vrijdag 25 maart 2016

Over de ziekte van Graves en TSH-receptor antistoffen

Bij de behandeling van Graves’ hyperthyreoïdie met schildklierremmers en operatie verdwijnen de TSH-receptor antistoffen geleidelijk. Na ongeveer 18 maanden zijn die antistoffen verdwenen bij 70-80% van die patiënten. Bij de behandeling met radioactief jodium gaat dat anders. In dat geval neemt het aantal TSH-receptor antistoffen toe en is na vijf jaar de hoeveelheid antistoffen nog steeds verhoogd.

TSH-receptor autoimmunity in Graves’ disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study.
Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Tørring O.
Eur J Endocrinol 2008;158:69-75.

The autoimmune response to treatment of Graves’ hyperthyroidism is considerably better with surgery and antithyroid drugs than with 131I
Robert D Utiger

Autoimmunity against the TSH receptor is a key pathogenic element in Graves’ disease. The autoimmune aberration may be modified by therapy of the hyperthyroidism.

Objective

To compare the effects of the common types of therapy for Graves’ hyperthyroidism on TSH-receptor autoimmunity.

Methods

Patients with newly diagnosed Graves’ hyperthyroidism aged 20-55 years were randomized to medical therapy, thyroid surgery, or radioiodine therapy (radioiodine was only given to patients over 35 years of age). L-thyroxine (L-T4) was added to therapy as appropriate to keep patients euthyroid. Anti-thyroid drugs were withdrawn after 18 months of therapy. TSH-receptor antibodies (TRAb) in serum were measured before and for 5 years after the initiation of therapy.

Results

Medical therapy (n=48) and surgery (n=47) were followed by a gradual decrease in TRAb in serum, with the disappearance of TRAb in 70-80% of the patients after 18 months. Radioiodine therapy (n=36) led to a 1-year long worsening of autoimmunity against the TSH receptor, and the number of patients entering remission of TSH-receptor autoimmunity with the disappearance of TRAb from serum during the following years was considerably lower than with the other types of therapy.

Conclusions

The majority of patients with Graves' disease gradually enter remission of TSH-receptor autoimmunity during medical or after surgical therapy, with no difference between the types of therapy. Remission of TSH-receptor autoimmunity after radioiodine therapy is less common.



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