Endocrinol Metab.  2023 Jun;38(3):338-346. 10.3803/EnM.2023.1664.

The Early Changes in Thyroid-Stimulating Immunoglobulin Bioassay over Anti-Thyroid Drug Treatment Could Predict Prognosis of Graves’ Disease

• Yu J
• Baek HS
• Jeong C
• Jo K
• Lee J
• Ha J
• Kim MH
• Lee J
• Lim DJ

• KMID: 2543320
• DOI: http://doi.org/10.3803/EnM.2023.1664

Abstract

Background
To determine whether baseline thyroid-stimulating immunoglobulin (TSI) bioassay or its early response upon treatment with an anti-thyroid drug (ATD) can predict prognosis of Graves’ disease (GD) in real-world practice.
Methods
This retrospective study enrolled GD patients who had previous ATD treatment with TSI bioassay checked at baseline and at follow-up from April 2010 to November 2019 in one referral hospital. The study population were divided into two groups: patients who experienced relapse or continued ATD (relapse/persistence), and patients who experienced no relapse after ATD discontinuation (remission). The slope and area under the curve at 1st year (AUC_1yr) of thyroid-stimulating hormone receptor antibodies including TSI bioassay and thyrotropin-binding inhibitory immunoglobulin (TBII) were calculated as differences between baseline and second values divided by time duration (year).
Results
Among enrolled 156 study subjects, 74 (47.4%) had relapse/persistence. Baseline TSI bioassay values did not show significant differences between the two groups. However, the relapse/persistence group showed less decremental TSI bioassay in response to ATD than the remission group (–84.7 [TSI slope, –198.2 to 8.2] vs. –120.1 [TSI slope, –204.4 to –45.9], P=0.026), whereas the TBII slope was not significantly different between the two groups. The relapse/persistence group showed higher AUC_1yr of TSI bioassay and TBII in the 1st year during ATD treatment than the remission group (AUC_1yr for TSI bioassay, P=0.0125; AUC_1yr for TBII, P=0.001).
Conclusion
Early changes in TSI bioassay can better predict prognosis of GD than TBII. Measurement of TSI bioassay at beginning and follow-up could help predict GD prognosis.

Keyword

Graves disease; Hyperthyroidism; Immunoglobulins, thyroid-stimulating; Thyrotropin-binding inhibitory immunoglobulin; Recurrence; Antithyroid agents

Figure

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  Fig. 1. Study population enrollment criteria. TSI, thyroid-stimulating immunoglobulin; ATD, anti-thyroid drug.

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  Fig. 2. The area under the curve (AUC) of thyroid-stimulating immunoglobulin (TSI) bioassay or thyrotropin-binding inhibitory immunoglobulin. AUC1yr, area under the curve at 1st year.

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  Fig. 3. Examples of calculation of the area under the curve (AUC) value. TSI, thyroid-stimulating immunoglobulin; AUC1yr, area under the curve at 1st year.

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  Fig. 4. Odds ratio (OR) for the relapse/persistent of Graves’ disease according to slope of thyrotropin-binding inhibitory immunoglobulin (TBII) and thyroid-stimulating immunoglobulin (TSI) bioassay and area under the curve (AUC) of TBII and TSI bioassay. AUC1yr, area under the curve at 1st year.

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