CLINICAL PROFILE AND BONE HEALTH STATUS IN PATIENTS WITH GRAVES’ DISEASE ON LONG-TERM ANTITHYROID DRUG THERAPY: A CROSS-SECTIONAL STUDY

ABSTRACT Background: Graves’ disease is the most common cause of hyperthyroidism in young/middle-aged individuals. While definitive therapies such as radioiodine ablation and surgery are widely performed, a considerable subset of patients are maintained on long-term antithyroid drug (ATD) therapy due to patient preference, comorbidities, or relapse after remission. However, data evaluating the skeletal health of patients on extended ATD therapy remain limited. This study aimed to assess BMD and related biochemical parameters in patients with graves’ disease treated with ATDs for ≥2 years. Methodology: This cross-sectional study included 60 patients (aged 18–50 years) of graves’ disease, duration of illness ≥2 years, and continuous ATD therapy for at least 2 years. BMD was measured using Dual-Energy X-ray Absorptiometry (DEXA) at the distal radius, bilateral femoral neck, and lumbar spine (L1–L4). Clinical, biochemical, and treatment-related data were collected and analyzed using appropriate statistical methods. Results: The median age was 36 ± 8.1 years, with a female predominance (86.7%). Median(IQR) duration of illness and ATD were 36 (24-84) and 35.5 (24-82) months respectively. Mean BMD values (g/cm 2 ) and Z-scores were as follows, distal radius: 0.55 ± 0.11 and Z-score: -1.86±1.68, left femoral neck: 0.76 ± 0.13 and Z-score: -0.52±1.2, right femoral neck: 0.75 ± 0.14 and Z- score: -0.58±1.2 and lumbar spine (L1–L4): 0.92 ± 0.14 and Z-score: -0.9±1.2. Subgroup analysis revealed lower mean Z scores at the distal radius in patients receiving ATD therapy for >5 years compared to those treated for 2–5 years duration (Z-score: -1.98±1.78 vs. - 1.83±1.67). Serum total T3 levels correlated negatively with distal radius Z scores (correlation coefficient -0.457, p = 0.007). Conclusion: Patients with graves’ disease on long-term ATD therapy exhibit measurable deficits in bone mineral density, most notably at the distal radius despite biochemical control of hyperthyroidism. These findings emphasize the need for proactive bone health monitoring and individualized risk assessment in patients maintained on prolonged ATD therapy.