{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T06:02:19Z","timestamp":1774245739988,"version":"3.50.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Evaluate and compare the patient-reported quality of life (QoL) outcomes in Graves\u2019 disease patients on long-term antithyroid drugs (ATDs) therapy and levothyroxine (L-T4) replacement after iodine-131, and explore factors influencing QoL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center cross-sectional observational study included refractory Graves\u2019 hyperthyroidism patients who were followed in outpatient between January 2015 and July 2024. Patients were divided into two groups based on their current treatment: the ATDs group and the L-T4 group. We collected demographic and clinical characteristics and assessed cross-sectionally QoL using the thyroid-related patient-reported outcome-39 questionnaire (ThyPRO-39). We compared QoL scores between the two groups and examined factors associated with QoL using regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 499 patients were enrolled, of whom 300 completed the ThyPRO-39 (response rate 60.1%; 172 in the ATDs group and 128 in the L-T4 group). Compared with the ATDs group, patients in the L-T4 group had significantly higher scores across several subscales, including hyperthyroid symptoms, hypothyroid symptoms, eye symptoms, anxiety, emotional susceptibility, social life, daily life, appearance, overall QoL, and the composite scale (all P &amp;lt; 0.05), indicating lower QoL. In the multiple linear regression analysis, female was positively correlated with the scores of hypothyroidism symptoms, tiredness and depressivity (all P &amp;lt; 0.05). Male was negatively correlated with the score of the composite scale, while L-T4 group was positively correlated with the score of the composite scale (all P &amp;lt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with refractory Graves\u2019 hyperthyroidism, female patients and those undergoing long-term L-T4 replacement therapy after iodine-131 treatment were associated with lower QoL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1776734","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T05:20:51Z","timestamp":1774243251000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quality of life in refractory Graves\u2019 hyperthyroidism: a cross-sectional study comparing long-term ATDs therapy versus L-T4 replacement after iodine-131"],"prefix":"10.3389","volume":"17","author":[{"given":"Anqi","family":"Yuan","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhe","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jialu","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yifei","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-020-0184-y","article-title":"Graves' disease","volume":"6","author":"Davies","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12060","article-title":"Incidence rate and clinical features of hyperthyroidism in a long-term iodine sufficient area of Sweden (Gothenburg) 2003-2005","volume":"78","author":"Nystr\u00f6m","year":"2013","journal-title":"Clin Endocrinol (Oxf)"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2018.18","article-title":"Global epidemiology of hyperthyroidism and hypothyroidism","volume":"14","author":"Taylor","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-2802","article-title":"Graves\u2019 hyperthyroidism: treatment with antithyroid drugs, surgery, or radioiodine--a prospective, randomized study. 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