Age‐Related Changes of Thyroid Function and Immunologic Abnormalities in Patients with Hyperthyroidism Due to Graves' Disease

Aizawa, T; Ishihara, Masaki; Hashizume, Kiyoshi; Takasu, Nobuyuki; Yamada, Takashi

doi:10.1111/j.1532-5415.1989.tb07279.x

Cited by 32 publications

(23 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As known, the prevalence of Graves' patients is associated to gender, and, in accordance with this view, our subjects were predominant female (85.6% females, 24.4% males). Nevertheless, differently with previous reports [24,25], any correlation between gender and relapse(s) was detected (p = 0.973). In a subgroup of women affected by GD, and after pregnancy, age resulted associated to relapse [26]; again, our data didn't show any correlation between age and this risk; probably it may due to different selection of patients.…”

Section: Discussioncontrasting

confidence: 99%

Prognostic Value of Thyrotropin Receptor Antibodies (TRAb) in Graves' Disease: A 120 Months Prospective Study

et al. 2007

View full text Add to dashboard Cite

Abstract. In most trials, at least 30-60% of patients with Graves' disease treated with antithyroid drugs relapse within 2 years after therapy withdrawal. At present, there are no prognostic parameters available early in treatment to indicate patients likely to achieve long-term remission. Because thyrotropin receptor autoantibodies (TRAb) are specific for Graves' disease, we evaluated the ability of their levels and of their rate of change to predict long-term prognosis. In our study 216 consecutive patients with newly diagnosed Graves' disease started a therapy with methimazole. Patients were treated until they achieved euthyroidism and TRAb were measured at 6-month intervals throughout a follow up of 120 months. Our study demonstrated that at the onset of hyperthyroidism patients' age, sex, fT4 levels and goiter size had no prognostic value in predicting long-term prognosis (respectively p = 0.79; p = 0.98; p = 0.83; p = 0.89). On the contrary, at the time of diagnosis TRAb titer was a good predictor of the final outcome (p<0.001); a titer equal to (or) more than 46.5 UI/L could identify patients who had never achieved long-term remission with a sensitivity of 52% and a specificity of 78%. Also fall rate of TRAb at 6 months of follow up and after therapy withdrawal were useful to predict the final outcome (p<0.001). At 6 months of follow up the time of therapy withdrawal, a decrease of TRAb lower than 52.3% or even its increase could identify patients who had never achieved permanent remission with a sensitivity of 55% and a specificity of 79.1%. No single parameter among TRAb, satisfactory identified a sub-set of patients who achieved long remission. Accordingly to our data, the best result in predicting long term remission is probably given by the presence of at least one of the two features evaluated at 6 months (TRAb titer and/or percentage of TRAb fall rate), with a sensitivity of 63% and specificity of 88%. TRAb titers evaluated both at the onset of hyperthyroidism that at 6 months of therapy or their rate of fall at 6 months and at ATD withdrawal are predictors of outcome. However, the presence of at least one, between titers of TRAb or their rate of fall at six months, resulted to be the best predictor of remission with the higher sensitivity and specificity.

show abstract

Section: Discussioncontrasting

confidence: 99%

Prognostic Value of Thyrotropin Receptor Antibodies (TRAb) in Graves' Disease: A 120 Months Prospective Study

et al. 2007

View full text Add to dashboard Cite

show abstract

“…FreeT 3 -index and freeT 4 -index are lower in the older age groups, as reported previously in several studies (7,9,19). Serum TBII also decreased with advancing age, again in agreement with the literature (7).…”

Section: Discussionsupporting

confidence: 92%

“…Age has consistently been observed as a significant modulating factor, advancing age being associated with less severe Graves' hyperthyroidism (7)(8)(9). The mechanism behind less severe Graves' hyperthyroidism in the older age groups is incompletely understood.…”

Section: Introductionmentioning

confidence: 99%

Age and stress as determinants of the severity of hyperthyroidism caused by Graves' disease in newly diagnosed patients

Vos

Smit

Endert

et al. 2009

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: The evidence that stress may provoke Graves' hyperthyroidism in genetically susceptible subjects is substantial. Whether exposure to stress is related to the severity of thyrotoxicosis has not been studied. Advancing age is associated with not only less severe Graves' hyperthyroidism but also self-reported stress. We tested the hypothesis whether advancing age is associated with less exposure to stress, resulting in a lower immunological response, and less severe Graves' hyperthyroidism. Design: Cross-sectional multicenter study. Patients: Two hundred and sixty-three consecutive untreated patients with a first episode of Graves' hyperthyroidism were included. The severity of Graves' hyperthyroidism was evaluated biochemically (freeT 4 -index and freeT 3 -index, thyrotropin-binding inhibitory immunoglobulin (TBII)) and clinically by the hyperthyroid symptom scale score (HSS score). Stress exposure was quantitated by three questionnaires. Results: Advancing age was associated with less severe Graves' hyperthyroidism, both biochemically by lower serum freeT 3 -index and freeT 4 -index (P!0.01), lower serum TBII (PZ0.05), and clinically by lower HSS scores (PZ0.04) and smaller goiter size (P!0.01). FreeT 3 -index and freeT 4 -index were directly associated with HSS scores (P!0.01). Stress scores were associated with HSS scores (P!0.01) but not with biochemical severity of Graves' hyperthyroidism. Advancing age was associated with lower scores for stress exposure. Multivariate regression analysis showed that HSS score was independently related to the tendency to report negative feelings (P!0.01) but not to other stress scores and also not to age. Conclusion: Advancing age is associated with less exposure to stress, lower serum TBII and less severe clinical and biochemical Graves' hyperthyroidism. Because no direct relationship exists between stress exposure and TBII or freeT 3 -index and freeT 4 -index, we reject our hypothesis that less stress is causally related to biochemically less severe Graves' hyperthyroidism in old age. HSS score is primarily determined by negative feelings and not by age.

show abstract

“…Thus, determinants for levels of serum T 3 and T 4 have not been studied in detail even if previous studies reported on various details such as influence of age (2,3), sex (3), iodine intake (4), and TSH receptor antibody (TRAb) concentration (5,6). Limited patient characteristics were included in most of these studies, and often they did not take various possible confounders into account, such as smoking, known to aggravate iodine deficiency (7) and to modulate thyroid autoimmunity (8), alcohol intake that besides from influencing the risk of Graves' disease (GD) (9) also may supply flavonoids known to modulate the selenodeiodinase activity (10), intake of vitamin supplements often containing iodine, and co-morbidity.…”

Section: Introductionmentioning

confidence: 99%

Determinants of serum T4 and T3 at the time of diagnosis in nosological types of thyrotoxicosis: a population-based study

Carlé

Knudsen

Pedersen

et al. 2013

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

Age‐Related Changes of Thyroid Function and Immunologic Abnormalities in Patients with Hyperthyroidism Due to Graves' Disease

Cited by 32 publications

References 18 publications

Prognostic Value of Thyrotropin Receptor Antibodies (TRAb) in Graves' Disease: A 120 Months Prospective Study

Prognostic Value of Thyrotropin Receptor Antibodies (TRAb) in Graves' Disease: A 120 Months Prospective Study

Age and stress as determinants of the severity of hyperthyroidism caused by Graves' disease in newly diagnosed patients

Determinants of serum T4 and T3 at the time of diagnosis in nosological types of thyrotoxicosis: a population-based study

Contact Info

Product

Resources

About