GREAT-Score (Recurrence Risk of Graves' Disease after Antithyroid Drugs)
Point-based scoring system in Graves' disease to estimate the risk of recurrence after discontinuation of antithyroid therapy.
Therapeutically, there are 3 procedures available in the treatment of Graves' disease: Radioiodine therapy, thyroidectomy, and medical treatment with antithyroid drugs, with the latter being the first-line therapy. The so-called Graves’ Recurrent Events After Therapy Score (GREAT-Score) was developed and validated to identify patients with a high risk of recurrence before starting therapy, with the aim of possibly referring these patients early to definitive therapy.
Parameter | Definition | Points |
|---|---|---|
Age at Diagnosis | > 40 years | 0 points |
| 20 – 40 years | 1 point | |
| < 20 years | 2 points | |
fT4 at Diagnosis | ≤ 2 times upper normal limit | 0 points |
| > 2 times upper normal limit | 1 point | |
TRAK Titer (TSH Receptor Antibodies) | ≤ 10 IU/l | 0 points |
| > 10 IU/l | 1 point | |
Eye Involvement (Endocrine Orbitopathy) | None | 0 points |
Present | 1 point |
Total Score and Interpretation
Total Points | Recurrence Risk after Discontinuation of Antithyroid Drugs |
|---|---|
| 0 – 1 points | Very low risk (~ 20%) |
| 2 – 3 points | Moderate risk (~ 50 – 60%) |
| 4 – 5 points | High risk (~ 80 – 90%) |
- 0 – 1 points → Antithyroid therapy likely successful, discontinuation of medication after 12 – 18 months advisable
- 2 – 3 points → Moderate recurrence risk, close follow-up necessary after discontinuation
- 4 – 5 points → Very high recurrence risk → consider alternative definitive therapies (e.g., radioiodine therapy or surgery)
Summary:
The GREAT-Score in Graves' disease regarding recurrence risk is a standardized way to predict the success probability of antithyroid treatment and to consider alternative therapies (radioiodine/surgery) in a timely manner. The younger, more severely affected (high fT4, high TRAK, eye involvement) → the higher the risk of relapse after discontinuation.
Source: Original GREAT Study by Vos et al. 2010
Vos XG, Endert E, Zwinderman AH, Tijssen JG, Wiersinga WM. Predicting the Risk of Recurrence Before the Start of Antithyroid Drug Therapy in Graves' Hyperthyroidism. JCEM 2010; 95(8): 3750–3757.