Integrating Shear Wave Elastography into Clinical Prediction of Graves' Disease Recurrence: A Novel Risk Scoring System

Xiao-Yun Zha Ze-Hong Xu Jia-Jia Dong Liang-Xiao Xie Peng-Bin Lai Chang-Shun Wei Hua-Qiang Zheng Duo-Bin Huang Jin-Zhi Wu ^*

• The First Department of Endocrinology and Metabolism, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China

Objective:This study aims to evaluate the utility of shear wave elastography (SWE) in predicting the recurrence risk of Graves' disease(GD), to construct a recurrence risk prediction model that integrates SWE and clinical characteristics, and to develop a risk scoring system aimed at enhancing the survival rate of patients with GD following drug treatment and prognosis management. Methods: A prospective cohort study was conducted involving with 169 patients diagnosed with first-episode GD.By analyzing SWE parameters, three-dimensional thyroid volume, TRAb levels, and other clinical indicators, the Cox proportional hazards model was used to construct a recurrence risk prediction model for GD. Bootstrap resampling was employed to verify the the model's reliability. A simple recurrence risk scoring system was also developed based on independent risk factors for clinical use.The study identified several factors significantly associated with GD recurrence: age <35 years, a family history of GD, an initial TRAb level≧15 IU/ml, a thyroid volume≧19 cm³, an initial SWE≧2.0 m/s, and a TSH(thyroid stimulating hormone ) normalization duration <4 months.Notably, SWE was found to be a strong predictor, with patients exhibiting SWE ≥2.0 m/s having a recurrence risk that is 4.54 times greater than those with lower values. Based on these risk factors, a scoring system was developed with a cutoff of of 4 points for recurrence risk, demonstrating a sensitivity of 74% and a specificity of 91.8%. The area under the curve (AUC) of the final model was 0.91, indicating high predictive accuracy. Conclusions: SWE is an independent predictor of recurrence risk in GD. When combined with traditional clinical indicators, it significantly enhances the predictive capability for GD recurrence. The risk score model provides a simple and effective tool for individualized management and optimization of treatment strategies..