Endocrinol Metab.  2016 Jun;31(2):300-310. 10.3803/EnM.2016.31.2.300.

Usefulness of Measuring Thyroid Stimulating Antibody at the Time of Antithyroid Drug Withdrawal for Predicting Relapse of Graves Disease

• Kwon H
• Kim WG
• Jang EK
• Kim M
• Park S
• Jeon MJ
• Kim TY
• Ryu JS
• Shong YK
• Kim WB

• KMID: 2308861
• DOI: http://doi.org/10.3803/EnM.2016.31.2.300

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.

Keyword

Graves disease; Hyperthyroidism; Immunoglobulins; Prognosis

MeSH Terms

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
Immunoglobulins
Immunoglobulins, Thyroid-Stimulating
Receptors, Thyrotropin
Thyrotropin

Figure

• 

  Fig. 1 Relapse-free survival of Graves disease patients after antithyroid drug withdrawal in the thyroid stimulatory antibody (TSAb) and thyrotropin-binding inhibitory immunoglobulin (TBII) groups. Among 74 patients, there was no significant difference in the relapse-free survival between the TSAb and TBII groups.

• 

  Fig. 2 Relapse-free survival of the patients after antithyroid drug (ATD) withdrawal in the thyroid stimulatory antibody (TSAb) group according to TSAb levels. At ATD withdrawal using a cut-off value of (A) 140%, (B) 130%, (C) 160%, and (D) at 3 months after ATD withdrawal.

• 

  Fig. 3 Relapse-free survival of the patients after antithyroid drug (ATD) withdrawal in the thyrotropin-binding inhibitory immunoglobulin (TBII) group according to TBII levels. At ATD withdrawal using a cut-off value of (A) 1.5, (B) 1.0, (C) 2.0, and (D) at 3 months after ATD withdrawal.

• 

  Fig. 4 Distribution of thyroid stimulatory antibody (TSAb) titers in patients with remission and Graves disease relapse. The medians of the TSAb titers were 61.1% and 203.5% in patients with remission and relapse, respectively (dotted lines).

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