{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:26:53Z","timestamp":1793370413506,"version":"4.5.0"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,3,20]],"date-time":"2022-03-20T00:00:00Z","timestamp":1647734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the long\u2010term outcomes and prognosis of thyrotoxicosis in a large number of patients in a single UK county (Leicestershire).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort analysis of 56,741 thyroid function test (TFT) results, treatment modalities and outcomes in a well\u2010established virtual thyrotoxicosis clinic database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>One thousand four hundred and eighty\u2010nine\u00a0patients were included with a median length of follow\u2010up of 10.9 years. The aetiology of thyrotoxicosis was autoimmune (85.9%), nodular (9.1%)\u00a0and mixed (5.0%). Treatment modalities included antithyroid drugs (ATDs), radioiodine (RAI; 555\u2009MBq fixed dose) and thyroidectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed both individual TFTs\u00a0and groups of sequential TFTs on\u00a0or after\u00a0the same thyroid treatment(s), which we describe as 'phase\u00a0of thyroid care'\u00a0(POTC). Patients studied entered the virtual clinic between 1 January 1995 and 1 January 2010; we exported data on every TFT sample up to April 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>ATD had been used in 99.2% (median 2, maximum\u00a0seven\u00a0courses) with long\u2010term ATD (&gt;2\u00a0years) in 48%. RAI and thyroidectomy were used more commonly with nodular and mixed aetiology. Overall, T4 was more often controlled than thyroid\u2010stimulating hormone (TSH), and at the latest follow\u2010up, T4 was normal in &gt;96%, TSH in &gt;79% and both in &gt;76% of different aetiologies. The mean percentage control of T4 was 85% and TSH 50%; in long\u2010term ATD courses, this improved to 89% and 62%, respectively. In the latest POTC, control of T4 and TSH was best in cases off treatment (95%\/87%) and on T4 without ablative therapy (94%\/72%), but was broadly similar in patients on long\u2010term ATD (90%\/68%), after RAI (92%\/60%) or after thyroidectomy (91%\/58%). After the first course of ATD, remission or hypothyroidism was seen in 47.3% autoimmune, 20.9% nodular and 32.5% mixed, with 90% relapses seen within 4\u00a0years. Relapse was more common in patients with ophthalmopathy, but there was no difference between the sexes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Thyrotoxicosis can be well controlled with minimal specialist clinic attendance using a software\u2010supported virtual shared\u2010care scheme. Long\u2010term ATD appears to be a valid patient choice achieving TFT control comparable to that seen after RAI or surgery. In patients with autoimmune disease, relapse is more common in patients with ophthalmopathy, and hypothyroidism is common after RAI. In nodular disease, we found that spontaneous remission may occur.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14721","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T08:36:40Z","timestamp":1646987800000},"page":"643-653","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Audit of long\u2010term treatment outcomes of thyrotoxicosis in a single\u2010centre virtual clinic: The utility of long\u2010term antithyroid drugs"],"prefix":"10.1111","volume":"97","author":[{"given":"Miles\u00a0J.","family":"Levy","sequence":"first","affiliation":[{"name":"Department of Endocrinology, University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narendra","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Price","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragini","family":"Bhake","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Bremner","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Barrowcliffe","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Kieffer","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Zaccardi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor\u00a0A.","family":"Howlett","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,20]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Thyroid Disease: Assessment and Management. 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