Clinical course and thyroid stimulating hormone (TSH) receptor antibodies during surgical treatment of Graves' disease

Abstract

This study assessed the results of surgical treatment for Graves' disease in our hospital and examined the relationship between the values of thyroid stimulating hormone (TSH) receptor antibodies and postoperative thyroid function. From 1983 to 1988, subtotal thyroidectomy was performed in 313 patients with Graves' disease. The follow-up rate was 89.1% (278 of 313 patients). Thirteen (4.2%) patients required methimazole postoperatively for hyperthyroidism and 23 (7.3%) patients required L-thyroxine postoperatively for hypothyroidism. The relationship between the postoperative thyroid function and TSH receptor antibodies was examined. The pre-operative thyrotropin binding inhibitory immunoglobulin (TBII) value had no relationship to postoperative thyroid function. Only in the patients who were hyperthyroid postoperatively did the TBII value remain elevated, but the value decreased gradually in patients who were not hyperthyroid postoperatively. In 43 of 94 patients whose pre-operative TBII values were high, the postoperative TBII value normalized. The higher the preoperative TBII value, the longer time was required for it to normalize postoperatively. The postoperative thyroid stimulating antibody (TSAb) values were higher in patients who remained hyperthyroid than in the patients who were not hyperthyroid. In the patients who remained hyperthyroid postoperatively, there was a significant correlation between the postoperative TBII value and the TSAB value. In the patients who were hypothyroid postoperatively, the TSBAb values were negative. In patients undergoing surgical treatment of Graves' disease, the postoperative TBII and TSAb values were related to postoperative hyperthyroidism. The TSBAb value had no relationship to postoperative hypothyroidism.

Changes in Serum TSH Receptor Antibody (TRAb) Values in Patients with Graves' Disease after Total or Subtotal Thyroidectomy

“…Although the changes in the TRAb value after surgery vary among several investigators [17][18][19][20][21]26], several years are required for normalization of the TRAb value. Mori et al reported that the normalization rates of TRAb were 34.5% at 1 year and 49.4% at 3 years after ST for Graves' disease (n = 87) [4]. We showed that the normalization rates after ST were 41.1% at 1 year and 42.4% at 3 years, which are not discrepant to those previous studies.…”

“…Although some reports have noted that the preoperative TRAb value could not predict the long-term outcome of surgically treated patients with Graves' disease [15,16,35,36], Sugino et al demonstrated that the preoperative TRAb value was related to the early recurrence of hyperthyroidism [15], and Mori et al reported that the higher the preoperative TRAb value, the longer the time required for it to normalize postoperatively [4]. In our study, the TRAb value decreased more rapidly in the TT group than the ST group (data not shown).…”

“…Changes in the serum TRAb value may represent the degree of hyperthyroidism. The continuation of a high (elevated) TRAb value or an increased TRAb value after surgery may cause hyperthyroidism recurrence [3,4]. In addition, previous studies demonstrated that a high TRAb value is linked to endocrine opthalmopathy [5,6], or risk for intrauterine death, and fetal or neonatal hyperthyroidism in pregnant women with Graves' disease [7][8][9][10][11][12].…”

“…ST is usually chosen for Graves' disease therapy, but 5-15% of patients have recurrent thyrotoxicosis after surgery [1], which is more likely to occur in patients with high serum TRAb values before surgery [15] and severe eye involvement [5]; such patients should therefore undergo TT rather than ST [1]. Although the surgical outcomes and their relation to serum TRAb values have been demonstrated by several authors [3,4,[14][15][16][17][18][19][20][21][22][23][24], there have been only a few reports concerning the surgical outcome of TT for Graves' disease [5,[25][26][27]. In addition, the changes in the TRAb value after TT over a long period of time have never been studied.…”

Total Thyroidectomy in Treatment of Graves' Ophthalmopathy

“…It is a well-known fact than a postoperative increase of the antibody titter is an unfavorable prognostic sign of recurrent hyperthyroidism. Such an increase may be dictated by leaving remnants of immunogenically active glandular tissue, which again becomes an inducer and at the same time an effector of the autoimmune process, both for the thyroid tissue (recurrent goiter) and for the orbital tissues (increased exophthalmus) (28,29).…”