Reappraisal of the 3,5,3′-Triiodothyronine-Suppression Test in the Prediction of Long Term Outcome of Antithyroid Drug Therapy in Patients with Hyperthyroid Graves’ Disease

Differences in the epitopes of thyroid-stimulating antibodies (TSAbs) from patients with untreated Graves’ disease were compared with long-term response to antithyroid drugs. Epitopes were measured using Chinese hamster ovary cells transfected with wild-type human TSH receptor (TSHR) and two receptor chimeras, wherein TSHR residues 9–165 or 90–165 had been substituted with comparable residues of the LH/chorionic gonadotropin receptor. Of 159 patients studied, 52 (32.7%) exhibited positive TSAb activity with one or both chimera lines (heterogeneous group), and 107 (67.3%) had no activity with either (homogeneous group). Independent of all other parameters, patients with heterogeneous epitopes responded more favorably to oral antithyroid drugs than patients with homogeneous epitopes (65.4% vs. 41.9%, P = 0.011: estimated odds ratio by logistic regression, 2.17). Although most clinical parameters were not different at presentation, significant differences in the size of goiters, total T3 concentrations, and titers of TSH-binding inhibitory Igs were evident in the successfully treated group (n = 80) by comparison to the group of patients whose treatment failed (n = 79). Alone, these three parameters did not predict outcome; however, when either of these parameters were considered together with epitope heterogeneity, predictability of a positive therapeutic response was increased to nearly 80%. Thus, the presence of TSAbs with a heterogeneous epitope in a patient with Graves’ disease is not only associated with a favorable response to antithyroid drug treatment, it may help predict the response to treatment when the patient is initially seen.

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A second course of antithyroid drug therapy is effective in patients with relapsed Graves' disease

Endocrine Abstracts ◽

10.1530/endoabs.59.p205 ◽

2018 ◽

Author(s):

Khyatisha Seejore ◽

Fozia Nawaz ◽

Katherine Kelleher ◽

Julie Kyaw-Tun ◽

Julie Lynch ◽

...

Keyword(s):

Drug Therapy ◽

Antithyroid Drug ◽

Graves Disease ◽

Antithyroid Drug Therapy

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Successful Treatment of Graves Disease in Pregnancy with Lugol's Iodine

Scottish Medical Journal ◽

10.1177/003693300004500107 ◽

2000 ◽

Vol 45 (1) ◽

pp. 20-21 ◽

Cited By ~ 1

Author(s):

A. Jamieson ◽

C.G. Semple

Keyword(s):

Drug Therapy ◽

Successful Treatment ◽

Surgical Intervention ◽

Antithyroid Drug ◽

Primary Treatment ◽

Graves Disease ◽

Lugol’S Iodine ◽

Organic Iodine ◽

Antithyroid Drug Therapy ◽

In Pregnancy

We report a case of Grave's disease in pregnancy complicated by intolerance of standard antithyroid drug therapy. We describe the success of prolonged use of organic iodine as a primary treatment prior to surgical intervention.

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Erratum

Acta Endocrinologica ◽

10.1530/acta.0.1210304 ◽

1989 ◽

Vol 121 (2) ◽

pp. 304

Author(s):

H. Schleusener ◽

J. Schwander ◽

C. Fischer ◽

R. Holle ◽

G. Holl ◽

...

Keyword(s):

Drug Therapy ◽

Relapse Rate ◽

Clinical Course ◽

Antithyroid Drug ◽

Graves Disease ◽

Trh Test ◽

Prospective Multicentre Study ◽

Antithyroid Drug Therapy ◽

Significant Difference ◽

The Individual

Abstract. Graves' disease is an autoimmune disease characterized by a course of remission and relapse. Since the introduction of antithyroid drug treatment, various parameters have been tested for their ability to predict the clinical course of a patient with Graves' disease after drug withdrawal. Nearly all these studies were retrospective and often yielded conflicting results. In a prospective multicentre study with a total of 451 patients, we investigated the significance of a variety of routine laboratory and clinical parameters for predicting a patient's clinical course. Patients who had positive TSH receptor antibodies activity at the end of therapy showed a significantly higher relapse rate than those without (P < 0.001). However, the individual clinical course cannot be predicted exactly (sensitivity 0.49, specificity 0.73, N = 391). The measurement of microsomal (P = 0.99, sensitivity 0.37, specificity 0.63, N = 275) or thyroglobulin antibodies (P = 0.76, sensitivity 0.18, specificity 0.84, N = 304) at the end of antithyroid drug therapy did not show a statistically significant difference in the antibody titre between the patients of the relapse and those of the remission group. Additionally, HLA-DR typing (HLA-DR3: P = 0.37, sensitivity 0.36, specificity 0.58, N = 253) was proven to be unsuitable for predicting a patient's clinical course. Patients with abnormal suppression or an abnormal TRH test at the end of antithyroid drug therapy relapse significantly more often (P< 0.001) than patients with normal suppression or normal TRH test. Patients with a large goitre also have a significantly (P< 0.001) higher relapse rate than those with only a small enlargement. The sensitivity and specificity values of all these parameters, however, were too low to be useful for daily clinical decisions in the treatment of an individual patient. This is also true for the combinations of different parameters. Though the highest sensitivity value (0.94) was found for a combination of the suppression and the TRH test at the end of therapy, the very low specificity value (0.13) for this combination reduced its clinical usefulness.

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