Usefulness of Measuring Thyroid Stimulating Antibody at the Time of Antithyroid Drug Withdrawal for Predicting Relapse of Graves Disease.
10.3803/EnM.2016.31.2.300
- Author:
Hyemi KWON
1
;
Won Gu KIM
;
Eun Kyung JANG
;
Mijin KIM
;
Suyeon PARK
;
Min Ji JEON
;
Tae Yong KIM
;
Jin Sook RYU
;
Young Kee SHONG
;
Won Bae KIM
Author Information
1. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. wongukim@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Graves disease;
Hyperthyroidism;
Immunoglobulins;
Prognosis
- MeSH:
Follow-Up Studies;
Graves Disease*;
Humans;
Hyperthyroidism;
Immunoglobulins;
Immunoglobulins, Thyroid-Stimulating*;
Prognosis;
Receptors, Thyrotropin;
Recurrence*;
Retrospective Studies;
Sensitivity and Specificity;
Thyroid Function Tests;
Thyroid Gland*;
Thyrotropin
- From:Endocrinology and Metabolism
2016;31(2):300-310
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Hyperthyroidism relapse in Graves disease after antithyroid drug (ATD) withdrawal is common; however, measuring the thyrotropin receptor antibody (TRAb) at ATD withdrawal in order to predict outcomes is controversial. This study compared measurement of thyroid stimulatory antibody (TSAb) and thyrotropin-binding inhibitory immunoglobulin (TBII) at ATD withdrawal to predict relapse. METHODS: This retrospective study enrolled patients with Graves disease who were treated with ATDs and whose serum thyroid-stimulating hormone levels were normal after receiving low-dose ATDs. ATD therapy was stopped irrespective of TRAb positivity after an additional 6 months of receiving the minimum dose of ATD therapy. Patients were followed using thyroid function tests and TSAb (TSAb group; n=35) or TBII (TBII group; n=39) every 3 to 6 months for 2 years after ATD withdrawal. RESULTS: Twenty-eight patients (38%) relapsed for a median follow-up of 21 months, and there were no differences in baseline clinical characteristics between groups. In the TSAb group, relapse was more common in patients with positive TSAb at ATD withdrawal (67%) than patients with negative TSAb (17%; P=0.007). Relapse-free survival was shorter in TSAb-positive patients. In the TBII group, there were no differences in the relapse rate and relapse-free survivals according to TBII positivity. For predicting Graves disease relapse, the sensitivity and specificity of TSAb were 63% and 83%, respectively, whereas those of TBII were 28% and 65%. CONCLUSION: TSAb at ATD withdrawal can predict the relapse of Graves hyperthyroidism, but TBII cannot. Measuring TSAb at ATD withdrawal can assist with clinical decisions making for patients with Graves disease.
