Author(s): Adeleye J O, Emuze M E, Azeez T A*, Esan A, Balogun W O and Akande T O
Background and Objectives: Graves’ disease is the commonest cause of thyrotoxicosis and it is much less common in males. Also, there is scanty information about the clinical characteristics of males with Graves’ disease. The objectives of the study were to determine the frequency of males with Graves’ disease seen by the Endocrinology unit of a tertiary hospital and describe their clinical characteristics. Subjects, Materials and Methods: Clinical data was retrieved from the case records of patients with thyroid disease seen between January, 2016 and January, 2018 and analyzed using descriptive and inferential statistics. Results: 61 patients with Graves’ disease were seen out of which 6 cases were males giving a frequency of 10.9%. The male-to-female ratio was 1:9. The mean age at diagnosis of the male cases was 45 ± 16 years. All the patients had goitre and weight loss. 50% had heat intolerance, excessive sweating, palpitation, hyperdefaecation and hand tremors. Thyroid eye disease and thyrotoxic heart disease were found in 50% of the cases respectively. There was no statistically significant difference in the initial free thyroxine between males and females (p=0.18). There was no statistically significant association between initial free thyroxine and thyroid eye disease (p=0.39). Conclusion: Graves’ disease is 9 times commoner in females compared to males in our centre. The clinical features in males are similar to reported features in females except thyroid eye disease which appears commoner in males.
Graves ‘disease is the commonest form of hyperthyroidism in
both males and females. It represents about 50-80% 0f cases of
hyperthyroidism. It is an autoimmune disease characterized by
the interaction between the thyroid stimulating hormone receptor
antibodies (TRAb) and the thyroid stimulating hormone receptor
[1-3].
The classical symptoms of hyperthyroidism include weight loss
despite increased appetite, heat intolerance, irritability, insomnia,
sweatiness, hyperdfaecation, palpitations, muscular weakness and
menstrual irregularity. Clinical signs include diffuse goitre, fine
resting tremor, tachycardia, hyperreflexia, lid lag, warm, smooth
skin and proximal myopathy. Less common findings include
atrial fibrillation and thyroid bruit reflecting the marked increase
in thyroid vascularity. The treatment modalities usually offered
to the patients with Graves’ disease include use of antithyroid
drugs, radioablative therapy or thyroidectomy, depending on the
circumstances [4].
Graves’ disease occurs with greater frequency in females, which
may relate to the influence of estrogens on the immune system,
particularly the B cell repertoire. It has been reported that the clinical profiles and response to treatment in patients with Graves’
disease are different between males and females. Despite these
differences, publications on the clinical profiles of males with
Graves’ disease are scanty compared with females. This is even
more pronounced in sub-Saharan Africa where there is paucity
of publications on Graves’ disease generally [1].
The study is a retrospective cohort study. The objectives of the study were to determine the frequency of males with Graves’ disease seen by the Endocrinology unit of a tertiary hospital in Nigeria over a two year period and describe their clinical characteristics.
Clinical data was retrieved from the case records of patients with thyroid disease seen between January, 2016 and January, 2018 by the Endocrinology Unit of University College Hospital, a tertiary hospital in South-western Nigeria. The data were analyzed using descriptive and inferential statistics with SPSS version 22. Statistical significance was taken as p<0.05.
Over a period of two years (January, 2016 to January, 2018), 61
patients with Graves’ disease were seen by the Endocrinology
Unit of University College Hospital. 6 patients were males while the rest were females. The frequency of Graves’ disease in males
was 10.9%. in other words, the male-to-female ratio of Graves’
disease in this study was 1:9. The mean age at diagnosis of the
male patients was 45 ± 16 years.
The commonest presenting complains were anterior necks swelling
and weight loss. 50% of the males had heat intolerance, excessive
sweating, palpitations, and hyperdefaecation respectively. Other
symptoms present in less than 50% were recent eyes protrusion,
fever and skin hyperpigmentation. There was no family history of
thyroid disorders in all the male cases. Also, there was no history
of smoking in the male participants.
The commonest signs were diffusely enlarged goitre and
tachycardia. Hand tremors and hyperreflexia were demonstrated
in 75% of the cases. Exophthalmos, lid lag and lid retraction were
demonstrated in 50% 0f the cases. Two patients had severe thyroid
eye disease and were referred to the Ophthalmology clinic. None
of the patients had pretibial myxedema. 50% had thyroid heart
disease and Cardiology consultations were requested. 66% were
commenced on antithyroid drug (Carbimazole), 22% opted for
radioablative therapy after initial medical therapy while another
22% was referred for thyroidectomy after initial medical therapy.
There was no significant difference in the mean free thyroxine
(free T4 in pmol/L) between males and females (42.2 ± 17.6 Vs
48.5 ± 18.3; p=0.18). The other hormones (free T3 and thyroid
stimulating hormone) were not significantly different between
genders.
The study showed that Graves’ disease is more common among
females (with a ratio of 9:1). This is in keeping with previous
studies that have found much higher prevalence of Graves’ disease
among females with a ratio of 5-10 to 1.The hormonal changes
of females are reported to be responsible for higher incidence of
autoimmune disorders, including Graves’ disease, among females.
Studies have reported the mean age at diagnosis of Graves’ disease
to be 30-50 years which is congruent to what was found in this
study [1,5].
The clinical characteristics of the male patients with Graves’
disease are not remarkably different to what has been reported
for females in the literature. A previous study has documented
a significant prevalence of smoking history among males with
Graves’ disease but no male in the present study smoked In terms
of hormonal profile, the freeT4 of males was higher than females
but it did not achieve statistical significance. A similar profile was
found in the study done by Allahabadia et al. The main modality of
treatment is pharmacotherapy with antithyroid drugs. A Nigerian
study also reported that the commonest treatment given to patients
with Graves’ disease was the use of antithyroid drugs [1,4,6,7].
Graves’ disease is 9 times commoner in females compared to males seen by the Endocrinology Unit of a tertiary hospital in Nigeria. The clinical features in males are similar to reported features in females except thyroid eye disease which appears commoner in males. The hormonal profiles were also comparable between the two genders. The commonest modality of treatment among the patients was pharmacotherapy while radioactive iodine has gained acceptance as much as surgical ablation.
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Ezigbo E et al.(2019) Prevalence and pattern of thyroid
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Teaching Hospital, Enugu, Southeastern Nigeria. NMJ 60:
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