maandag 4 juli 2016

‘Remission induction and sustenance in Graves’ disease study’

Graves’ disease (GD) was originally described as a syndrome consisting of hyperthyroidism, goitre, and orbitopathy. It is now clear that the central element is autoimmunity directed against the TSH-receptor, and the vast majority of patients newly diagnosed with Graves’ disease have detectable TSH-receptor autoantibodies (TRAb) in serum.

Association between TSH-receptor autoimmunity, hyperthyroidism, goitre, and orbitopathy in 208 patients included in the ‘Remission Induction and Sustenance in Graves’ Disease Study’
Peter Laurberg, Birte Nygaard, Stig Andersen, Allan Carlé, Jesper Karmisholt, Anne Krejbjerg, Inge Bülow Pedersen, Stine Linding Andersen

Aim of the research was to study associations between serum levels of TSH-receptor autoantibodies and the three main manifestations of Graves’ disease (hyperthyroidism, goiter, and presence of orbitopathy) at the time of diagnosis of hyperthyroidism.


Methods

We describe a cohort of 208 patients with newly diagnosed Graves’ hyperthyroidism. Patients were enrolled in a multiphase study of antithyroid drug therapy of Graves’ hyperthyroidism, entitled ‘Remission Induction and Sustenance in Graves’ Disease (RISG)’. Patients were systematically tested for degree of biochemical hyperthyroidism, enlarged thyroid volume by ultrasonography, and the presence of orbitopathy.


Results

Positive correlations were found between the levels of TSH-receptor autoantibodies in serum and the three manifestations of Graves’ disease: severeness of hyperthyroidism, presence of enlarged thyroid, and presence of orbitopathy, as well as between the different types of manifestations. Only around half of patients had enlarged thyroid gland at the time of diagnosis of hyperthyroidism, whereas 25–30% had orbitopathy.


Conclusions

We describe a large cohort of patients with newly diagnosed Graves’ disease who entered a study aimed to improve quality of ATD therapy. Analysis of patient characteristics corroborated the central role of TSH receptor autoimmunity in Graves’ disease and the association between the three common manifestations of Graves’ disease. Future results of the RISG study may clarify if TRAb levels and the various clinical manifestations at entry are useful for tailoring duration of ATD therapy to individual patients with hyperthyroidism caused by Graves’ disease.

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