title: A SURVEY OF CLINICAL PRACTICE PATTERNS IN MANAGEMENT OF GRAVES DISEASE IN THE MIDDLE EAST AND NORTH AFRICA.
abstract: OBJECTIVE
  Graves disease (GD) is commonly seen in endocrine clinical practice. The objective of this study was to evaluate the current diagnosis and management of patients with GD in the Middle East and North Africa (MENA).
  
  
  METHODS
  An electronic survey on GD management was performed using an online questionnaire of a large pool of practicing physicians. Responses from 352 eligible and willing physicians were included in this study. They were mostly endocrinologists (157) and internal medicine physicians (116).
  
  
  RESULTS
  In addition to serum thyroid-stimulating hormone (TSH) and free thyroxine assays, most respondents would request serum antithyroid peroxidase antibody and TSH-receptor autoantibody (50% and 46%, respectively), whereas serum antithyroglobulin antibodies would be ordered by fewer respondents (36%). Thyroid ultra-sound would be requested by a high number of respondents (63.7%), while only a small percentage would order isotopic thyroid studies. Antithyroid drug (ATD) therapy was the preferred first-line treatment (52.7%), followed by radio-iodine (RAI) treatment (36.8%), β-blockers alone (6.9%), thyroidectomy (3.2%), and no therapy (1.3%). When RAI treatment was selected in the presence of mild Graves orbitopathy and/or associated risk factors for its occurrence/exacerbation, steroid prophylaxis was frequently used. The preferred ATD in pregnancy was propylthiouracil in the first trimester and carbimazole in the second and third trimesters. On most issues, choices of the MENA physicians fell between European and American practices.
  
  
  CONCLUSIONS
  Hybrid practices are seen in the MENA region, perhaps reflecting training and affiliations. Management approaches most suitable for patients in this region are needed.
  
  
  BACKGROUND
  ATD = antithyroid drug CBZ = carbimazole FT3 = free T3 FT4 = free T4 GD = Graves disease GO = Graves orbitopathy MENA = Middle East and North Africa MMI = methimazole RAI = radioactive iodine RAIU = RAI uptake T3 = tri-iodothyronine T4 = thyroxine TG Ab = antithyroglobulin antibodies TRAb = TSH-receptor autoantibody TSH = thyroid-stimulating hormone PTU = propylthiouracil TID = thrice daily UAE = United Arab Emirates US = ultrasound.
authors.forename: Salem A
authors.initials: SA
authors.lastname: Beshyah
authors.forename: Aly B
authors.initials: AB
authors.lastname: Khalil
authors.forename: Ibrahim H
authors.initials: IH
authors.lastname: Sherif
authors.forename: Mahmoud M
authors.initials: MM
authors.lastname: Benbarka
authors.forename: Syed Abbas
authors.initials: SA
authors.lastname: Raza
authors.forename: Wiam
authors.initials: W
authors.lastname: Hussein
authors.forename: Ali S
authors.initials: AS
authors.lastname: Alzahrani
authors.forename: Asma
authors.initials: A
authors.lastname: Chadli
mesh_terms: D000328:Adult; D000352:Africa, Northern / Q000453:epidemiology; D000368:Aged; D013956:Antithyroid Agents / Q000627:therapeutic use; D000072097:Endocrinologists; D005260:Female; D006111:Graves Disease / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine; D020407:Internet; D007453:Iodide Peroxidase / Q000097:blood; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D013954:Thyroglobulin / Q000032:analysis; D013965:Thyroidectomy; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood
chemical_list: D013956:Antithyroid Agents; D007457:Iodine Radioisotopes; D013972:Thyrotropin; D013954:Thyroglobulin; D007453:Iodide Peroxidase; D013974:Thyroxine