Prognostic Factors and Therapeutic Response During Basedow Desease: Study of 3007 Patients Followed Over 25 Years at the Clinique Médicale II (CHAN), Dakar

Introduction: Basedow (Graves’) desease remains the leading cause of hyperthyroidism (40–60%), affecting mainly young women with a prevalence varying according to the iodization of the populations. Methods: Retrospective, descriptive and analytical study, covering 25 years (01/01/1998–31/12/2023) at the Medical Clinic II/CHAN; inclusion of all hyperthyroidism files related to Graves' disease, operative criteria and standardized definitions; descriptive and comparative analysis. Results: Our cohort included 3007 patients, with a female predominance; the most common initial clinical signs were goiter (nearly 89%) and exophthalmos (approximately 69%). Under ATS, a decrease in pulse rate and weight regain were observed at 18 months. Overall outcomes showed failure in 48–49% of cases, remission in nearly 33%, and recurrence around 18%; cardiac complications included cardiothyreosis in nearly 6% and acute thyrotoxic crisis in 0.3%. The worst outcomes were associated with grade 3 goiter, exophthalmos, a consultation time > 12 months and a loading dose > 40 mg/day. Conversely, early initiation of maintenance treatment (<6 months) was associated with more remissions and fewer recurrences. Conclusion: Rapid initiation and reasoned adjustment of ATS, coupled with stratification by severity (goiter, orbitopathy, delay), optimize the response and limit surgery; these levers can be used in resource-constrained systems.