TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study

Abstract

Introduction: Autoimmunity against the TSH receptor is a key pathogenic element in Graves' disease. The autoimmune aberration may be modified by therapy of the hyperthyroidism. Objective: To compare the effects of the common types of therapy for Graves' hyperthyroidism on TSHreceptor autoimmunity. Methods: Patients with newly diagnosed Graves' hyperthyroidism aged 20-55 years were randomized to medical therapy, thyroid surgery, or radioiodine therapy (radioiodine was only given to patients R35 years of age). L-thyroxine (L-T 4 ) was added to therapy as appropriate to keep patients euthyroid. Anti-thyroid drugs were withdrawn after 18 months of therapy. TSH-receptor antibodies (TRAb) in serum were measured before and for 5 years after the initiation of therapy. Results: Medical therapy (nZ48) and surgery (nZ47) were followed by a gradual decrease in TRAb in serum, with the disappearance of TRAb in 70-80% of the patients after 18 months. Radioiodine therapy (nZ36) led to a 1-year long worsening of autoimmunity against the TSH receptor, and the number of patients entering remission of TSH-receptor autoimmunity with the disappearance of TRAb from serum during the following years was considerably lower than with the other types of therapy. Conclusion: The majority of patients with Graves' disease gradually enter remission of TSH-receptor autoimmunity during medical or after surgical therapy, with no difference between the types of therapy. Remission of TSH-receptor autoimmunity after radioiodine therapy is less common.

Does thyroid surgery for Graves’ disease improve health-related quality of life?

“…None of the patients took long-term calcium replacement therapy (after 6 months); in all patients there was a gradual decrease in serum TRAb levels and no significant differences between the pre and postoperative PTH values, which were normal (Table 4). However, it should n total number of patients Surg Today be borne in mind that the general consensus in the literature is that normalization of the autoimmune abnormality comes much later, after at least 18 months [20,21]. One patient (2 %) in our study had transient unilateral vocal cord palsy detected by the fiberoptic laryngoscope, but without evident impairment of the voice.…”

The relationship between circulating estradiol and thyroid autoimmunity in males

“…Thyroid autoimmunity as measured by thyroid autoantibodies usually decreases with anti-thyroid drug treatment or thyroid surgery (10,11), suggesting an intrathyroidal origin of thyroid autoimmunity. However, a number of patients do not demonstrate decreases in thyroid autoantibodies after medical or surgical treatment, indicating extra-thyroidal influence in thyroid autoimmunity.…”

Clinical features of thyroid-associated ophthalmopathy in clinically euthyroid Korean patients

“…TRAb levels could be affected by environmental factors such as peripheral thyroid function. [20][21][22] In addition, TRAb was reported to decrease over time after the occurrence of TAO. There are several studies reporting variations of TRAb over time, 16,23 and one of them showed that TBII levels were markedly decreased over time regardless of a mild or severe course of GO.…”