2021 Asia Pacific Graves' Disease Consortium Survey of Clinical Practice Patterns in the Management of Graves' Disease
Bibliographic record
Abstract
Abstract Aim Although Graves' disease (GD) is common in endocrine practices worldwide, global differences in diagnosis and management remain. We sought to assess the current practices for GD in countries across Asia and the Pacific (APAC), and to compare these with previously published surveys from North-America and Europe. Methods A web-based survey on GD management was conducted on a pool of practicing physicians. Responses from 542 eligible physicians were received and subsequently analysed and compared to outcomes from other, similar surveys. Results During initial work-up, majority of respondents would request thyroid-stimulating hormone (TSH; 73%) and free thyroxine assays (75%), as well as TSH-receptor autoantibodies (68%). Thyroid ultrasound would be requested by about half of respondents (53%), while the use of nuclear medicine scans was very limited. The preferred first-line treatment was antithyroid drug (ATD) therapy (79%) with methimazole (MMI) or carbimazole (CBZ), followed by radioiodine (RAI; 19%) and surgery (2%). In case of surgery, one-third of respondents would opt for a subtotal rather than a total thyroidectomy. In case of mild Graves orbitopathy (GO), ATDs (67%) remained the preferred treatment, but a larger proportion would prefer surgery (20%). For a patient with a pregnancy (wish), the overall preferred treatment pattern remained unchanged, although propylthiouracil (PTU) became the preferred ATD-agent during the first trimester. While on most issues choices of the physicians from APAC fell between European and American practices, marked differences were noted in the relatively infrequent usage of nuclear medicine scans and the overall higher concomitant use of a ATDs and β-blockers and adjunctive ATD-treatment during RAI. Conclusion Although regional differences regarding the diagnosis and management of GD are apparent in this first pan-Asia-Pacific survey, the overall approach to the management of this disease in APAC to generally fall between the trends appreciated in the American and European cohorts.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".