Latent Hypothyroidism Research Articles

Hypothyroidism After Using Superior Thyroid Artery as A Recipient Artery.

Superior thyroid artery (SThA) is a common recipient artery in free tissue transfer even after total pharyngolaryngoesophagectomy (TPLE) with hemithyroidectomy. The aim of this study was to evaluate whether the use of SThA as a recipient vessel affect thyroid function in patients undergoing TPLE with hemithyroidectomy. From 2011 to 2020, 91 patients who underwent free jejunum transfer after TPLE with hemithyroidectomy were divided into two groups. In Group1 (n=47), the contralateral SThA was used for the anastomosis. In Group2 (n=44), other vessels were used. Retrospective chart review was performed comparing postoperative thyroid function between two groups. In group1, 17 patients presented hypothyroidism, 21 presented latent hypothyroidism and 9 presented no thyroid dysfunction comparing 15, 19, and 10 respectively in group 2. There were no significant differences between the two groups. Even after hemithyroidectomy, with inferior thyroid arteries are preserved, the SThA can be used as a recipient vessel. 3 Laryngoscope, 133:557-561, 2023.

Клініко-лабораторні особливості застосування замісної тиреоїдної терапії в пацієнтів похилого віку

Клінічний і субклінічний гіпотиреоз — один з найпоширеніших станів у практиці лікаря-ендокринолога після цукрового діабету 2-го типу. Частка пацієнтів, у яких латентний (субклінічний) гіпотиреоз переходить у клінічний, щороку становить до 5 %. Попри відносно виражену симптоматику діагностика гіпотиреозу, особливо в людей похилого віку, становить певні труднощі. Це обумовлено переважанням у цій категорії хворих симптомів із боку певної системи. Розпочинати терапію в таких людей слід із мінімальних доз препаратів тиреоїдних гормонів, а титрування дози необхідно проводити поступово й повільно, з постійним контролем як тиреоїдного гормонального статусу, так і кардіальних показників.

Behavioural and morphological changes in rats with lead poisoning aggravated by medicinal hypothyroidism

Relevance. Metals are transported by run-off from human settlements and industrial plants and accumulate in the sediments of water bodies. Lead is found in high concentrations in the soil of agricultural land. Lead can be transported with water, seafood, animal products and plants to humans. Poisoning may occur in workers and in the population in contact with lead. At the same time, hypothyroidism is a widespread disease, often due to living in areas of endemic iodine deficiency in water and soil. Latent hypothyroidism can aggravate occupational effects of heavy metals in exposed workers.Intention. To study behavioural and morphological changes in rats with lead poisoning aggravated by medicinal hypothyroidism. Methodology. 32 albino outbred adult male rats were studied. Lead poisoning was induced by lead acetate at a dose of 60 mg/kg body weight in drinking water tanks for 30 days. Hypothyroidism in rats was induced from the ninth day of the experiment with daily injections of thyrozol (thyroid static substance) at a dose of 30 mg/kg for 21 days. Behavioral responses in rats were studied using open field tests, and survey records were processed using Real Timer. For morphological analysis, layered serial cuts of brain tissue were prepared and painted using the Nissl method, and slides were visualized via observation microscopy.Results and Discussion. Under lead poisoning, animals demonstrated decreased locomotor and exploration activity and increased anxiety with increasing intoxication combined with hypothyroidism. Changes in the rat brain after exposure to lead were confirmed histologically: increased neuron degeneration, neuronophagia and glyosis. New histological data were obtained in case of lead-thyrozol combination: increased neuronal death, decreased number of astroglial cells compared to animals exposed to lead only. This suggests predominant irreversible neurodegeneration due to combined effects of lead poisoning and thyroidstatic exposure.Conclusion. Under combined exposure to lead and tyrozol, the thyroidstatic substance exacerbated decline in locomotor and exploration activity as well as lead-associated neurodegenerative processes in the rat brain.

Levels of thyroid-stimulating and thyroid hormones in pregnant women with obesity and their newborns

Aim: To study the level of thyroid-stimulating and thyroid hormones in pregnant women with obesity and their newborns.Materials and Methods. We consecutively recruited 40 pregnant women and their newborns. Blood sampling in pregnant women was carried out at the end of the third trimester 12 hours after the last meal while in newborns it was conducted immediately after birth. Measurement of serum thyroid-stimulating hormone, thyroxine, triiodothyronine, and free thyroxine was performed using chemiluminescent immunoassay.Results. Thyroid disease was significantly more common in pregnant women with obesity. Clinical and latent hypothyroidism in obese pregnant women was observed 1.5-fold more frequently as compared with those having normal body weight. In keeping with these findings, goiter and elevated thyroxine were also more common in obese pregnant women. Newborns from obese women were more often characterized by a transient hypothyroidism in combination with an augmented thyroid-stimulating hormone.Conclusion. Levels of thyroid-stimulating and thyroid hormones in obese pregnant women and their newborns significantly differ from the patients with normal body weight.

VARIANTS OF THYROID GLAND PATHOLOGY IN CHRONIC HEPATITIS C PATIENTS

Introduction. HCV is the cause not only of cirrhosis, hepatocellular carcinoma, but also extrahepatic manifestations. Currently, HCV is considered as an independent risk factor for thyroid pathology. In recent years, the level of pathology of the thyroid gland in the Altai Territory has increased by 16.4 times, which determined the purpose of this study: to study the features of the thyroid status in patients with chronic hepatitis C (CHC) in the Altai Territory. Materials and methods. There was executed a prospective, dynamic clinical, laboratory and instrumental examination of 240 CHC patients (47,5% of men and 52,5% of women aged of from 18 to 50 years), 120 of whom had HCV (49,1% of men and 50,9% of women, aged of from 18 to 50 years, mean age: 41,1±9,91 years) who did not receive antiviral therapy (HTV), the pathology of the thyroid gland in them was established for the first time. The study included the assessment of the level of TSH, total and free T3, T4, antibodies to thyreperoxidase (APPO), ultrasound examination of the thyroid gland. The diagnosis of CHC is based on HCV RNA, anti-HCV (core, NS3-5), blood biochemistry, fibrosis level score according to Metavir (elastometry, PBP). Results of the study. In HCV patients there were revealed autoimmune thyroiditis (AIT) (5%), AIT with hypothyroidism (10%), AIT with latent hypothyroidism (8,3%), latent hypothyroidism (10%), hypothyroidism (16,6%), euthyroidism (49,1%) and thyrotoxicosis in only 1 patient. Variants of thyroid dysfunction were presented in the form of euthyroidism (60%), hypothyroidism (20%), hyperthyroidism (10%) and autoimmune thyroiditis (10%). The relationship between the development of the thyroid dysfunction (TD) and the history of the history of HCV infection has been established. Discussion and conclusions. CHC patients were more likely to have a history of euthyroidism and hypothyroidism. The relationship between TD and the duration of HCV infection can be regarded as its extrahepatic manifestation, and not as comorbid conditions. Thorough examination of the thyroid status it makes possible to identify TD people, which can be reflected in the choice of antiviral therapy and will determine the prognosis of the development of side effects.

Latent Hypothyroidism in Adults.

The prevalence of latent/subclinical hypothyroidism is between 3% and 10%, according to epidemiologic studies that have been carried out in the USA, the United Kingdom, and Denmark. As persons with latent hypo - thyroidism are often asymptomatic, the diagnosis is often made incidentally in routine laboratory testing. This review is based on a selective search in PubMed for publications on the diagnosis and treatment of latent hypothyroidism. All pertinent articles and guidelines published from 1 January 2000 to 31 July 2016 were included. The diagnosis of latent hypothyroidism is generally assigned after repeated measurement of a TSH concentration above 4.0 mU/L in a person whose fT4 concentration is in the normal range. The most common cause is autoimmune thyroiditis, which can be detected by a test for autoantibodies. L-thyroxin supplementation is a controversial matter: its purpose is to prevent the development of overt hypothyroidism, but there is a danger of overtreatment, which increases the risk of fracture. To date, no benefit of L-thyroxin supplementation has been demonstrated with respect to morbidity and mortality, health-related quality of life, mental health, cognitive function, or reduction of overweight. There is, however, evidence of a beneficial effect on cardiac function in women, and on the vascular system. At present, treatment is generally considered indicated only if the TSH level exceeds 10.0 mU/L. Limited data are available on the relevant clinical endpoints and undesired side effects of supplementation therapy. Physicians should advise patients about the indications for such treatment on an individual basis after due consideration of the risks and benefits.

Thyroidal response following iodine excess for cardiac catheterisation and intervention in early infancy

BackgroundCardiac catheterisation requiring the use of contrast medium is increasingly utilised in infants with congenital heart disease. Thyroid function in infants is potentially vulnerable to relatively high doses of iodine. MethodsSingle-centre prospective study of 21 patients (10 neonates, 11 infants) exposed to iodine during cardiac catheterisation. Median age was 30days (1–180), median body weight 3.3kg (1.6–7.0). Serum-levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4) were measured at baseline before, and at three different times points after intervention. ResultsBaseline thyroidal levels were within normal range in all patients. After applying contrast media of median 6.8ml/kg (range 4.5–14.9), we observed a wide range of TSH values: median 5.01μg/l (range 0.59–37.73; reference 0.72–11.0) three to five days after catheterisation. Five of the 10 neonates demonstrated transient TSH elevation consistent with latent hypothyroidism, and a sixth a transient drop in all hormone levels typical of non-thyroidal illness syndrome. However, circulating thyroid hormones remained within normal range, except for two borderline-low fT4 values within the first week after catheterisation that normalised without any medical intervention. ConclusionSystemic iodine exposure during cardiac catherterisation seems to be clinically well tolerated in early infancy. However, exposure to iodine has demonstrable but apparently reversible effects on thyroid hormones during a potentially important developmental period. The implications of this are unclear, but warrant further investigation in larger cohorts.

Level of certain serum hormones in experimental liver metastasis

Studying tumor and metastasis biology is an important challenge of both biology and medicine, since only an experiment may reveal fine mechanisms of pathogenesis. We analyzed the dynamics of serum hormones in a model of rat liver metastates designed by our group, which excluded toxic carcinogen effects, sharp surgical influence and narcosis. The results showed that liver metastases were associated with the following: 1) hyperthyroidism developing at early stages of metastatic process was replaced by latent hypothyroidism after 5 weeks of the carcinogenesis as a result of autoimmune thyroiditis; 2) the increase of progesterone, LG and prolactin levels after 5 weeks of tumor metastasis in liver after the 2 weeks ’ initial decrease; 3) sexual hormones metabolism activation: after a week - increase offree testosterone level, after 2 weeks -rise of estrone and total testosterone and the decrease of estrogen levels after 5 weeks of carcinogenesis; 4) adrenal gland activation leading to the enhancement of serum stress hormone corticosterone and its antagonist DHEA.

PRIMARY-MULTIPLE TUMORS IN PATIENTS WITH NEOPLASMS OF THYROID GLAND

The authors studied the long-term results of surgical treatment of 949 patients with thyroid carcinoma. The malignant tumors of other organs were revealed in 55 (5,8%) cases during 20 years of follow-up. It was stated that patients with thyroid carcinoma had a higher risk of developing other malignant tumors than in population. A typical background for onset of other neoplasms was a latent hypothyroidism, hyperlipidemia, hypersecretion of gonadotropins, an influence of occupational hazard of chemical nature and hereditary load of oncology.

Fatigue in male lymphoma survivors differs between diagnostic groups and is associated with latent hypothyroidism

Background. Few studies have explored fatigue in different groups of lymphoma survivors and the association with hormonal dysfunctions. The aims were to analyze associations between fatigue and thyroid and gonadal function in male lymphoma survivors. In addition, the impact of chronic fatigue on work situation and daily functioning were explored.Patients and methods. This cross-sectional study included male lymphoma survivors diagnosed in 1980–2002, aged ≤ 50 years at diagnosis and > 18 years at survey in 2007. The participants (n = 233, median age at survey: 48 years, median observation time: 15 years) completed questionnaires assessing levels of fatigue, chronic fatigue (duration ≥ 6 months), mental distress, daily functioning and work situation. Levels of thyroid and gonadal hormones were assessed. The participants were grouped according to diagnosis: Hodgkin lymphoma (HL, n = 131), aggressive/very aggressive non-Hodgkin lymphoma (NHL) (n = 67) and indolent NHL (n = 35). Thyroid hormones were categorized as normal (n = 174) or latent hypothyroidism (elevated thyroid stimulating hormone, n = 59). Gonadal hormones were categorized as normal (n = 111), elevated follicle stimulating hormone only (n = 45), primary (n = 35) or secondary hypogonadism (n = 42). Uni- and multivariate regression analyses were performed. A p value < 0.05 indicated the level of significance.Results. The survivors of HL and aggressive/very aggressive NHL had similar fatigue levels and similar prevalence of chronic fatigue (HL: 31%, aggressive/very aggressive; NHL: 27%). Survivors of indolent NHL had lower fatigue levels and prevalence of chronic fatigue (11%). Latent hypothyroidism was associated with increased fatigue levels (p = 0.042). Gonadal function was not associated with levels of fatigue or chronic fatigue. Mental distress was associated with increasing fatigue levels and chronic fatigue (p < 0.001). We found negative associations between chronic fatigue, daily functioning and work status.Conclusions. Fatigued lymphoma survivors should be investigated for thyroid function. The negative impact of chronic fatigue on daily functioning and work status emphasizes the importance of maintaining the effort in understanding the mechanisms behind fatigue.

Celiac disease as potential obstacle to childbearing

AIM: The authors have aimed at confirming or excluding gluten sensitivity in infertile couples. PATIENTS AND METHODS: Between 2004 and 2010, at our outpatient clinics of immunology, both partners of 223 couples, who had striven for having a child unsuccessfully, underwent history taking, physical examination, laboratory and immuno-serologic tests including anti-tissue-transglutaminase antibody (antitTG), as well as deep duodenal biopsy in antibody-carrying patients. RESULTS: Antibodies against tissue transglutaminase were positive in 6/223 female patients of whom the diagnosis of celiac disease was histologically confirmed in 3/223 cases (1.34%). Of the male patients 2/223 (0.9%) have proven to be carriers of the antibody; histology was pathognomonic in both of them. Curiously, one of the male patients with celiac disease has been the partner of a woman who also had celiac disease diagnosed by the authors. In the followup period, a female patient and the female member of the couple with celiac disease gave birth to healthy newborns after spontaneous conception, as the result of a strictly kept gluten-free diet, as well as occasional treatments of acetylsalicylate for antiphos-pholipid syndrome or levothyroxine for latent hypothyroidism due to autoimmune thyroiditis. CONCLUSION: The results underline that it is worth performing a screening for celiac disease in both partners of couples assessed due to the lack of success in having a child, as infertility can be ceased by an appropriate diet.

Index of Suspicion

A 5-year-old previously healthy boy presents to the emergency department (ED) with a 2-week history of intermittent left groin pain, usually occurring later in the day. Pain is not related to eating, movement, urination, or stooling. There is no report of trauma or precipitating event. He screams and refuses to stand up during pain episodes, which occur suddenly and last approximately 1 to 2 hours at a time. He otherwise has normal gait and activity when pain free. He does not wake up at night in pain. No recent illnesses or fevers are reported. Review of systems and his examination findings are unremarkable. Two days prior, he was evaluated in the ED for the same issue and had normal urinalysis, urine culture, and scrotal ultrasonogram results. The consulting urologist did not suspect a urologic process. He was discharged home with pain medication. Today, he returns to the ED because of the intense pain. The patient is admitted for further evaluation and pain management. Complete blood cell (CBC) count, C-reactive protein level, urinalysis results, and plain radiographs of the hips are unremarkable. Computed tomography of the abdomen and pelvis reveals a trace amount of nonspecific free fluid in the pelvis. His pain appears to be alleviated with ibuprofen and bed rest. The following day, he has another episode of intense groin pain after returning from the play room. Physical examination at this time demonstrates only point tenderness on palpation over his symphysis pubis area. No swelling, erythema, or increased warmth was noted in that area. An additional imaging study reveals the diagnosis. A 15-year-old girl presents to the clinic with an itchy rash, fever, headache, nausea, and dizziness. A few days earlier she was evaluated for rash on her back and low-grade fevers. She was prescribed amoxicillin clavulanate for suspected streptococcal …

Physiological Aspects of Analysis of Heart Rate Variability Parameters in Adolescents with Latent Hypothyroidism

Physiological Aspects of Analysis of Heart Rate Variability Parameters in Adolescents with Latent Hypothyroidism

Intensity of In Vitro Incorporation of 3H-Melatonin in the Thyroid Gland of Rabbits with Pineal Gland Hypofunction

The structure and hormonal activity of the thyroid gland and its capacity to bind (3)H-melatonin were studied in young adult Chinchilla rabbits with pineal gland hypofunction induced by 2-month exposure to constant illumination. After 2 months of constant exposure to light, the experimental animals exhibited signs of the so-called "latent hypothyroidism" and more intense binding of (3)H-melatonin by the thyroid gland. This fact indicated intactness of its receptor system underlying the possibility of restoring activity of the thyroid gland under conditions of melatonin replacement therapy in hypothyroidism induced by chronic melatonin insufficiency.

Hypothyreose

An autoimmune thyroiditis represents the main reason of hypothyroidism, defined as a lack of thyroid hormone. This autoimmune process results in destruction of functioning thyroid follicles. While subclinical or latent hypothyroidism is defined on the basis of laboratory values (an elevation of TSH with normal peripheral hormone levels), the typical signs and symptoms are associated with hypothyroidism. In about 80% of cases antibodies against thyroid peroxidase can be measured, but only in about 40-50% of cases antibodies against thyroglobulin are detectable. If hypothyrodism has been diagnosed, substitution with levothyroxine should be initiated, with the therapeutic goal to decrease TSH level to the lower normal range. In cases of subclinical hypothyroidism, levothyroxine medication should be started in patients with a high TSH value, positive antibodies and/or the typical ultrasound of autoimmune thyroiditis. However, substitution with levothyroxine in any case of elevated TSH values should be avoided.

Two different entities of spontaneous ovarian hyperstimulation in a woman with FSH receptor mutation

Spontaneous ovarian hyperstimulation syndrome (OHSS) is an extremely rare event. Normally OHSS is seen in the context of IVF. In 2003 a mutation of the FSH receptor (FSHR D567N) was identified for the first time as a cause of spontaneous OHSS. In most FSHR mutations, a hypersensitivity to human chorionic gonadotrophin (HCG) or thyroid-stimulating hormone (TSH) is described. This clinical case presents for the first time two occurrences of spontaneous OHSS in a single woman with a FSHR mutation and two different entities. Pathophysiology of both pregnancies was completely different. During the first pregnancy, elevated HCG and androgen concentrations led to spontaneous OHSS and finally to miscarriage. The second pregnancy with spontaneous OHSS was dominated by a latent hypothyroidism and normal HCG concentrations and ended in a delivery of a healthy female newborn. Due to the unusual courses of the pregnancies, the study looked for a mutation in the FSHR and surprisingly identified the same mutation previously described. This report confirms for the first time the in-vitro findings in a single clinical case that TSH as well as HCG leads to spontaneous OHSS in patients with FSHR D567N mutation. Hypothyroidism has to be treated or ruled out.

Successful treatment with levothyroxine for idiopathic hypersomnia patients with subclinical hypothyroidism

Objective Our objective was to discuss the effect of levothyroxine on excessive daytime sleepiness (EDS) and a prolonged nocturnal sleep at patients with idiopathic hypersomnia who presented with subclinical hypothyroidism. Methods We present two patients with hypersomnia who complained of EDS and a prolonged nocturnal sleep time. Sleep architecture and subjective daytime sleepiness were estimated by polysomnography (PSG) and Epworth Sleepiness Scale (ESS), respectively. Diagnoses were made using the International Classification of Sleep Disorders, 2nd Edition criteria for idiopathic hypersomnia with long sleep time. Results PSG demonstrated a short sleep latency, a prolonged total sleep time and normal proportions of all non-rapid eye movement (REM) and REM sleep stages. Nocturnal PSG excluded other causes of EDS. No medical, neurological and mental disorders were present. Their laboratory data indicated mildly elevated thyrotropin, despite free thyroxine (T4) and triiodothyronine (T3) estimates within their reference ranges, which is a characteristic of latent hypothyroidism. Levothyroxine (25 μg/day) was administrated orally. After treatment with levothyroxine for 8 weeks, the mean daily sleep times decreased. EDS was also improved, and a significant decrease in the ESS score was observed. Levothyroxine was effective for their hypersomnia and well tolerated. Conclusions It should be noted that hypersomnia may be associated with subclinical hypothyroidism, although few abnormalities in physical and neurological examinations are present.

Diagnostic accuracy of basal TSH determinations based on the intravenous TRH stimulation test: An evaluation of 2570 tests and comparison with the literature

BackgroundBasal TSH levels reflect the metabolic status of thyroid function, however the definition and interpretation of the basal levels of TSH is a matter of controversial debate. The aim of this study was to evaluate basal TSH levels in relation to the physiological response to i.v. TRH stimulation.MethodsA series of 2570 women attending a specialized endocrine unit were evaluated. A standardized i.v. TRH stimulation test was carried out by applying 200 μg of TRH. TSH levels were measured both in the basal and the 30 minute blood sample. The normal response to TRH stimulation had been previously determined to be an absolute value lying between 2.5 and 20 mIU/l. Both TSH values were analyzed by cross tabulation. In addition the results were compared to reference values taken from the literature.ResultsBasal TSH values were within the normal range (0.3 to 3.5 mIU/l) in 91,5% of cases, diminished in 3,8% and elevated in 4.7%. Based on the response to TRH, 82.4% were considered euthyroid, 3.3% were latent hyperthyroid, and 14.3% were latent hypothyroid. Combining the data on basal and stimulated TSH levels, latent hypothyroidism was found in the following proportions for different TSH levels: 5.4% for TSH < 2.0 mIU/l, 30.2% for TSH between 2.0 and 3.0 mIU/l, 65,5% for TSH between 3.0 and 3.50 mIU/l, 87.5% for TSH between 3.5 and 4.0 mIU/l, and 88.2% for TSH between 4 and 5 mIU/l. The use of an upper normal range for TSH of 2.5 mIU/l, as recommended in the literature, misclassified 7.7% of euthyroid cases.ConclusionOur analysis strategy allows us to delineate the predictive value of basal TSH levels in relation to latent hypothyroidism. A grey area can be identified for values between 3.0 and 3.5 mIU/l.

Generalisierte Lymphadenitis mit Hashimoto-Thyreoiditis

A 26-year-old Pakistani woman was admitted to hospital with fever, nausea and vomiting, abdominal pain and general weakness for the previous two weeks, but no diarrhea or constipation. Antibiotic therapy as an out-patient had not provided relief. She also had enlarged cervical lymph nodes. She reported that she had always been in good health before onset of the described symptoms. Laboratory tests revealed pancytopenia and a decrease in C3 and C4. The ANA titer was positive. The serum was positive for preceding infections with EBV, CMV, Chlamydia trachomatis, HHV type 6, and toxoplasmosis. There was no evidence of current or previous infections with HIV, Bartonella henselae, Treponema pallidum, Listeria, Hantavirus, Leishmania or dengue fever. The patient's symptoms were found to be associated with Hashimoto's thyroiditis in conjunction with latent hypothyroidism. Abdominal, thoracic and cervical CT scan revealed enlarged lymph nodes, up to 2 cm in size, and enlarged spleen and liver. Histopathology of a cervical lymph node showed features of Kikuchi (Kikuchi-Fujimoto) disease (histiocytic necrotizing lymphadenitis). Prednisone administration (2 mg/kg body weight) led to the patient's rapid recovery. Kikuchi disease should be considered in patients with cervical but also general lymphadenopathy, after exclusion of other causes. The specific diagnosis is based on biopsy of affected lymph nodes.

Changes in thyroid function and immunological parameters long after subtotal thyroidectomy for Graves' disease.

To find out whether subtotal thyroidectomy results in long term stable functional and immunological remission in patients with Graves' disease. Retrospective study. Teaching hospital, Japan. 176 patients who underwent subtotal thyroidectomy for Graves' disease, 1970-79. Follow up surveys in 1984 and 1992. Changes in thyroid function, antibody titres, and lymphocyte subsets. 29/79 patients (39%) who were euthyroid in 1984 had evidence of thyroid dysfunction in 1992. Of the 8 patients with latent hypothyroidism in 1984, 3 (38%) had become euthyroid by 1992, and none required treatment. Of the 29 patients who were hypothyroid in 1984, 5 had latent hypothyroidism and 1 was euthyroid in 1992, and of the 18 patients with recurrent hyperthyroidism in 1984, 1 had become euthyroid by 1992. The number of positive titres to TSH-binding inhibitory immunoglobulin was significantly higher in the recurrence group (31/36, 86%) compared with the hypothyroid (7/26, 27%), latent hypothyroidism (8/37, 22%), and euthyroid (22/77, 29%) groups (p < 0.01). There were also significant differences in the mean (SD) number of Leu HLA DR subsets between the control (17 (3), n = 18) and recurrence (21 (6), n = 38), hypothyroid (22 (6), n = 35), latent hypothyroidism (22 (6), n = 22), and euthyroid (22 (9), n = 64) groups (p < 0.002). There were no differences in the number of T cell subsets among the groups. Treatment of Graves' disease by subtotal thyroidectomy does not necessarily result in stable late functional or immunological remission. Long term follow up of such patients may be necessary.