Changes in Thyroid Peroxidase and Thyroglobulin Antibodies Might Be Associated with Graves' Disease Relapse after Antithyroid Drug Therapy

Abstract

BackgroundGraves' disease (GD) is an autoimmune thyroid disorder caused by antibodies stimulating the thyrotropin (TSH) receptor. TSH receptor antibody (TRAb) measurement is useful for predicting GD relapse after antithyroid drug (ATD) treatment. However, the association of other thyroid autoantibodies with GD relapse remains obscure.MethodsThis retrospective study enrolled patients with GD who were initially treated with ATD. TRAb, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were measured at the initial diagnosis and at the time of ATD discontinuation.ResultsA total of 55 patients were enrolled. The mean age was 49.7 years, and 39 patients (70.9%) were female. Antibody positivity at diagnosis was 90.9%, 69.1%, and 61.9% for TRAb, TPOAb, TgAb, respectively. Median ATD treatment period was 15.1 months. At the time of ATD withdrawal, TRAb titers decreased uniformly overall. Conversely, TPOAb and TgAb showed various changes. After withdrawal of ATD, 19 patients (34.5%) experienced relapse. No clinical features or laboratory results were significantly related to relapse in the overall patient group. However, in the TPOAb positive group at diagnosis, increasing titer of TPOAb or TgAb after ATD treatment was significantly and independently related to relapse free survival (TPOAb: hazard ratio [HR], 17.99; 95% confidence interval [CI], 1.66 to 195.43; P=0.02) (TgAb: HR, 5.73; 95% CI, 1.21 to 27.26; P=0.03).ConclusionChanges in TPOAb or TgAb titers during treatment might be useful for predicting relapse after ATD treatment in patients with positive TPOAb at diagnosis.

Usefulness of Real-Time Quantitative Microvascular Ultrasonography for Differentiation of Graves’ Disease from Destructive Thyroiditis in Thyrotoxic Patients

“…The close correlation between the MVUS-VI and TSH-R-Ab has important clinical implication for managing false negative results in case that the VI was low despite of GD. Because TSH-R-Abs mirror severity of GD [ 29 , 30 ], low VI could imply the severity of the disease is relative low so the beginning of ATD is not so urgent.…”

Differential Diagnosis of Thyrotoxicosis by Machine Learning Models with Laboratory Findings

“…This study suggests that TgAb is useful in autoimmune thyroid disease, which is consistent with the thoughts of previous researchers [ 32 ]. However, these antibodies are also increased in Grave’s disease, so they are not specific to painless thyroiditis [ 33 ]. In addition, the sensitivity and specificity of differential diagnoses can vary depending on case series, and clinicians need to pay attention to their interpretation.…”

Programmed Cell Death-Ligand 1 (PD-L1) gene Single Nucleotide Polymorphism in Graves’ Disease and Hashimoto’s Thyroiditis in Korean Patients

“…Positivity for anti-TPO and Tg autoantibodies was frequently observed in patients with GD during antigen spreading, even though a definitive patho-mechanism was not established [ 26 ]. One small study showed an increased anti-TPO titer was associated with relapse among GD patients with anti-TPO positivity at the time of diagnosis [ 27 ]. In a Japanese study, A/C SNP in the PD-L1 gene intron 4 position 8923 was related to difficulty in achieving remission of GD [ 14 ].…”