Predictors of Non-Remission on ATDs
A 32-year-old woman with Graves' disease has a large goitre, positive TRAb, active ophthalmopathy, family history of thyroid disease, and is a current smoker. She is on antithyroid drugs. Which combination of features most strongly predicts failure of remission?
Correct Answer — B
The established predictors of non-remission on antithyroid drugs are: large goitre (index of disease burden), positive TRAb (persisting autoimmune drive), ophthalmopathy (systemic autoimmune activity), smoking (independent immune modulator that worsens Graves' outcomes), and family history of thyroid disease. This patient has all five. These structural and immunological factors — not demographics or biochemistry alone — are the validated markers of likely treatment failure.
Key concept
Predictors of non-remission on ATDs: large goitre, TRAb positivity, ophthalmopathy, smoking, family history of thyroid disease.