TSH Receptor Antibody Levels Research Articles

Comprehensive Analysis of lncRNA Expression Profile and the Potential Role of ENST00000604491 in Graves' Disease.

Background Graves' disease (GD) is one of the most common autoimmune diseases worldwide and develops in 20 to 50 cases per 100,000 persons annually. Long noncoding RNAs (lncRNAs) are widely expressed in multiple human diseases and have pivotal functions in gene regulation. This study is aimed at determining the lncRNA profile in peripheral blood mononuclear cells (PBMCs) from GD patients and investigating the role of ENST00000604491 in GD. Methods A total of 31 GD patients and 32 normal controls were enrolled in the study. Next-generation sequencing was performed to identify the dysregulated lncRNAs in the PBMCs from the 5 GD patients and 5 normal controls, and 26 GD patients and 27 controls were used to verify the selected lncRNAs. The relative expression of verified lncRNAs, forkhead box P1 (FOXP1), and IKAROS family zinc finger 3 (IKZF3) from these samples was detected by quantitative real-time PCR. The potential biomarker value was assessed by using receiver operating characteristic (ROC) curve analysis. Results A total of 37,683 dysregulated expressed lncRNAs were indicated, of which 5 lncRNAs were significantly upregulated and 83 lncRNAs were remarkably downregulated in the GD patients compared with healthy subjects. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses showed that abnormally expressed lncRNAs were mainly enriched in immune system-related signalling pathways. Among the selected lncRNAs, the relative expression of ENST00000604491 was significantly downregulated and negatively correlated with the serum levels of thyroid-stimulating hormone receptor antibodies (TRAb) in GD patients. Further studies confirmed that decreased FOXP1 expression was inversely correlated with serum TRAb levels in GD patients. Moreover, there was a notably positive correlation between ENST00000604491 expression and FOXP1 transcript levels in GD. The area under the ROC curve of ENST00000604491 was up to 0.74 (95% confidence interval: 0.60-0.87, p < 0.01), and the sensitivity and specificity were 53.85% and 88.89%, respectively. Conclusion The present study identifies ENST00000604491 as a significantly attenuated lncRNA in GD patients, which may contribute to the pathogenesis of GD by regulating FOXP1 and represent a potential biomarker for GD.

Consistency Between Thyrotropin Receptor Antibody (TRAb) and Thyroid-Stimulating Antibody (TSAb) Levels in Patients with Graves Disease.

To investigate the consistency between thyrotropin receptor antibody (TRAb) and thyroid-stimulating antibody (TSAb) levels in patients with Graves disease (GD). We performed a cross-sectional observational study to recruit eligible patients with GD who visited the outpatient endocrinology clinic for the purpose of evaluating the consistency between their TRAb and TSAb levels. Our cohort included 28 men and 99 women. The median levels of TRAb and TSAb were 5.65 IU/L and 3.76 IU/L, respectively, in the enrolled patients with GD. The levels of TRAb (5.03 vs 8.42 IU/L; P = .008) and TSAb (2.69 vs 5.37 IU/L; P = .008) in patients with adequate thyroid regulation were all lower than those in patients with inadequate thyroid regulation. Although TRAb is closely related to TSAb, we observed high heterogeneity of TRAb due to relatively low consistency between the levels of the 2 antibodies.

The prevalence and significance of nonuniform thyroid radio-isotope uptake in patients with Graves' disease.

ObjectiveTo evaluate the prevalence and clinical significance of nonuniform technetium (99mTc) uptake among patients with Graves’ disease (GD).Design, Patients and MeasurementsPatients with GD, referred between July 2005 and March 2018, had Tc99‐ uptake scans and TSH‐receptor antibody (TRAb) measured before antithyroid drug (ATD) therapy. Risk of relapse after ATD cessation was monitored until June 2021 and compared between GD patients based on uptake patterns.ResultsOf the 276 GD patients (mean age, 49.8 years; 84% female), 25 (9.0%) had nonuniform Tc99 uptake. At diagnosis, individuals with nonuniform uptake were older (mean age of 61.8 vs. 48.5 years, p < .001), had lower mean thyroid hormone levels (free thyroxine: 36.3 vs. 45.4 pmol/L, p = .04 and free triiodothyronine: 10.0 vs. 17.8 pmol/L, p < .001) and median TRAb levels (4.2 vs. 6.6 U/L, p = .04) compared with those with a uniform uptake. Older age was a significant predictor for the presence of nonuniform uptake in GD patients; odds ratio (95% confidence intervals) of 1.07 (1.03 – 1.10). The risk of relapse was similar in both groups after a median (IQR) follow‐up of 41 (13–74) months after ATD cessation (56.0% vs. 46.3%, respectively); hazard ratio (95% confidence intervals) of 1.74 (0.96–3.15).ConclusionsNonuniform radio‐isotope uptake is seen in 1 in 11 patients with GD which could be misdiagnosed as toxic multinodular goitre if TRAb levels are not measured. Treatment of GD patients with nonuniform radio‐isotope uptake with ATD therapy as first‐line appears to be equally effective as compared with those with uniform uptake. TRAb testing should be the main diagnostic test for patients with suspected GD with radio‐labelled uptake scans being reserved for those who are TRAb negative.

Graves’ disease after COVID-19 vaccination

Dear Editor, Case 1 was a 41-year-old man with a history of primary hyperthyroidism. At the time of diagnosis, thyroglobulin antibodies were elevated although no thyrotropin receptor antibodies (TRAB) were available. The patient was treated with carbimazole for 20 months. At the time of cessation of carbimazole in May 2020, thyroid function and TRAB levels

The value of SPECT/CT imaging of lacrimal glands as a means of assessing the activity of Graves’ orbitopathy

BackgroundGraves’ orbitopathy (GO) is an autoimmune disease with mechanical impairment of orbital muscles and lacrimal gland dysfunction. The frequently used methods of assessing GO activity include Clinical Activity Score (CAS), CT, and MRI. These approaches are mainly associated with orbital muscles; however, there are not many studies that focus on the lacrimal gland inflammation of GO patients.ObjectiveThe aim of this study is to assess the usefulness of 99mTc-DTPA single-photon emission (SPE) CT/CT in evaluating the lacrimal gland inflammation in GO, as compared with other methods.MethodsA retrospective analysis of 48 patients with active GO compared with 33 controls was conducted. All subjects underwent clinical–endocrinological analyses, CAS evaluation, CT scans, and SPECT/CT examination. Lacrimal gland dimensions were determined and analyzed.ResultsThe lacrimal glands in patients with GO were significantly larger in all measured dimensions (P < 0.001) on CT scans relative to those in controls. Increased lacrimal gland diethylene triamine pentaacetic acid (DTPA) uptake ratios (P < 0.001) were displayed in active GO patients compared to controls and were also correlated with thyrotropin receptor antibody levels. The cut-off value for discriminating active and inactive disease was calculated to be 1.735, with specificity of 82.6% and sensitivity of 74.2%. SPECT/CT uptake ratios and CAS values were positively correlated in all GO patients. SPECT/CT uptake ratios were also positively correlated with CT measurements including lacrimal gland volume and coronal width in GO patients.ConclusionsThese data indicated that lacrimal gland SPECT/CT images can serve as a good tool for assessing the inflammation and disease activity of GO.

Relationship between autoantibodies against type 2 deiodinase and antithyroid autoantibodies in Graves’ disease using antithyroid drug therapy

Background: Previously, the presence of autoantibodies against type 2 deiodinase cys- and hom-peptides was investigated in Graves’ disease with relation to thyroid function, ophthalmopathy and therapy. The new design was to reveal the relationship among antithyroid antibodies involved in hormone synthesis. Aim and scope: To demonstrate some regularity between the appearance of peptide autoantibodies and antithyroid antibodies against TSH receptor, thyroid peroxidase and thyroglobulin, the study followed the main path of hormone synthesis and the effect of antithyroid drug treatment. Has any effect of peptide autoantibodies on the titers of other autoantibodies? Methods: The methods were described in our previous papers detailed. Autoantibodies against type 2 deiodinase peptides were detected with enzyme-linked immunosorbent assay in 78 patients with Graves’ disease and 30 controls. Thyroid hormones (TSH, FT4 and FT3) and antibodies against TSH receptor, thyroid peroxidase and thyroglobulin were measured with chemiluminescence immunoassay. Results: The frequency of cys-peptide antibodies was greater in the new onset of Graves’ disease. Propylthiouracil treatment was associated with increased occurrence of cys-peptide antibodies (p&lt;0.0069). No dose-dependency in methimazole treatment could be demonstrated for cys-peptide antibody levels. Antibodies against hom-peptide or both peptides demonstrated a strong relationship with the appearance of antithyroid antibodies. No peptide antibodies were associated with anti-thyroglobulin antibody positivity (0 cases out of 11 for hom-peptide, p&lt;0.0071 and 0 cases out of 8 for both peptides, p&lt;0.0251). In contrast, all cases with TSH receptor antibody positivity were positive for peptide antibodies (all cases out of 13 for hom-peptide, p&lt;0.0139 and all cases out of 9 for both peptides, p&lt;0.0470). TSH receptor antibody levels were relevantly decreased, when hom-peptide antibodies were present [24.35(15.68-37.8) vs 11.8(8.16-17.07) IU/l, p&lt;0.0437]. Conclusion: The presence of hom-peptide antibodies was connected to the absence of antibodies against thyroglobulin and smaller anti-thyroid peroxidase antibody positivity. The presence and the high titers of TSH receptor antibodies demonstrated a close relationship with the appearance of hom-peptide antibodies. The relationship among the studied autoantibodies may depend on the alteration of thyroid hormone synthesis and the steric hindrance of targets and antithyroid drug treatment. Autoantibodies against type 2 deiodinase peptides can influence the therapeutical effectiveness

Динаміка гормональних та імунологічних показників у процесі консервативного лікування хворих на дифузний токсичний зоб

У дослідженні вивчено динаміку структурного та функціонального стану щитоподібної залози, а також рівні антитиреоїдних антитіл у хворих на дифузний токсичний зоб (ДТЗ) у процесі довготривалої терапії тиреостатичними препаратами. Мета дослідження — провести аналіз змін рівнів антитіл до рецептора тиреотропного гормона (АТ рТТГ), антитіл до тиреоїдної пероксидази (АТ ТПО) при маніфестації ДТЗ та на фоні довготривалої медикаментозної терапії, а також визначити рівні АТ рТТГ при рецидивуючому перебігу захворювання. Матеріали і методи. Обстежено 112 пацієнтів із ДТЗ. Тривалість захворювання на момент початку обстеження була від одного місяця до 15 років. Усі хворі були розподілені на дві групи залежно від тривалості ДТЗ: першу групу становили 46 осіб із тривалістю захворювання до року (у середньому 3,96 міс.), другу групу — 66 осіб, які хворіли понад 1 рік (у середньому 3,32 року). Такий розподіл обумовлений бажанням вивчити динаміку рівнів антитиреоїдних антитіл при маніфестації захворювання та при довготривалому перебігу автоімунного процесу. Результати. На тлі прийому тиреостатиків збільшувалась кількість пацієнтів з вогнищевими утвореннями щитоподібної залози. При аналізі рівнів антитиреоїдних антитіл на початку дослідження виявлено, що рівень АТ ТПО в обох групах хворих на ДТЗ вірогідно перевищував показники контрольної групи (група 1 — 283,33 ± 86,61 Од/мл проти 35,65 ± 4,9 Од/мл; група 2 — 207,34 ± 42,52 Од/мл проти 35,65 ± 4,90 Од/мл) і не залежав від тривалості захворювання та строків попереднього лікування. Через 6 місяців лікування рівень АТ ТПО в обох групах не зменшувався. При вивченні динаміки АТ рТТГ у процесі тиреостатичної терапії виявлено, що у хворих першої та другої групи зниження рівня АТ рТТГ зафіксовано лише через 6–12 місяців після початку тиреостатичної терапії (група 1 — з 17,19 ± 2,17 мОд/л до 6,95 ± 2,39 мОд/л, р &lt; 0,05; група 2 — з 14,20 ± 2,04 мОд/л до 5,81 ± 2,26 мОд/л, р &lt; 0,05). Через 24 місяці лікування рецидиви тиреотоксикозу спостерігались у 24 хворих (21,4 %). При дослідженні рівнів АТ рТТГ у хворих з рецидивуючим перебігом захворювання спостерігалось їх суттєве збільшення (24,27 ± 2,86 мОд/л проти 12,28 ± 3,57 мОд/л). Через 6 місяців тиреостатичної терапії рівні АТ рТТГ у хворих з рецидивами суттєво не зменшувались і значно перевищували аналогічні показники хворих на ДТЗ у стадії ремісії (17,22 ± 3,37 мОд/л проти 4,64 ± 1,99 мОд/л). Висновки. У хворих на ДТЗ рівень АТ рТТГ зменшується лише через 6–12 місяців після початку тиреостатичної терапії. У хворих із рецидивуючим перебігом захворювання спостерігаються вірогідно більші розміри зоба, а також рівні АТ рТТГ, що через 6 місяців безперервного лікування значно перевищують нормальні значення й показники хворих з ремісією захворювання.

The effect of radioiodine treatment on the characteristics of TRAb in Graves\u2019 disease

BackgroundGraves’ disease (GD) is one of the most common autoimmune thyroid diseases (AITDs) in humans, and thyrotropin receptor antibody (TRAb) is a characterized autoantibody in GD. The use of radioactive iodine therapy (RAI) for GD treatment is increasing.ObjectivesWe studied the biological properties of TRAb and evaluated the effect of RAI therapy on TRAb in GD patients.MethodsIn total, 225 patients (22 onset GD patients without 131I therapy, 203 GD patients treated with 131I therapy) and 20 healthy individuals as normal controls were included in this study. Clinical assessments were performed, and we examined in vitro the biological properties of TRAb in the 22 onset GD patients and 20 controls as well as 84 GD patients with 131I therapy.ResultsSerum TRAb and thyroid peroxidase antibody (TPOAb) levels increased in the initial year of RAI treatment, and both antibodies decreased gradually after one year. After 5 years from radioiodine treatment, TRAb and TPOAb levels decreased in 88% and 65% of GD patients, respectively. The proportion of patients positive for thyroid-stimulatory antibody (TSAb) was significantly higher in the 7–12-month group, and thyroid-blocking antibody (TBAb) levels were elevated after one year in half of the patients who received 131I treatment.ConclusionsTreatment of GD patients with radioiodine increased TPOAb and TRAb (their main biological properties were TSAbs) within the first year after therapy, and the main biological properties of elevated TRAb were TBAbs after 1 year.

Possible interplay between estrogen and the BAFF may modify thyroid activity in Graves\u2019 disease

A link between sex hormones and B-cell activating factor (BAFF), a crucial immunoregulator of autoimmune thyroid disease (AITD), may exist. The study aimed to elucidate the role of estrogen (E2) in regulating BAFF in Graves' disease (GD). In clinical samples, serum BAFF levels were higher in women than in men in both the GD and control groups. serum BAFF levels were associated with thyroid-stimulating hormone receptor antibody levels and thyroid function only in women and not in men. BAFF transcripts in peripheral blood mononuclear cells were higher in women with GD than those in the control group. Among GD patients with the AA genotype of rs2893321, women had higher BAFF transcripts and protein levels than men. In the progression of a spontaneous autoimmune thyroiditis (SAT) murine model, NOD.H-2h4, serum free thyroxine and BAFF levels were higher in female than in male mice. Moreover, exogenous E2 treatment increased serum BAFF levels in male SAT mice. Meanwhile, female SAT mice exhibited higher thyroid BAFF transcripts levels than either the E2-treated or untreated male SAT mouse groups. Our results showed that E2 might be implicated in modulating BAFF expression, and support a possible mechanism for the higher incidence of AITD in women.

Alemtuzumab-induced autoimmune thyroid events in patients with relapsing-remitting multiple sclerosis: A real-life and monocentric experience at a tertiary-level centre.

Alemtuzumab-induced autoimmune thyroid events (AIATEs) are the most common adverse effects observed in relapsing-remitting multiple sclerosis (RRMS) patients. This study aims to explore the clinical and biochemical characteristics of such AIATEs, and to examine the risk factors for their occurrence, particularly for the worst clinical phenotype of fluctuating Graves' disease (GD). We retrospectively analysed a real-life single-centre consecutive series of 57 RRMS patients treated with alemtuzumab whose clinical and biochemical parameters were collected before starting the treatment and then monthly during their follow-up. AIATEs developed in 39% of patients a mean 17 months ± 11 after the first cycle of alemtuzumab. The most common AIATEs were GD (64%), followed by Hashimoto's thyroiditis with hypothyroidism (23%), TSH-receptor-antibody (TRAb)-positive hypothyroidism (9%), and silent thyroiditis (4%). GD showed a fluctuating course in 57% of cases. Baseline positivity for anti-thyroperoxidase antibodies, and higher absolute titers of anti-thyroglobulin and anti-thyroperoxidase antibodies correlated significantly with the risk of developing AIATEs, but TRAb positivity did not. Higher TRAb titers at the time of GD being diagnosed correlated strongly with a greater risk of the fluctuating GD phenotype. On ROC curve analysis, we found that a cut-off of 7.3 IU/L could be used to predict the risk of developing a fluctuating GD, with a positive predictive value of 100%. TRAb levels measured with commercial automatic methods at the time of a patient being diagnosed with alemtuzumab-induced GD emerged as a novel biomarker for predicting a fluctuating disease phenotype, with an influence on subsequent therapeutic decisions and patients' follow-up.

Comparison of Thyrotropin Receptor Antibodies Levels Before and After Methimazole Therapy for 6 months in Children With Graves Disease

Background : Graves’ disease is the leading cause of hyperthyroidism in children. The increase of hormones thyroxine (T4), free thyroxine (fT4) and triiodothyronine (T3) in Graves' disease is caused by the presence of thyroid stimulating antibodies (TSHR-Ab) or Thyrotopin receptor antibodies (TRAb). Methimazole (MMI) is often use as anti thyroid medication in children. Methimazole therapy may give a good response to patients with new-onset Graves’ disease, high levels of thyroxine, high TRAb), and no or small goiters. Objective : The purpose of this study was to determine the differences in TRAb before and after Methimazole Therapy for 6 months in children with Graves’ disease. Method : Retrospective study on 28 children below 18 year old with Graves’ disease at H. Adam Malik General Hospital Medan with TRAb, fT4, TSH data collection before and after Methimazole therapy for 6 months taken from medical records. Result : Median age 11.85 ± 3.73 with the number of women 85.7% compared to men 14.3%. The median value before Methimazole therapy was TRAb 32,11 IU/L, fT4 3.56 ng/dl and TSH 0.01 mU/l. Median values after 6 months of Methimazolee therapy were TRAb 17.15 IU/L, fT4 1.51 ng/dl and TSH 0.51 mU/l with P values <0.001, P = 0.006, P <0.001 respectively. Conclusion: There was significant differences in TRAb, fT4, and TSH median values before and after 6 months of Methimazole therapy in children with Graves’ disease.

Incidence, risk factors, natural history and outcomes of heart failure in patients with Graves’ disease

ObjectiveGraves’ disease (GD) can both aggravate pre-existing cardiac disease and cause de novo heart failure (HF), but large-scale studies are lacking. We aimed to investigate the incidence, risk factors and...

The association between serum adenosine deaminase levels and Graves’ disease

BackgroundAdenosine deaminase (ADA) is essential for the differentiation and maturation of lymphocytes, while lymphocytes infiltration in thyroid tissue is a vital pathological feature of Graves’ disease (GD). The aim of the present study was to compare the concentration of ADA between healthy controls (HC) and patients with GD, and evaluate the association between ADA and GD.MethodsA total of 112 GD patients and 77 matched HC were enrolled in this study. Each participant was examined for thyroid hormones and autoantibodies, ADA concentration, and thyroid ultrasonography.ResultsSerum ADA levels in GD patients were significantly higher than that in HC subgroup (P < 0.001). In GD patients, serum ADA levels were positively associated with serum-free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb), thyroid-stimulating hormone receptor antibody (TRAb) levels, and total thyroid gland volume (thyroid VolT) and negatively associated with serum thyroid-stimulating hormone receptor (TSH) levels (all P < 0.05). There were no similar correlations in the HC subgroup. Multiple linear regression analysis suggested that serum TSH, FT3, and ADA levels played an important role in serum TRAb levels.ConclusionsOur results demonstrated that serum ADA levels were closely associated with GD.

Характеристика окремих імунологічних показників у пацієнтів із післяопераційним рецидивом хвороби Грейвса

Актуальність. Головну роль у розвитку рецидиву гіпертиреозу відіграє активність автоімунних процесів. Багато досліджень вказують на те, що рівень антитіл до рецептора тиреотропного гормона (ТТГ) є основним чинником, який зумовлює виникнення рецидиву і може використовуватись як критерій оцінки його розвитку. Метою дослідження було вивчення клінічного перебігу, гормональних та імунологічних показників у пацієнтів із післяопераційним рецидивом хвороби Грейвса (ХГ) під час виникнення рецидиву та під час його терапії антитиреоїдними препаратами. Матеріали та методи. Групу пацієнтів становили 25 жінок віком від 23 до 73 років (у середньому 53,56 ± 2,31 року). Період часу від першого оперативного лікування до розвитку рецидиву тиреотоксикозу перебував у межах від 1 до 29 років і в середньому становив 13,33 ± 1,66 року. Результати. Рівні антитіл до рецептора ТТГ, що є основними чинниками в патогенезі ХГ, не зменшуються під час медикаментозного лікування, що вказує на безперспективність консервативної терапії післяопераційного рецидиву цього захворювання. Висновки. Після досягнення стану медикаментозної компенсації тиреотоксикозу рекомендується проведення терапії131 I чи хірургічне лікування рецидиву ХГ.

Serum thyroid-stimulating hormone receptor antibody levels and thyroid dysfunction after hysterosalpingography: a case-control study

Objective Hysterosalpingography (HSG) performed with an iodine contrast media can cause thyroid dysfunction, including thyrotoxicosis and hypothyroidism. We investigated the association between the serum levels of thyroid-stimulating hormone receptor antibody (TRAb), an indicator of Graves’ disease, and abnormal thyroid function after performing HSG. Methods The screening of TRAb was conducted in 362 patients who first visited the Tawara IVF Clinic between April and September 2018. The association between TRAb levels and the effects of HSG examinations on thyroid function were evaluated. Results Of the 362 patients, 2 (0.55%) had high levels (>2.0 IU/L) of TRAb, whereas 18 (5.0%) had intermediate TRAb levels, ranging from 0.3 to 1.9 IU/L. Of the 98 women (including 7 of the 18 women with TRAb level 0.3–1.9 IU/L, and 91 of the 342 women with TRAb level <0.3 IU/L) who had undergone HSG, two women developed overt thyrotoxicosis after HSG, and the frequency was significantly higher (p = .0044) in the group with intermediate levels of TRAb (28.6%, 2 of 7) than that in the group with low TRAb levels (<0.3 IU/L; 0.0%, 0 of 91). Conclusions These findings indicate that increased serum levels of TRAb are significantly associated with the development of thyrotoxicosis after HSG.

Overtreatment of Transient Maternal Hyperthyroidism Resulting in Fetal Goiter.

Overtreatment of Transient Maternal Hyperthyroidism Resulting in Fetal Goiter.

45-Year-Old Woman With Fever and Malaise

45-Year-Old Woman With Fever and Malaise

Characterization of Graves' disease development after partial thyroidectomy for thyroid cancer.

BackgroundGraves’ disease (GD) is the most common cause of hyperthyroidism, and it rarely develops in patients who undergo partial thyroid removal for thyroid cancer. The present study characterized and analyzed the GD development mechanism after partial thyroidectomy for thyroid cancer and suggested optimized treatments for the condition.MethodsA retrospective study from January 2013 to March 2017 was conducted in patients where GD occurred after partial thyroidectomy for thyroid cancer. Reviewed laboratory data included free 3,5,3'-triiodothyronine, free thyroxine, thyroid-stimulating hormone (TSH), thyroglobulin (Tg), anti-Tg antibody, anti-peroxidase antibody, and TSH receptor antibody levels. All laboratory indicators included preoperative and postoperative data. In addition, we collected patient neck ultrasound examination records and radioiodine (RAI) uptake test data.ResultsAmong 5,600 patients diagnosed with GD, 5 (0.09%) met the inclusion criteria and were enrolled. Patient mean age was 47.4±9.6 years, and all were female with a papillary thyroid carcinoma stage I diagnosis. The interval between partial thyroidectomy and hyperthyroidism onset ranged from 2 to 25 months. We proposed possible mechanisms for this medical condition and identified several factors accelerating the disease course. To treat GD, a low RAI (30 mCi) dose was prescribed to patients. All exhibited hypothyroidism at a 3- or 6-month follow-up, with stable clinical status at 1-year follow-up.ConclusionsGD rarely develops after partial thyroidectomy for thyroid cancer. We recommend a low RAI dose to manage GD and ablate the remnants of thyroid cancer.

Age Moderates the Impact of TRAbs on Thyroid Hormones and Hepatic Function in Patients with Graves' Disease.

Thyrotropin receptor antibodies (TRAbs) play a significant role in the course of hepatic dysfunction (HDF) in patients with Graves' disease (GD). However, few studies have considered the factors that influence the relationships among TRAbs, thyroid hormone levels, and hepatic function in subjects with newly diagnosed GD. Here we investigated the associations of TRAbs with thyroid hormones and hepatic function and assessed potential factors that can influence these associations among patients with GD. A total of 368 patients newly diagnosed with GD were collected in this cross-sectional study. Patients who had received antithyroid drugs, radioactive iodine, or surgery were excluded. Levels of TRAbs and thyroid hormones and hepatic function were recorded. Linear and binary logistic regression analysis models were applied to investigate associations among these variables after adjusting for confounding characteristics. There was a significant difference in TRAbs indices between the HDF and normal hepatic function groups (p <0.05). After adjusting for confounders, the relationship between TRAbs and thyroid hormones was nonlinear, showing a curve with an initial positive slope and a subsequent flattening (p <0.05). Higher TRAbs were associated with HDF [odds ratio (OR) 1.036, 95% confidence interval (CI) 1.018-1.053 per 1-IU/l increase]. These associations were modified by age, but not by gender, smoking status, Graves' orbitopathy, thyroid-peroxidase antibody levels, or thyroglobulin antibody levels. In younger patients, increasing TRAbs were correlated with higher thyroid hormones and HDF (OR 1.034, 95% CI 1.017-1.052) per1-IU/l increase). In older patients, TRAbs were not correlated with thyroid hormones or HDF (OR 1.024, 95% CI 0.993-1.056) per 1-IU/l increase. Age can affect the impact of TRAbs on thyroid hormone levels and hepatic function in GD. TRAb measurement can have good predictive value in younger patients.

Predictive factors for recurrence in patients with Graves’ Disease following treatment with methimazole

Graves’ disease (GD) contributes for 60–80% of all hyperthyroidism. Methimazole is the first line drug and most commonly used as antithyroid drug (ATD). However, the relapse rate following ATD therapy is 40–50%. The aimed of this study was to evaluate long-term ATD treatments and to identify prognostic factors that contribute to GD recurrence. A total of 46 GD patients who referred to the Endocrinology Clinic, Dr. Sardjito General Hospital, Yogyakarta between January 2016 and December 2018 with thyrotropin receptor antibody (TRAb) tested and treated with methimazole were included in this study. Size of goiter was measured based on WHO grading system and eye syndrome based on NOSPEC score system. Patients were classified into recurrence and remission groups based on TRAb evaluation at 12 month following treatment. Result of thyroid hormone level (FT4) and subject characteristic as predictive factors observed at 3-, 6- and 12-month post- treatment were compared and analyzed. Among 46 patient involved in this study, 23 patients demonstrated remission of hyperthyroidism based on TRAb evaluation at 12-month. The size of thyroid at onset of disease in 30 (65%) patients was grade 2 or above (p<0.05). Free FT4 levels at the end of observation (12 month) was 1.9±0.6 ng/ dL in recurrent and 1.4±0.5 ng/dL in remission group (p<0.05). TRAb levels at early of study was higher in the recurrent group (p<0.05). Logistic regression analysis demonstrated that thyroid size, FT4 level, and TRAb at diagnosis were associated with recurrencies. In conclusion, GD patients with large thyroids size, high TRAb levels, and high FT4 level at the onset of disease tended to fail to respond to ATD and were associated with recurrence incidence.