THE EVOLUTION OF THE DIAGNOSTIC AND THERAPEUTIC CRITERIA OF GRAVES-DISEASE IN SPAIN - COMPARISON OF THE RESULTS OF 2 SURVEYS FROM 1987 AND 1995

BACKGROUND: To assess the new diagnostic and therapeutic trends for hy perthyroidism due to Graves' disease in Spain and the differences with respect to a previous study performed in 1987. METHODS: A questionnai re about a typical clinical case of hyperthyroidism due to Graves' dis ease and 10 variations to it, in which different diagnostic and therap eutic options are exposed. These questionnaires were mailed to 70 Span ish units of endocrinology during 1995, and 51 participated finally in the study. The results are compared with those obtained in Spain with a similar study in 1987. RESULTS: Thyrotropin (98%) and free thyroxin e (88%) were the most used tests for diagnosis of Graves' disease, wit h a significant decrease (p < 0.001) in the use of total T-4 and total T-3 in comparison with the results of the questionnaire performed in 1987. The measurement of antibodies against thyrotropin receptor (TSH- R-Ab) was the most frequently used immune marker for the diagnosis (78 %), with significant differences (p < 0.001) with respect to questionn aire in 1987. The use of antithyroperoxidase antibodies (anti-TPO-Ab) (36%) in diagnosis of this disease, significantly increased (p < 0.05) with respect to 1987. Antithyroid drugs were the most frequent initia l treatment (98%), with significant differences (p < 0.001) in use of radioiodine (24%) as treatment of choice in elderly patients respect t o 1987, Surgery was mainly used for large-size goiters (33%) and radio iodine for recurrences after medical (61%) or surgical (80%) treatment . Antithyroid drugs were the most frequent treatment for children and for recurrences during gestation. CONCLUSIONS: In Spain, the measureme nts of TSH, FT4 and TSH-R-Ab are the main diagnostic test of hyperthyr oidism. Antithyroid drugs are still the treatment of choice in typical case of hyperthyroidism due to Graves' disease, in recurrences during gestation and children. Surgery is only used for large goiters and ra dioiodine is the treatment of choice in recurrences after medical or s urgical treatment.