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*Corresponding author: Demba Diédhiou, Department of Internal Medicine,
University Hospital Center of Dakar, Cheikh Anta Diop University, Dakar, Sene-
gal, Tel: +221 779641994; E-mail: dembadiedhiou1976@gmail.com
Citation: Diedhiou D, Diallo IM, Ndour MA, Sow D, Diallo AK, et al. (2018)
Graves’ Disease in Men’s Subjects. J Hum Endocrinol 3: 012.
Received: March 12, 2018; Accepted: May 16, 2018; Published: May 31, 2018
Introduction
Hyperthyroidism is the most common endocrinopathy whose ma-
jor etiology is Graves’ disease. Graves’ disease is characterized by a
thyrotoxicosis syndrome associated with a vascular diffuse goiter, a
Graves’ orbitopathy and presence of anti-TSH receptor antibodies. It
is more common in women with a peak frequency between 40 and 60
years [1,2]. Graves’ disease is an autoimmune thyroid disorder with
a genetic component and environmental factors predisposing to its
occurrence. Associated environmental factors include stress, infec-
tion and peripartum [3,4]. The pathophysiology of Graves’ disease is
based on an auto-stimulatory by TSH-Receptor Antibodies (TRAb)
on the thyroid gland (vascular goiter), retro-orbital smooth muscle
and retro-bulbar broblasts (Graves’ orbitopathy), and subcutaneous
tissue (dermopathy) [5]. The diagnosis associates a thyrotoxicosis
and specic signs such as Graves’ orbitopathy, vascular goiter and
pretibial myxoedema in rare cases. The medical treatment is mainly
based on Antithyroid Drug (ATD) treatment over a period of 18 to
24 months. Ablative treatments (i.e., radioiodine therapy and surgery)
are the cornerstones of healing. Although the particularities in women
are sufciently well documented [3], specic data in male subjects
remain rare, most often embedded in an overall description of Graves’
disease. A moroccan series reports on 6 years of follow-up, a mean
age of 45 years, a more severe Graves’ orbitopathy and a higher re-
lapse rate compared to the female sex [6]. The objective of this work
was to study the epidemiological, clinical and evolutionary character-
istics of Graves’ disease in male subjects at the Medical Clinic II of
Abass Ndao University Hospital Center in Dakar (Senegal).
Patients and Methods
This was a descriptive and analytical retrospective study conduct-
ed from January 1, 1998 to December 31, 2017 (20 years). It was
performed at the Medical Clinic II of Abass Ndao Hospital Center
in Dakar (Senegal). The Medical Clinic II houses a hospitalization
service of internal medicine with a diabetology orientation, a unit for
Diédhiou D, et al., J Hum Endocrinol 2018, 3: 012
DOI: 10.24966/HE-9640/100012
HSOA Journal of
Human Endocrinology
Research Article
Demba Diedhiou1*, Diallo Ibrahima Mané1, Michel Assane
Ndour1, Djib Sow1, Abdou Karim Diallo2, Djibril Boiro3, Marie
Ka-Cisse1, Anna Sarr1 and Maimouna Ndour-Mbaye1
1Department of Internal Medicine, University Hospital Center of Dakar,
Cheikh Anta Diop University, Dakar, Senegal
2Department of Preventive Medicine and Public Health, University Hospital
Center of Dakar, Cheikh Anta Diop University, Dakar, Senegal
3Department of Pediatric, University Hospital Center of Dakar, Cheikh Anta
Diop Unive Dakar, Senegal
Graves’ Disease in Men’s Sub-
jects
Abstract
Introduction
Graves’ disease remains the most frequent cause of hyperthy-
roidism but poorly described in men. The objective was to study the
specicities of Graves’ disease in this population at Abass Ndao Uni-
versity Hospital Center in Dakar (Senegal).
Patients and methods
It was a descriptive and analytical retrospective study conducted
over 20 years. The parameters taken into account were epidemio-
logical, clinical, and progressive.
Results
624 cases were reported with a prevalence of 28.79% among
2167 cases of Graves’ disease. The mean age was 32.1±13
years, family history and irritating factors were respectively found
in (15.4%) and (42.46%). The delay of consultation was 11.79±25
months and there were goiter in 89.90% and Graves’ orbitopathy
in 72.92%. The goiter was statistically correlated with free T4 > 70
pmol/l [OR=2.85(1.53-5.30), p=0.0002] and Graves’ orbitopathy
with volume of goiter [OR=2.08(1.42-3.07), p=0.0001]. The average
starting treatment dose with of Antithyroid Drug (ATD) was 38.3±1
mg/day of Carbimazol. Only a dose of ATD > 30 pmol/l was sig-
nicantly correlated with early maintenance therapy (≤ 3 months)
[OR=0.078(0.04-0.14), p=0.0000].
Complications were thyrotoxic heart diseases (06.89%), mod-
erate-to-severe or sight-threatening orbitopathy (01.12%). After
30 months, 250 subjects (40.06%) were regularly followed. The
remission affected 96 patients (38.4%) of whom 26 subjects re-
lapsed at the end of the follow-up. Among the 154 patients (61.60%)
who failed treatment, 48 (31.17%) had a thyroidectomy. Failure to
medical treatment was signicantly correlated with age <30 years
[OR=1.96(1.11-3.47), p=0.009], size of goiter [OR=2.50(1.34-4.64),
p=0.002] and initial values of free T4 > 70 pmol/l [OR=1.89(1.04-
4.42), p=0.017].
Conclusion
Graves’ disease in male subject is characterized by delayed di-
agnosis, a larger goiter, a high rate of lost sight and relapse. The
follow-up needs to take into account the risk factors of failure to im-
prove the choices and therapeutic recourses. Radioiodine treatment
remains a necessity.
Keywords: Dakar; Graves’ disease; Male; Senegal
Citation: Diedhiou D, Diallo IM, Ndour MA, Sow D, Diallo AK, et al. (2018) Graves’ Disease in Men’s Subjects. J Hum Endocrinol 3: 012.
• Page 2 of 5 •
J Hum Endocrinol ISSN: 2572-9640, Open Access Journal
DOI: 10.24966/HE-9640/100012
Volume 3 • Issue 1 • 100012
consultation and follow-up of pathologies of internal medicine and
endocrinology (including thyroid diseases), diagnostic assistance
units and the National Diabetes Center Marc Sankale. We have in-
cluded the records of male patients with Graves’ disease conrmed
and followed in the service. Graves’ disease is characterized by a thy-
rotoxicosis syndrome associated with a vascular diffuse goiter or a
Graves’ orbitopathy. The dosage of the anti-TSH receptor antibodies
is not always available on the Senegal. Incomplete or misinformed
les were excluded.
The parameters considered in the evaluation were:
Epidemiological aspects
Age divided into children (under 11 years), adolescents (from 11
to 20 years old), adults (over 20 years old), family history of thy-
ropathy, and trigger or self-maintenance factors (family difculties,
professional, and other difculties).
Clinical aspects
Delay of consultation, anthropometric data. The existence of a
Graves’ orbitopathy [7], a goiter (classed in grade according to the
World Health Organization classication) [8], the values of free Tet-
ra iodothyronine (free T4), free Triiodothyronine (T3 free) and ul-
trasensitive Thyroid Stimulating Hormone (TSHus) were also eval-
uated at baseline and at follow-up. The biochemical standards in our
laboratory were 0.17 to 4.05 mIU/l for TSHus, 9 to 22 pmol/l for
free T4 and 2.5 to 5.8 pmol/l for free T3. Cervical ultrasound with
doppler was systematic in case with goiter. Scintigraphy and assay of
anti-TSH receptor antibodies were not regularly performed because
few available in Senegal.
Treatment and evolution
The modalities of medical and surgical management (no patient
had beneted radioiodine therapy unavailable in Senegal) were eval-
uated over a period of 30 months. We studied the prescribed drugs
(antithyroid drug, beta-blockers and anxiolytics), drug dosages at the
beginning and during the follow-up. Carbimazol was the only one
antithyroid drug used in the medical treatment of Graves’ disease.
The efciency of the treatment was based on an overall assessment
(clinical, changes in Carbimazol doses and biological parameters, ap-
pearance of complications). The remission was a stabilization of the
disease after 12 months of discontinuation of medical treatment. Re-
lapse was dened as a reappearance of thyrotoxicosis after a success-
ful cessation of medical treatment. Failure of medical treatment was
dened by a poor recovery of the disease occurring during treatment
[9,10]. The latter also concerned the voluntary cessation of treatment
for whatever reason and loss of sight. Complications sought were thy-
rotoxic heart diseases [11], acute thyrotoxic crisis, moderate-to-se-
vere or sight-threatening orbitopathy [7], and agranulocytosis. The
care of the complications is multidisciplinary with the cardiologists in
case of thyrotoxic heart diseases and the ophthalmologists in case of
moderate-to-severe or sight-threatening orbitopathy. Indications for
thyroidectomy were also taken into account.
For the descriptive analysis, the data were presented as a percent-
age for the qualitative variables and as averages with standard devia-
tion for the quantitative variables. The statistical tests used were the
Chi-2 test for qualitative variables and the student’s test for quanti-
tative variables. We also made a univariate analyze to evaluate the
factors associated with relapse. A p value < 0.05 was considered sta-
tistically signicant with a 95% Condence Interval (CI). The capture
and the exploitation were carried out by the software Epi info version
7.2.2.2.
Results
Epidemiological and clinical data
A total of 624 cases of Graves’ disease were collected in male sub-
ject. The prevalence was 6.4% among 9750 cases of all thyropathies,
24.60% among 2536 cases of hyperthyroidism and 28.79% among
2167 cases of Graves’ disease. The average age was 32.1±13 years.
A family history of thyroid disease was found in 97 patients (15.4%)
and a trigger or self- maintenance factors in 265 subjects (42.46%).
The average delay of consultation was 11.79±25 months (range 1
to 36 months). The mean heart rate was 104 pulses/mn and tachycar-
dia was found in 308 patients (50.08%). It was a goiter in 561 cases
(89.90%), a Graves’ orbitopathy in 455 cases (72.92%). All patients
had a TSH <0.01 mIU/ml. Free T4 value was normal in 139 cases
(22.27%), between 23 and 49 pmol/l in 175 cases (28.04%), between
50 and 100 pmol/l in 50 cases (8.01%) and greater than 100 pmol/l
in 260 patients (41.66%). The presence of goiter was statistically cor-
related with the value of free T4 > 70 pmol/l [OR=2.85(1.53-5.30)
p=0.0002]. Graves’ orbitopathy was statistically correlated with the
size of goiter [OR=2.08(1.42-3.07) p=0.0001]. We found no signi-
cant correlation with family history thyropathy, trigger or self-main-
tenance factors, delay of consultation, and age. Table 1 shows the
epidemiological and clinical prole of subjects on admission.
Therapeutic data
All patients had initially received medical treatment with ATD
(only Carbimazol). The average starting dose of treatment was 38.3±1
Characteristics of patients on admission Values
Sociodemographic data
Mean age 32.1±13 years
Children 28 cases (04.49%)
Teenager 82 cases (13.40%)
Adults 514 cases (82.37%)
Triggers or self maintaining factor 265 cases (42.46%)
Abandonment or isolation 67 cases (10.74%)
Family conict 65 cases (10.42%)
Professional difculties 137 cases (21.10%)
Clinical and para clinical data
Delay of consultation 11.79±25 months
Thinness 321 cases (51.44%)
Overweight and obesity 22 cases (03.52%)
Mean heart rate 104±16 pulses/mn
Graves’ orbitopathy 455 cases (72.92%)
Goiter 561 cases (89.90%)
Goiter grade 2 212 cases (33.97%)
Goiter grade 3 254 cases (40.71%)
Goitre and Graves’ orbitopathy 415 cases (66.5%)
Mean free T4 71.8±51 pmol/l
Table 1: Epidemiological and clinical prole of subjects at admission.
Citation: Diedhiou D, Diallo IM, Ndour MA, Sow D, Diallo AK, et al. (2018) Graves’ Disease in Men’s Subjects. J Hum Endocrinol 3: 012.
• Page 3 of 5 •
J Hum Endocrinol ISSN: 2572-9640, Open Access Journal
DOI: 10.24966/HE-9640/100012
Volume 3 • Issue 1 • 100012
mg/day. This dose was less than 30 mg/day in 35.97% of cases, be-
tween 30 and 50 mg/day in 53.71%. In 10.32% of cases, it was greater
than 50 mg/day. Anxiolytics and beta blocker was prescribed in 244
patients (39.10%) and 350 patients (56.09%), respectively. The si-
multaneous use of beta blockers and anxiolytics was found in 227 pa-
tients (36.37%). The mean duration of the attack treatment was 6.73
months. Among the patients who complied with their appointment,
the maintenance treatment was effective in the rst 3 months in 282
(61.84%), within 6 months in 310 patients (79.69%). Only the ATD
peak dose > 30 pmol/l was signicantly correlated with early initiat-
ing maintenance treatment in the rst 3 months [OR=0.078(0.044-
0.14) p=0.0000]. We don’t found a signicant correlation between
early initiating maintenance treatment and respectively the initial free
T4 value, the use of beta blocking or anxiolytics therapy.
Evolutive data
Among the 624 patients initially selected, those lost to follow-up
represented 229 cases (36.69%) at 6 months and 334 cases (53.52%)
at 12 months of follow-up. Complications were thyrotoxic heart dis-
eases in 43 cases (06.89%), moderate-to-severe or sight-threatening
orbitopathy in 7 cases (01.12%), and agranulocytosis in 2 cases. We
did not nd an acute thyrotoxic crisis.
After 30 months, only 250 subjects were regularly followed,
with a percentage of 40.06%. Remission was observed in 96 patients
(38.40%). Among them, 26 subjects (27.03%) had relapse. The 70
patients (28%) with full remission had a remission delay of 15 months
in 45 cases (64.29%), 18 months for 14 cases (20%), and 21 months
in 10 cases (14.29%). A failure of medical treatment was found in
154 patients (61.60%). Among the subjects with treatment failure,
48 (31.17%) had a thyroidectomy; the others (68.83%) are still un-
der ATD treatment. Indications for thyroidectomy were failure of
medical treatment in 33 cases, thyrotoxic heart diseases in 11 cases
(23.40%), moderate-to-severe or sight-threatening orbitopathy in 2
cases (04.25%) and agranulocytosis in 2 cases.
Failure to medical treatment was signicantly correlated with
age < 30 years [OR=1.96(1.11-3.47), p=0.009], presence of goi-
ter [OR=3.43(1.41-8.37), grades of goiter [OR=2.50(1.34- 4.64),
p=0.002] and initial values of free T4 > 70 pmol [OR=1.89(1.04-
4.22), p=0.017]. Other parameters such as body mass index, family
history of thyropathy, trigger or self-maintenance factors, delay of
consultation, Graves’ orbitopathy, and Carbimazol initial dose were
not shown to be signicant. Table 2 shows the factors associated with
the failure of medical treatment in the 250 male subjects who com-
pleted 30 months of treatment.
Discussion
Epidemiological and clinical data
Epidemiological data on Graves’ disease in male subjects remain
variously reported by series and authors. In the western countries,
frequencies vary from 12.1% in French [9] to 17.2% in the United
Kingdom [12]. In Africa, values between 8.6% and 12.4% are found
[13,14]. Like data in our patients, the average age stabilizes between
35 and 45 years [13,14,15-18]. The inclusion of children and adoles-
cents partly explains the decline of this average age to 32.1 years in
our study.
The importance of the environment and genetics in the genesis of
Graves’ disease is well known [19-21]. These include smoking, trig-
gers or self maintaining factors, and a family history of thyroid dis-
ease [12,18,22]. In male subjects, Manji et al. [18], and Allahabadia et
al. [12], in the United Kingdom respectively reported a family history
of thyropathy in (40% and 42.5%) and active smoking in (31.4% and
44%). For Magri et al. [23], in Italy, the existence of family thyrop-
athy was signicantly more common in men. The prole of mainte-
nance factors for the disease would rather depend on societal realities.
Diop et al. [24], had already described the role and impact of stress in
the onset of Graves’ disease. In Senegal, Sarr et al. [13], found family
conict and psycho-emotional shock in 22.8% and 14.9% respective-
ly.
The frequency of the specic signs of Graves’ disease was almost
identical to the literature data [10,13 14,25,26]. The presence of goiter
seems less frequent compared to the female sex [12,18]. But male
subjects would be characterized by a larger goiter [18,23]. As pre-
viously described in the literature, the presence of goiter in the male
subject was statistically correlated with young age, Graves’ orbitopa-
thy, and free T4 value [12,18,19,23].
Therapeutic aspects
For medical treatment, the recommendations suggest an adapta-
tion of the initial dose of ATD to the intensity of hyperthyroidism and
prole of the patient [10]. This is to obtain at the same time anti-thy-
roid and immunosuppressive actions without major adverse effects
[27-29]. Our study also shows a signicant correlation between the
intensity of the initial dose of ATD and the early maintenance treat-
ment. The β blockers play a major role in controlling the symptoms
of thyrotoxicosis. Aside from their inhibitory action on cardiovas-
cular symptoms, they would block the peripheral transformation of
Tetraiodothyronine (T4) into the more active Triiodothyronine (T3).
Evolutionary criteria
(n=250 subjects)
Therapeutic failure Odds ratio (95% IC),
p value
Yes (n=180) No (n=70)
Age < 30 years 94 (52.22%) 25 (35.71%) 1.96 (1.11-3.47),
p=0.009*
Body mass index < 25
kg/m² 145 (96.03%) 47 (94%) 1.54 (0.37-6.41),
p=0.277
Delay of consultation <
12 mois 125 (70.22%) 45 (67.16%) 1.15 (0.63-2.10),
p=0.321
Triggers or self main-
taining factor 95 (52.78%) 30 (42.86%) 1.94 (0.85-2.59),
p=0.081
Family thyropathy 36 (20.00%) 10 (14.28%) 1.53 (0.72-3.29),
p=0.136
Goiter 169 (93.88%) 59 (83.10%) 3.43 (1.41-8.37),
p=0.003*
Goiter grades 2 et 3 147 (81.66%) 46 (65.71%) 2.50 (1.34-4.64),
p=0.002*
Graves’ orbitopathy 138 (76.66%) 51 (72.85%) 1.32 (0.71-2.46),
p=0.193
Free T4 value > 70
pmol/l 77 (44.77%) 21 (30%) 1.89 (1.04-3.42),
p=0.017*
Initial Carbimazol dose
< 40 mg/24h 126 (70%) 48 (68.57%) 1.06 (0.58-1.94),
p=0.410
Table 2: Factors associated with failure of medical treatment in the 250 subjects
followed for 30 months.
Citation: Diedhiou D, Diallo IM, Ndour MA, Sow D, Diallo AK, et al. (2018) Graves’ Disease in Men’s Subjects. J Hum Endocrinol 3: 012.
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J Hum Endocrinol ISSN: 2572-9640, Open Access Journal
DOI: 10.24966/HE-9640/100012
Volume 3 • Issue 1 • 100012
Their prescription should be systematic until euthyroidism. To this
prescription, should be added a supportive psychotherapy and anxi-
olytics. As in our study, the rst-line medical treatment remains the
preference in Europe, Latin America and Japan; in contrast to the
USA where it is rather radioiodine therapy with Iodine 131 which
predominates in 59.7% [10].
If the patient remains in persistent hyperthyroidism beyond 2
years of medical treatment, the surgical indication should be consid-
ered. However, the option of prolonged low-dose medical treatment
may be used in case of patient preference [10,30]. In the absence of
radioiodine therapy not available in Senegal, many of our patients
preferred the long-term medical option despite its inefciency.
Evolutionary data
In Sub-Saharan Africa, spontaneous therapeutic disruption is the
main obstacle to optimizing treatment [20]. In addition to the delay in
management, this fact explains the high rate of mainly cardiovascular
complications. They were reported at 9.8% and 16.6% respectively in
Senegal [31] and Morocco [6]. However, it is rather the female sex
which would be more at risk of thyrotoxic heart diseases [31].
The frequency of remission varies considerably by geographical
area. After 30 months of follow-up, we report a complete remission
in 28%. In the USA, remissions in 20 to 30% were reported after 12
to 18 months of medication [32]. A European study of 5 to 6 years of
medical treatment reports a remission in 50 to 60% [33]. However,
the remission rate in adults would not be improved by medical treat-
ment beyond 18 months [34] or high doses of initial treatment by
ATD [35]. In addition, the male sex is more likely to recur, especially
in smokers and those with large goiter [6,12,36,37]. In our study, fail-
ure in medical treatment was signicantly correlated with young age
[OR=1.96(1.11-3.47), p=0.009], goiter size [OR=2.50(1.34-4.64),
p=0.002] and intensity of hyperthyroidism [OR=1.89(1.04-4.42),
p=0.017].
Conclusion
Graves’ disease in male subjects remains an underrated reality. It
is characterized by a delay in diagnosis, a larger goiter, a high rate of
lost sight and more relapse. Apart from therapeutic education, patient
support remains essential. The follow-up will have to take into ac-
count the risk factors of failure to improve the choices and therapeutic
recourses. The fear of thyroidectomy should lead us to more advoca-
cies to make available radioiodine therapy.
Conict of Interest
The authors do not declare any conict of interest.
References
1. Girgis CM, Champion BL, Wall JR (2011) Current concepts in Graves’
disease. Ther Adv Endocrinol Metab 2: 135-144.
2. Franklyn JA, Boelaert K (2012) Thyrotoxicosis. The Lancet 379: 1155-
1166.
3. Phillipe JM (2009) Graves’s disease in 2009. Rev Med Suisse 5: 764-768.
4. Brent GA (2008) Clinical practice Graves disease. N Engl J Med 358:
2594-2605.
5. Orgiazzi J (2013) Thyroid autoimmunity. Bull Acad Natle Méd 197: 43-
63.
6. Bouziane T, Larwanou M, El Ouahabi H (2017) The predictive factors of
relapse in Graves disease treated by ATS: About 72 cases. Ann Endocrinol
78: 326-352.
7. Bartalena L, Baldeschi L, Dickinson AJ, Eckstein A, Kendall-Taylor P,
Marcocci C, et al. (2008) Consensus statement of the European Group on
Graves’ Orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol
158: 273-285.
8. World Health Organization (1994) United nation children’s fun & interna-
tional council for control of iodine deciency disorders Indicators for as-
sessing iodine deciency disorders and the control through salt iodization.
World Health Organization, Geneva, Switzerland. Pg no: 1-55.
9. Goichot B, Caron P, Landron F, Bouée S (2016) Clinical presentation of
hyperthyroidism in a large representative sample of outpatients in France:
Relationships with age, etiology and hormonal parameters. Clin Endocri-
nol (Oxf) 84: 445-445.
10. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, et al. (2016)
2016 American thyroid association guidelines for diagnosis and manage-
ment of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 26:
1343-1421.
11. Dahl P, Danzi S, Klein I (2008) Thyrotoxic cardiac disease. Curr Heart
Fail Rep 5: 170-176.
12. Allahabadia A, Daykin J, Holder RL, Sheppard MC, Gough SCL, et al.
(2000) Age and gender predict the outcome of treatment for Graves’ hy-
perthyroidism. J Clin Endocrinol Metab 85: 1038-1042.
13. Sarr A, Diédhiou D, Ndour-Mbaye NM, Sow D, Diallo IM, et al. (2016)
Graves’ disease in Senegal: Clinical and evolutionary aspects. Open Jour-
nal of Internal Medicine 6: 77-82.
14. Diagne N, Faye A, Ndao AC, Djiba B, Kane BS, et al. (2016) Epidemi-
ological, clinical, therapeutic and evolutive aspects of Basedow-Graves
disease in the Depatment of Internal Medicine at CHU Aristide Le Dantec,
Dakar (Senegal). Pan Afr Med J 25: 6.
15. Bilosi M, Binquet C, Goudet P, Lalanne-Mistrih ML, Brun JM, et al.
(2002) [Is subtotal bilateral thyroidectomy still indicated in patients with
Grave’s disease?]. Ann Chir 127: 115-120.
16. Hussain YS, Hookham JC, Allahabadia A, Balasubramanian SP (2017)
Epidemiology, management and outcomes of Graves’ disease - Real life
data. Endocrine 56: 568-578.
17. Abodo J, Kélie E, Kof Dago P, Kouassi F, Hué LA, Lokrou A (2016)
Prole of the thyroid pathologies in sub-Saharan Africa: About 503 cases.
Ann Endocrinol 77: 372-412.
18. Manji N, Carr-Smith JD, Boelaert K, Allahabadia A, Armitage M, et al.
(2006) Inuences of age, gender, smoking, and family history on autoim-
mune thyroid disease phenotype. J Clin Endocrinol Metab 91: 4873-4880.
19. Boiro D, Diédhiou D, Niang B, Sow D, Mbodj M, et al. (2017) [Hyper-
thyroidism in children at the University Hospital in Dakar (Senegal)]. Pan
Afr Med J 28: 10.
20. Akossou SY, Napporn A, Goeh-Akuee E, Hillah A, Sokpoh-Diallo K, et
al. (2001) [Problems in the management of thyrotoxicosis in Black Africa:
The Tongolese experience]. Ann Endocrinol (Paris) 62: 516-520.
21. Léger J, Carel JC (2013) Hyperthyroidism in Childhood: Causes, when
and how to treat. J Clin Res Pediatr Endocrinol 5: 50-56.
22. Deleveaux I, Chamoux A, Aumaître O (2013) Stress and auto-immunity.
Rev Med Interne 34: 487-492.
Citation: Diedhiou D, Diallo IM, Ndour MA, Sow D, Diallo AK, et al. (2018) Graves’ Disease in Men’s Subjects. J Hum Endocrinol 3: 012.
• Page 5 of 5 •
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DOI: 10.24966/HE-9640/100012
Volume 3 • Issue 1 • 100012
23. Magri F, Zerbini F, Gaiti M, Capelli V, Ragni A, et al. (2016) Gender inu-
ences the clinical presentation and long-term outcome of Graves disease.
Endocr Pract 22: 1336-1342.
24. Diop SN, Diédhiou D, Sarr A, Ndour Mbaye M, Sylla O, et al. (2011) Psy-
chological aspects and psychiatric manifestation of grave’s disease about
104 cases. Rev Cames 12: 62-64.
25. Hadj Ali I, Khiari K, Chérif L, Ben Abdallah N, Ben Maiz H, et al. (2004)
[Treatment of Graves’ disease: 300 cases]. Presse Med 33: 17-21.
26. Morax S, Badelon I (2009) Basedow exophthalmos. J Fr Ophtalmol 32:
589-599.
27. Nakamura H, Noh JY, Itoh K, Fukata S, Miyauchi A, et al. (2007) Compar-
ison of methimazole and propylthiouracil in patients with hyperthyroidism
caused by Graves’ disease. J Clin Endocrinol Metab 92: 2157-2162.
28. Page SR, Sheard CE, Herbert M, Hopton M, Jeffcoate WJ (1996) A com-
parison of 20 or 40 mg per day of carbimazole in the initial treatment of
hyperthyroidism. Clin Endocrinol (Oxf) 45: 511-516.
29. Wartofsky L, Glinoer D, Solomon B, Nagataki S, Lagasse R, et al. (1991)
Differences and similarities in the diagnosis and treatment of Graves’ dis-
ease in Europe, Japan, and the United States. Thyroid 1: 129-135.
30. Villagelin D, Romaldini JH, Santos RB, Milkos A, Ward LS (2015) Out-
comes in relapsed Graves’ disease patients following radioiodine or pro-
longed low dose of methimazole treatment. Thyroid 25: 1282-1290.
31. Diédhiou D, Sow D, Lèye MM, Diallo IM, Bodian M, et al. (2017) Car-
diothyreosis: Risk factors and clinical prole. Open Journal of Internal
Medicine 7: 1-11.
32. Klein I, Becker DV, Levey GS (1994) Treatment of hyperthyroid disease.
Ann Intern Med 121: 281-288.
33. Mazza E, Carlini M, Flecchia D, Blatto A, Zuccarini O, et al. (2008) Long-
term follow-up of patients with hyperthyroidism due to Graves’ disease
treated with methimazole. Comparison of usual treatment schedule with
drug discontinuation versus continuous treatment with low methimazole
doses: A retrospective study. J Endocrinol Invest 31: 866-872.
34. Abraham P, Avenell A, Park CM, Watson WA, Bevan JS (2005) A system-
atic review of drug therapy for Graves’ hyperthyroidism. Eur J Endocrinol
153: 489-498.
35. Kruljac I, Solter D, Vrkljan AM, Solter M (2015) Remission of Graves’
disease is not related to early restoration of euthyroidism with high-dose
methimazole therapy. Endocr Res 40: 25-28.
36. Bolanos F, Gonzalez-Ortiz M, Duron H, Sanchez C (2002) Remission of
Graves’ hyperthyroidism treated with methimazole. Rev Invest Clin 54:
307-310.
37. Kimball LE, Kulinskaya E, Brown B, Johnston C, Farid NR (2002) Does
smoking increase relapse rates in Graves’ disease? J Endocrinol Invest 25:
152-157.
