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Serum thyrotropin-receptor and antithyroid peroxidase antibodies change differently during treatment of patients with hyperthyroidism caused by Graves’ disease
The background of the study. Most patients with hyperthyroidism caused by Graves’ disease have high serum concentrations of thyrotropin receptor (TSHR) and antithyroid peroxidase (anti-TPO) antibodies. In this study, both were measured during and after antithyroid drug therapy in patients with Graves’ hyperthyroidism to determine whether their production differed.
How the study was done. Seventy-five patients with recent-onset Graves’ hyperthyroidism were studied. The patients were treated with carbimazole for 18 months. Triiodothyronine was added after the first month, and was continued as needed to maintain normal thyroid status for 17 months. Both were then stopped, and the patients were followed for up to 3 years. They were evaluated clinically and had measurements of serum thyrotropin (TSH), free thyroxine (T4), TSHR-stimulating antibodies, and anti-TPO antibodies at base line and repeatedly during and after treatment.
The results of the study. Thirty-four of the 75 patients (45 percent) had recurrent hyperthyroidism during the three-year posttreatment follow-up period.
Serum TSHR-stimulating antibody concentrations were high in 99 percent of the patients at base line and 20 percent at the end of treatment, and the median value decreased by 69 percent. Most of the patients with persistently high values had recurrent hyperthyroidism, whereas most of the 60 patients in whom the serum antibody values were not high remained normal.
Serum anti-TPO antibody concentrations were high in 85 percent of the patients at base line and 47 percent at the end of treatment, and the median value decreased by 89 percent. Fifty-one percent pf the patients with high concentrations at that time remained euthyroid, as did 58 percent of those with normal concentrations. The concentrations increased substantially after treatment, independent of recurrence.
The conclusions of the study. In patients with hyperthyroidism caused by Graves’ disease, serum anti-TPO antibody concentrations fall more than serum TSHR-stimulating antibody concentrations during antithyroid drug therapy, independent of later recurrence of hyperthyroidism. Serum anti-TPO antibodies are more of an indicator of autoimmune thyroid disease in general, whereas serum TSHR-stimulating antibodies are more closely related to the presence of hyperthyroidism.
The original article. Guilhem I, Massart C, Poirier JY, Maugendre D. Differential evolution of thyroid peroxidase and thyrotropin receptor antibodies in Graves’ disease: thyroid peroxidase activity reverts to pretreatment level after carbimazole withdrawal. Thyroid 2006;16:1041-5.
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