Long-Term Antithyroid Drug Treatment: Trends in Serum TSH and TSH Receptor Antibody Changes in Patients with Graves’ Disease

Objectives: Trends in serum thyroid-stimulating hormone (TSH) and TSH receptor antibody (TRAb) changes during antithyroid drug treatment, and long-term prognosis were evaluated in Graves’ hyperthyroidism (GD). Methods: In 609 GD patients initially treated with 15 mg of methyl-mercapto imidazole (MMI), the changes in serum TRAb and long-term prognosis were compared in the TSH-normalized group (A) and the TSH-suppressed group (B and C) during the initial 180 days of treatment. Results: Early responses to MMI during 180 days of treatment were as follows: 48 cases (7.9%) became hypothyroid with elevated TSH (A1), and 188 cases (30.9%) became euthyroid with normal TSH (A2). Among patients with continuously suppressed TSH, the free T4 (fT4) level was low in 31 cases (5.1%) (B1-inappropriately suppressed TSH), fT4 and fT3 were normal in 185 cases (30.4%) (B2), fT4 was normal, but fT3 remained high in 84 cases (13.8%) (B3), and fT4 remained high in 73 cases (12.0%) (C-refractory). Serum TRAb became negative after < 5 years then remained negative in 25% - 51% of the cases (smooth type), became negative after < 5 years then became positive again in 30% - 43% of the cases (fluctuating type), and remained positive after > 5 years in 10% - 42% of the cases (smoldering type). In total, remission occurred after 6.2 (3.0 - 10.4) years of treatment in 42%, possible remission on a small maintenance dosage of antithyroid drug occurred in 13%, and spontaneous hypothyroidism occurred in 4.4% of the cases. The smoldering type was more frequent in the B1 and C groups than in others, and remission was less frequent. The difference in the long-term prognosis depending on the early response to MMI disappeared after excluding the ablated patients. Without ablation, remission or spontaneous hypothyroidism could be expected in 60% - 75% of patients after tenacious treatment for > 10 years. Conclusions: Prolonged suppression of serum TSH may suggest active TRAb activity during treatment, and continuous TRAb positivity for more than 5 years suggests persistent GD activity.

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Determinants of Extraocular Muscle Volume in Patients with Graves' Disease

Journal of Thyroid Research ◽

10.1155/2012/368536 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Samer El-Kaissi ◽

Jack R. Wall

Keyword(s):

Extraocular Muscle ◽

Tsh Receptor ◽

Graves Disease ◽

Thyroid Function Tests ◽

Thyroid Scintigraphy ◽

Free T4 ◽

Receptor Antibody ◽

Tsh Receptor Antibody ◽

Antibody Positivity ◽

Serum Tsh

Background. To examine factors contributing to extraocular muscle (EOM) volume enlargement in patients with Graves’ hyperthyroidism.Methods. EOM volumes were measured with orbital magnetic resonance imaging (MRI) in 39 patients with recently diagnosed Graves’ disease, and compared to EOM volumes of 13 normal volunteers. Thyroid function tests, uptake on thyroid scintigraphy, anti-TSH-receptor antibody positivity and other parameters were then evaluated in patients with EOM enlargement.Results. 31/39 patients had one or more enlarged EOM, of whom only 2 patients had clinical EOM dysfunction. Compared to Graves’ disease patients with normal EOM volumes, those with EOM enlargement had significantly higher mean serum TSH (0.020±0.005versus0.007±0.002mIU/L;Pvalue 0.012), free-T4 (52.9±3.3versus41.2±1.7 pmol/L;Pvalue 0.003) and technetium uptake on thyroid scintigraphy (13.51±1.7%versus8.55±1.6%;Pvalue 0.045). There were no differences between the 2 groups in anti-TSH-receptor antibody positivity, the proportion of males, tobacco smokers, or those with active ophthalmopathy.Conclusions. Patients with recently diagnosed Graves’ disease and EOM volume enlargement have higher serum TSH and more severe hyperthyroidism than patients with normal EOM volumes, with no difference in anti-TSH-receptor antibody positivity between the two groups.

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The prognostic value of TSH receptor binding and thyroid stimulating antibodies following antithyroid drug treatment of Graves' disease

Acta Endocrinologica ◽

10.1530/acta.0.1210666 ◽

1989 ◽

Vol 121 (5) ◽

pp. 666-670 ◽

Cited By ~ 7

Author(s):

R. Wilson ◽

W. D. Fraser ◽

J. H. McKillop ◽

J. A. Thomson

Keyword(s):

Receptor Binding ◽

Antithyroid Drug ◽

Tsh Receptor ◽

Assay Method ◽

Graves Disease ◽

Receptor Antibody ◽

Tsh Receptor Antibody ◽

Thyroid Stimulating Antibodies ◽

Antithyroid Drug Treatment ◽

Antibody Levels

Abstract. Following a course of medical therapy for Graves' disease approximately 50% of patients relapse. Previous studies have tried to identify these patients by measuring antibodies to the TSH receptor using a range of assay methods. Such studies have produced widely discrepant results. The aim of the present study was to compare the accuracy with which TSH receptor binding antibodies and thyroid-stimulating antibodies could identify cases of relapse and remission. Fifty-six newly diagnosed and previously untreated Graves' disease patients were recruited into the study. At presentation 4 were negative for TSH receptor antibody and 5 negative for TS-ab. The remaining 47 were positive for TSH receptor antibody and TS-ab although correlation of the degree of abnormality between methods was poor (r = 0.13 NS). After 12 months carbimazole treatment 28 patients relapsed during the following year and 19 remained in remission. TSH receptor antibody levels obtained at the end of a 12-month course of treatment correctly identified 93% who relapsed and 95% who remained in remission. TS-ab levels could only correctly identify 68% who relapsed and 53% who remained in remission. These results have shown that the accuracy with which patients likely to relapse can be identified depends on the assay method chosen which may account for some of the discrepancies found in previously published studies.

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Sensitive Thyrotropin and Thyrotropin-Receptor Antibody Determinations One Month After Discontinuation of Antithyroid Drug Treatment as Predictors of Relapse in Graves' Disease

Thyroid ◽

10.1089/thy.2005.15.1047 ◽

2005 ◽

Vol 15 (9) ◽

pp. 1047-1054 ◽

Cited By ~ 50

Author(s):

Beate Quadbeck ◽

Rudolf Hoermann ◽

Ulla Roggenbuck ◽

Susanne Hahn ◽

Klaus Mann ◽

...

Keyword(s):

Drug Treatment ◽

Antithyroid Drug ◽

Graves Disease ◽

Thyrotropin Receptor ◽

Receptor Antibody ◽

Thyrotropin Receptor Antibody ◽

Antithyroid Drug Treatment

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Clinical Features and Remission Rate of Pediatric Graves’ Hyperthyroidism Treated With Antithyroid Drug

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1447 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A710-A711

Author(s):

Kyusang You ◽

Goo Lyeon Kim ◽

Jeesuk Yu

Keyword(s):

Children And Adolescents ◽

Clinical Features ◽

Remission Rate ◽

Antithyroid Drug ◽

Tsh Receptor ◽

Receptor Antibody ◽

Tsh Receptor Antibody ◽

Tertiary Center ◽

Significant Difference

Abstract Introduction: Pediatric Graves’ hyperthyroidism needs long-term therapy and there is no specific guideline. Antithyroid medication is used as the first line of treatment, among antithyroid medication, radioiodine therapy, and surgery. The study was designed to investigate the clinical features and remission rate and the factors associated with the remission of Graves’ hyperthyroidism treated with antithyroid drug in children and adolescents. Methods: Initially, 114 children and adolescents who have been managed with thyrotoxicosis in a single tertiary center were included in the study. Retrospective review of medical records was performed on the demographic data, clinical information, and laboratory results. Ten patients with Hashitoxicosis, 36 patients who were followed less than 1 year, and 19 patients with no available initial results of thyroid function test were excluded from the study. We analyzed the clinical features and remission rate between the group with remission and the group without remission. Chi-square, Fisher’s exact test, and t-test were used for statistics. Results: A total of 49 patients were included in the study (M:F 11:38). Mean age at diagnosis was 12.6±3.7 years old and the follow up duration was 4.9±2.5 years. Goiter was visible in 47 patients (96%) and exophthalmos was found in 12 patients (24%). Thirteen patients (27%) showed treatment-related hypothyroidism during follow up. Twenty-seven patients (55%) could discontinue the medication for more than 1 month. Among those, eleven patients showed recurrence and 6 out of 11 patients reached remission again. As a result, 22 patients (45%, male 7) maintained the remission state. Average time till remission was 4.2±2.4 years. Remission rate was 2%, 8%, 12%, 35%, and 45% during the treatment of 1, 2, 3, 4, and 5 years, respectively. Mean follow up duration was significantly longer in the group with remission (5.7±2.2 years), compared with the group without remission (4.3±2.6 years) (p<0.05). There was no significant difference in the presence of goiter or exophthalmos between two groups (goiter 95.5% vs 96.3%; exophthalmos 18% vs. 30%). Incidence rate of hypothyroidism during treatment was also not statistically different between the groups (36% vs. 19%). Age at onset, recent age, initial levels of T3, free T4 or TSH, and the presence of anti-thyroglobulin antibody or anti-thyroid peroxidase antibody were not significantly different between the groups. In contrast, initial levels of TSH receptor antibody was significantly lower in the group with remission (15.6±9.7 IU/L vs. 26.2±14.7 IU/L, p=0.004). Conclusion: This study showed that the remission rate was 45% during the treatment duration of 5 years. Initial titer of TSH receptor antibody was the most important factor associated with the remission in the pediatric Graves’ hyperthyroidism.

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