5.1. Epidemiological Data
5.1.1. Age
The mean age of patients with Graves’ disease in the literature is 34.6 years [9]. In our study the mean age was 38.45 years. Our results are comparable with the study of Insaf Hadj Ali et al., where the mean age was 38.17 years [10]. The most affected age group in our series was between 30 - 39 years with 30%. For A. Toft et al., the peak frequency of Graves’ disease is between 30 and 40 years [11].
5.1.2. Gender
Graves’ disease is more common in women. In our study 91.42% were women with a sex ratio = 0.09. A work done by M. Mbodj et al. showed a lower percentage of which 79% of patients with Graves’ disease were women [12].
5.1.3. Background
- Familialgoiter
A notion of familial goiter was objectified in 4.65% of cases. The study of Ndour Oumar shows a higher percentage of which 25% of people diagnosed with Graves’ disease had a positive family history of goiter [13].
-Pregnancy
In our study 8.14% of patients had a history of abortion. Our results can be correlated with those of the study of H. Marhari et al., including 16.66 % of abortion cases for 12 cases of Graves’ disease associated with pregnancy [14].
5.1.4. Clinical Data
1)Consultationperiod
We noted a diagnostic delay in our study. 24.29% of patients were diagnosed after one year. Only 11.42% of patients waited less than a month before consulting. This situation can be explained either by the non-specificity of the signs of hyperthyroidism favoring diagnostic wandering; or by the low socio-economic level of the population who have difficulty accessing quality care. For Khatraty cheikh saad bouh, the consultation time varies between 10 days and 10 years with an average of 2 and a half years [15].
2)Accordingtoclinicalmanifestations
In our study 30% of patients had goiter, 11.42% had orbitopathy, 52.85% had palpitation, 41.42% had weight loss, 12.85% suffered from asthenia, 34.28% had insomnia, 20% complained of nervousness, 14.28% had thermophobia, 22.85% had tremors of the extremities, 1.42% suffered from motor diarrhea. Our results are similar to those of Nafissatou Diagne and al including 32.4% of patients had goiter, 38% had orbitopathy, 46.3% had palpitation, 39.8% had weight loss, 17.6% suffered from asthenia, 20.4% had insomnia, 24.1% complained of nervousness, 19.4% had thermophobia, 33.3% had tremors of the extremities, 5.5% suffered from motor diarrhea [15].
5.1.5. Paraclinical Data
Anti-TSHreceptorantibodyassays
In our study, anti-RTSH antibodies were performed in 06 patients and were positive in 100% of them. Our results are similar to those of Nafissatou Diagne et al., in whom 28 patients had benefited from the dosage of anti-RTSH antibodies and were positive in 100% of them [9]. A study carried out in Morocco [16], found anti-RTSH antibodies at a positive rate in 87.5% of cases.
5.1.6. Distribution According to Complications
Cardiothyreosis is a common cardiovascular complication of Graves’ disease. In our study, 15.71% of patients had cardiothyreosis. Our results can be correlated with those of Nafissatou Diagne et al., who objectified cardiothyreosis in 11.1% of cases [9]. According to Allanic et al., cardiothyreosis accounts for 65.7% of cases [17].
5.1.7. Distribution According to Comorbidities
-HTA
HTA appears insidiously and silently, all the earlier subject is exposed to certain risk factors: aging, which promotes the loss of elasticity of the arteries, constitutes the first non-modifiable risk factor. But other risk factors are determined by habits or a lifestyle that can be modified: being overweight, being sedentary, high salt consumption, smoking or alcohol [18]. In our study, high blood pressure is the most common cardiovascular comorbidity with 30% of subjects.
-Type1diabetic
In our study 8.57% had type 1 diabetics. For N. Rekik et al., out of a total of 60 subjects with T1D 28.33% had Graves’ disease [19]. For M. Bennour et al. Graves’ disease was found in 3.89% of patients with type 1 diabetes [20].
-Type2diabetic
In our study 7.14% had type 2 diabetic.
-Biermer’sdisease
In our study 2.85% suffered from Biermer’s disease. For MT Oh et al., out of a total of 28 subjects with Biermer’s disease 21% had Graves’ disease [21]. For M. Mtir et al. Graves’ disease was found in 5.97% of patients with diabetes and Bier-mer’s disease [22].
5.1.8. According to the Etiological Factors
-Thefemalesex
In our study, the predominant etiological factor was female gender with 91.42%. Several studies have shown the clear female predominance observed in Graves’ disease with prevalence’s of 19 per 1000 women [23].
-Stress
The origin of autoimmune diseases is multifactorial. Stress is probably one of the etiological components. It is indeed often found during questioning of patients with an autoimmune disease or during relapses of the latter as a triggering element. The biological consequences of stress are increasingly better understood. During stress, glucocorticoids and catecholamines released by the hypothalamic-pituitary axis will modify the balance of the Th1/Th2 and Th17/ Treg cytokine balances and be at the origin of an inhibition of cellular immunity, a decrease in immune tolerance and a stimulation of humoral immunity. These modifications expose individuals to autoimmune diseases among other things [24]. In our study, 10% of patients suffered from stress.
5.1.9. According to the Treatment
Treatment is always medical at first, then it can be supplemented by surgical or isotopic treatment depending on the indication, the age of the patient and the evolution of the thyroid disease. In our study 61.42% of patients were on thyrozol. 58.57% of patients were on propranolol or 58.57%. 20% of patients were on carbigene.
5.1.10. According to the Evolution
In the literature, the recurrence rate after medical treatment with Synthetic Antithyroid drugs reaches 50%. In order to have an optimal effect of Synthetic Anti Thyroid (ATS) the duration of treatment must be between 12 and 24 months [25]. In our study, the evolution was favorable in 22.41% of patients and was marked by a normalization of thyroid hormones after medical treatment well followed for a period of 6 months. At 18 months the evolution was favorable in 34.28% of patients. A prospective study published by Allanic [26], comparing the respective effects of a 6-month and 18-month treatment, shows that 58.3% of patients treated for 6 months relapse. This figure decreases to 38.2% in patients treated for 18 months.
5.1.11. Limitation of the Study
The limitations encountered were mainly:
- This was a retrospective study;
- Some files were incomplete compared to the explorations;
- Long-term monitoring difficulties.