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 TSH-receptor 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 > or = 35 years of age). L-thyroxine (L-T4) 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 Anti-thyroid drugs were withdrawn after 18 months of therapy.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 (n=48) and surgery (n=47) 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 (n=36) 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.

• Authors: Peter Laurberg, Göran Wallin, Leif Tallstedt, Mirna Abraham-Nordling, Göran Lundell, Ove Tørring
• Journal: European journal of endocrinology (Eur J Endocrinol) Vol. 158 Issue 1 Pg. 69-75 (Jan 2008) ISSN: 1479-683X [Electronic] England
• PMID: 18166819 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antithyroid Agents
• Autoantibodies
• Immunoglobulins, Thyroid-Stimulating
• Iodine Radioisotopes
• Receptors, Thyrotropin
• thyrotropin-binding inhibitory immunoglobulin
• Triiodothyronine
• Thyroxine

Topics

• Adult
• Antithyroid Agents (therapeutic use)
• Autoantibodies (blood, immunology)
• Autoimmunity (immunology)
• Graves Disease (blood, immunology, therapy)
• Humans
• Immunoglobulins, Thyroid-Stimulating
• Iodine Radioisotopes (therapeutic use)
• Middle Aged
• Prospective Studies
• Receptors, Thyrotropin (immunology)
• Thyroidectomy (methods)
• Thyroxine (blood, metabolism)
• Time Factors
• Treatment Outcome
• Triiodothyronine (blood)