Long-Term Antithyroid Drug Treatment: Trends in Serum TSH and TSH Receptor Antibody Changes in Patients with Graves’ Disease
| Author | Ken Okamura | en |
| Author | Sachiko Bandai | en |
| Author | Megumi Fujikawa | en |
| Author | Kaori Sato | en |
| Author | Hiroshi Ikenoue | en |
| Author | Takanari Kitazono | en |
| Orcid | Ken Okamura [0000-0003-3869-6800] | en |
| Orcid | Sachiko Bandai [0000-0001-6354-6359] | en |
| Orcid | Megumi Fujikawa [0000-0002-9911-0263] | en |
| Orcid | Kaori Sato [0000-0001-5216-5817] | en |
| Orcid | Hiroshi Ikenoue [0000-0002-2301-6019] | en |
| Orcid | Takanari Kitazono [0000-0002-9006-5937] | en |
| Issued Date | 2020-06-30 | en |
| Abstract | Objectives: Trends in serum thyroid-stimulating hormone (TSH) and TSH receptor antibody (TRAb) changes during antithyroid drug treatment, and long-term prognosis were evaluated in Graves’ hyperthyroidism (GD). Methods: In 609 GD patients initially treated with 15 mg of methyl-mercapto imidazole (MMI), the changes in serum TRAb and long-term prognosis were compared in the TSH-normalized group (A) and the TSH-suppressed group (B and C) during the initial 180 days of treatment. Results: Early responses to MMI during 180 days of treatment were as follows: 48 cases (7.9%) became hypothyroid with elevated TSH (A1), and 188 cases (30.9%) became euthyroid with normal TSH (A2). Among patients with continuously suppressed TSH, the free T4 (fT4) level was low in 31 cases (5.1%) (B1-inappropriately suppressed TSH), fT4 and fT3 were normal in 185 cases (30.4%) (B2), fT4 was normal, but fT3 remained high in 84 cases (13.8%) (B3), and fT4 remained high in 73 cases (12.0%) (C-refractory). Serum TRAb became negative after < 5 years then remained negative in 25% - 51% of the cases (smooth type), became negative after < 5 years then became positive again in 30% - 43% of the cases (fluctuating type), and remained positive after > 5 years in 10% - 42% of the cases (smoldering type). In total, remission occurred after 6.2 (3.0 - 10.4) years of treatment in 42%, possible remission on a small maintenance dosage of antithyroid drug occurred in 13%, and spontaneous hypothyroidism occurred in 4.4% of the cases. The smoldering type was more frequent in the B1 and C groups than in others, and remission was less frequent. The difference in the long-term prognosis depending on the early response to MMI disappeared after excluding the ablated patients. Without ablation, remission or spontaneous hypothyroidism could be expected in 60% - 75% of patients after tenacious treatment for > 10 years. Conclusions: Prolonged suppression of serum TSH may suggest active TRAb activity during treatment, and continuous TRAb positivity for more than 5 years suggests persistent GD activity. | en |
| DOI | https://doi.org/10.5812/ijem.101139 | en |
| URI | https://brieflands.com/journals/ijem/articles/101139 | en |
| Keyword | Hyperthyroidism | en |
| Keyword | Antithyroid Drug | en |
| Keyword | Graves’ Disease | en |
| Keyword | Thyroid | en |
| Keyword | TSH Receptor Antibody | en |
| Publisher | Brieflands | en |
| Title | Long-Term Antithyroid Drug Treatment: Trends in Serum TSH and TSH Receptor Antibody Changes in Patients with Graves’ Disease | en |
| Type | Research Article | en |
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