. E-mail: vortexgin7@mail.ru

S.M. Panchoyan — Academician I.P. Pavlov First St. Petersburg State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Ministry of Health; 6-8 Lev Tolstoy St., St. Petersburg, Russian Federation 197022. E-mail: stella.stella1994@mail.ru

Fig. 1. Design of a prospective observational study in a group of patients with toxic diffuse goiter

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Table
Significant variables influencing the prognosis for patients receiving treatment for toxic diffuse goiter

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Fig. 2. ROC curve for sensitivity/specificity of the prognostic model for remission probability in patients with toxic diffuse goiter

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Fig. 3. Assessment of toxic diffuse goiter remission using the D value: Group 1 – D value below 3.26, Group 2 – D value 3.26 or higher

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Received: 21.01.2020
Accepted: 19.02.2020

A Prognostic Model for Predicting the Probability of Remission of Toxic Diffuse Goiter
22 April 09:25
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