Prediction of Remission or Relapse for Graves’ Hyperthyroidism by the Combined Determination of Stimulating, Blocking and Binding TSH-Receptor Antibodies after the Withdrawal of Antithyroid Drug Treatment

Abstract. In patients with Graves' hyperthyroidism, the relapse rate after antithyroid drug treatment is in the range of about 30–70%. Different attempts have been made to obtain criteria for the prediction of the clinical outcome after drug therapy, especially HLA-DR typing and measurement of TSH receptor antibodies. So far, very conflicting results have been reported. This is not surprising in view of the many genetically controlled and environmental factors that play a role in the pathogenesis of this disease. Moreover, most reports are based on retrospective studies with a relatively small number of patients. Our own data, obtained in a prospective multicenter study, yield strong evidence against the relevance of HLA-DR3 typing (n = 187, sensitivity = 0.38, specificity = 0.67) or measurement of TSH receptor antibodies at the end of therapy (n = 269, sensitivity = 0.49, specificity = 0.72) for the prediction of the clinical course after drug treatment.

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Usefulness of the 2nd Generation Assay for Anti-TSH Receptor Antibodies to Differentiate Relapse of Graves' Thyrotoxicosis from Development of Painless Thyroiditis after Antithyroid Drug Treatment for Graves' Disease

Endocrine Journal ◽

10.1507/endocrj.52.493 ◽

2005 ◽

Vol 52 (4) ◽

pp. 493-497 ◽

Cited By ~ 15

Author(s):

Yukiko IZUMI ◽

Keiko TAKEOKA ◽

Nobuyuki AMINO

Keyword(s):

Drug Treatment ◽

Antithyroid Drug ◽

Tsh Receptor ◽

Graves Disease ◽

2Nd Generation ◽

Painless Thyroiditis ◽

Antithyroid Drug Treatment ◽

Receptor Antibodies ◽

Tsh Receptor Antibodies

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Remission Rate of Graves' Disease and the Trend of Changes in Serum TSH Receptor Antibodies in Prolonged Antithyroid Drug Treatment

International Journal of Endocrinology and Metabolism ◽

10.5812/ijem.101473 ◽

2020 ◽

Vol 18 (Suppl) ◽

Cited By ~ 1

Author(s):

Danilo Villagelin ◽

Roberto Bernardo Santos ◽

João Hamilton Romaldini

Keyword(s):

Drug Treatment ◽

Remission Rate ◽

Antithyroid Drug ◽

Antithyroid Drugs ◽

Graves Disease ◽

Remission Rates ◽

Thyrotropin Receptor Antibodies ◽

Antithyroid Drug Treatment ◽

The Impact ◽

Receptor Antibodies

Context: Graves’ disease is an autoimmune disease caused by thyrotropin receptor antibodies (TRAb). These antibodies can be measured and used for the diagnosis, prediction of remission, and risk of Graves’ orbitopathy development. There are three treatments for Graves’ disease that have remained unchanged for the last 75 years: Antithyroid drugs, radioiodine, and surgery. Antithyroid drugs are the first treatment option worldwide and are usually used for 12 - 18 months. Recent reports suggest the use of antithyroid drugs for more than 18 months with better outcomes. This review focuses on two aspects of treatment with antithyroid drugs: The impact of using antithyroid drugs for more than 12 - 18 months on remission rates and the trend of TRAb during prolonged antithyroid drug treatment. Evidence Acquisition: A review was performed in Medline on the published work regarding the duration of ATD treatment and remission of Graves' disease and also ATD treatment and TRAb status during the 1990 - 2019 period. Results: Remission rates are variable (30% - 80%), and many clinical and genetic factors serve as predictors. The long-term use of antithyroid drugs appears to increase remission rates. TRAb values usually decline during ATD treatment, but the trend could occur in two ways: Becoming negative or showing a fluctuating pattern. However, approximately 10% of the patients will remain TRAb-positive after five years of treatment with antithyroid drugs. Conclusions: Antithyroid drugs can be used for long periods with an increase in remission rates, and a gradual decrease in TRAb levels, with the disappearance of TRAb in 90% of the patients after 60 months.

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