Gender-related Differences In Patients With Graves' Disease

Objectives To investigate the gender-related differences in patients with Graves' disease (GD).Methods 1140 patients diagnosed with GD in out-patient clinic of Dept. of endocrinology of PLA General hospital in the period Oct.2009 to Feb.2011 were enrolled in the study. The diagnosis of GD was made according to common clinical and laboratory criteria. Questionnaires were used to investigate the general imformation, clinical symptoms and signs, family history of GD, treatmeant, recurrence and laboratory results of all the patients. The clinical data of all the patients were analyzed according to gender.Results1. Graves' disease presented a marked female preponderance. Female patients with GD presented at a younger age, compared with males (33.27+12.93 vs 35.44+13.20yr P=0.015), and the peak age incidence in female was 20～29 yr. The female/male ratio was 3.04:1. Among female patients aged over 30 years old, the older the patients were, the higher the prevalence rate of GD was.2. Among the common clinical symptoms and signs of GD, males presented a higher prevalence of weight loss, hyperthyroid cardiopathy, periodic paralysis and non-invasive ophthalmopathy whereas tachycardia, diffuse goiter were more common in females.3. The females presented higher serum T4, FT4 (P<0.05).TgAb levels were significantly higher in females than that in males, but there were no statistical difference of TRAb and TPOAb levels between male and female patients.The one with TRAb>30U/L was more common in females, however the one with TRAb 10～30U/L was more common in males.4. There was no significant difference of the incident rate of thyrotoxic hepatic lesion between male and female patients with GD.The common abnormal hepatic function parameter were alkalin phosphate enzyme(ALP) and alanine transaminase(ALT).The hepatic-lesion caused by ATD was more common in males (P=0.000)5. There is no gender-related difference in Color Doppler Flow Imaging of thyroid. Patients with markedly increased flow signals presented higher thyroid hormones,TRAb levels and TPOAb levels than those with little or nomal flow signal. Among the patients with markedly increased flow signals, the one with TRAb>30U/L was more common in patients without diffuse lesion, but the one with TPOAb>1500IU/ml was more common in patients with diffuse lesion.6. The family history of GD were common in their first-degree relatives.There is no difference in the distribution of the ABO blood group between female and male patients.7. GD may coexist with other autoimmune diseases, and females were more than males.8. There is no gender-related difference in relapse rate after ATD therapy withdrawal. Patients experiencing 1 relapse were most common.9. Spearman correlateon analysis indicated that age at onset was correlated negatively with diffuse goiter, the levels of thyroxine and the titers of TRAb. The titers of TRAb were positively associated with the degree of diffuse goiter and ophthalmopathy, the levels of thyroxine and the titers of TPOAb.ConclusionGD appeared at a younger age and larger diffuse goiters in females, together with more pronounced elevation of serum T4, FT4 and TgAb. However, males presented a higher prevalence of weight loss, hyperthyroid cardiopathy, periodic paralysis, non-invasive ophthalmopathy and the hepatic-lesion caused by ATD Altogether, these findings depict a different pattern for GD in males and females.