zondag 4 november 2012

Graves’ disease: test to predict remission and relapse


Patients with Graves’ disease, an autoimmune disorder, develop hyperthyroidism because their immune system makes antibodies that turn on the thyroid gland, causing the thyroid to enlarge and make excessive amounts of thyroid hormones.

The antibodies turn on the thyroid by acting like TSH and binding to the TSH receptor. Sometimes the antibody goes away and Graves’ disease goes into remission. Indeed, that is the goal when patients stay on antithyroid drugs, such as Methimazole or Propylthiouracil, for 12-18 months and then the drugs usually are stopped.

Unfortunately, a large percentage of patients either do not go into remission or relapse within the first year after stopping the antithyroid drugs. Therefore, any test that would predict which patients would remain in remission and which would relapse before stopping the antithyroid drugs would be useful.

Clinical Thyroidology for Patients / Glenn Braunstein, MD
New test may help predict which patients with Graves’ disease will remain in remission after stopping antithyroid drugs

The authors developed a test that measured one type of thyroid-stimulating antibodies (the Mc4 assay) which was shown to be positive in the patients with Graves’ disease, but negative in patients without thyroid problems, patients with hyperthyroidisms from other causes and patients with Graves’ disease that are in remission. In this study, they tested the ability of the Mc4 assay to serve as a sensitive index of remission or relapse of Graves’ disease after treatment with antithyroid drugs.

The full article title
A TSHR-LH/CGR chimera that measures functional thyroid-stimulating autoantibodies (TSAb) can predict remission or recurrence in Graves’ patients undergoing antithyroid drug (ATD) treatment
Giuliani C et al. J Clin Endocrinol Metab.
April 6 2012 [Epub ahead of print]. doi: 10.1210/jc.2011-2897.

Summary of the study

A total of 55 patients with Graves’ disease who received antithyroid drugs for 12-48 months were followed for 12-120 months after the antithyroid drugs were stopped. Of the 28 patients who stayed in remission, 22 (78%) had normal Mc4 levels, while 10 of 12 (83%) patients who relapsed had elevated levels, as did all 15 patients who could not get off antithyroid drug therapy because they had evidence of persistent hyperthyroidism.

What are the implications of this study?

This is an important study that identifies a test with potential to identify remission of Graves’ disease in patients on antithyroid drugs as well as possibly identify those at high risk for relapse. However, a larger prospective study of patients with Graves’ disease needs to be performed to determine if similar results are obtained in larger populations.

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