{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T08:17:56Z","timestamp":1769069876636,"version":"3.49.0"},"reference-count":26,"publisher":"The Endocrine Society","issue":"2","license":[{"start":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Transition from hypothyroidism to Graves' disease (GD) is uncommon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare presentation, management, and outcomes of GD after hypothyroidism (post-hypo-GD) with GD controls (no prior thyroid disease).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort 2010 to 2022, followed through October 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Maccabi Healthcare Services, Israeli health maintenance organization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>Adults with incident GD and thyroid-stimulating immunoglobulin activity \u2265140% within 1 year of thyrotoxicosis (N = 2402, 256 post-hypo-GD, 2146 GD controls). Excluded prior or current amiodarone users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Longitudinal assessment of usual care with antithyroid drugs, radioactive iodine, or total thyroidectomy, and subsequent hypothyroidism requiring levothyroxine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Usual care treatments and incident hypothyroidism requiring levothyroxine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to GD controls, post-hypo-GD patients were older (51.4 \u00b1 14.3 vs 47.4 \u00b1 13.6 years, P &amp;lt; .001), predominantly female (88.2% vs 76.9%, P &amp;lt; .001), and with higher prevalence of autoimmune disease (19.5% vs 12.9%, P = .003). At diagnosis, post-hypo-GD patients had milder disease with lower median free T4 (21.7 vs 26.8\u2005pmol\/L, P &amp;lt; .001) and free T3 (8.5 vs 10.4\u2005pmol\/L, P &amp;lt; .001) levels. Over a 7.2-year median follow-up, post-hypo-GD patients were less frequently treated with antithyroid drugs (65.6% vs 81.0%, P &amp;lt; .001). Radioactive iodine ablation and total thyroidectomy use were comparable. Post-hypo-GD patients were more than twice as likely to develop hypothyroidism requiring levothyroxine at the end of follow-up (41.8% vs 21.0%, P &amp;lt; .001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Post-hypo-GD (\u223c10% of new GD cases) is a distinct, predominantly female phenotype marked by milder thyrotoxicosis, lower antithyroid drug use, and a high rate of relapse into hypothyroidism warranting routine assessment of prior thyroid status and close biochemical monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf426","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T11:46:19Z","timestamp":1753357579000},"page":"348-357","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Characteristics and Outcomes of Graves' Disease in Individuals with Prior 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