Clinical Thyroidology® for the Public
Summaries for the Public from recent articles in Clinical Thyroidology
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GRAVES’ DISEASE
Thyroid antibody tests in the management of Graves’ disease
BACKGROUND
Graves’ disease is the most common cause of hyperthyroidism in the United States. Graves’ disease is an autoimmune disease, meaning that the body makes antibodies that attack and turn on the thyroid, causing the hyperthyroidism. Graves’ disease is often treated with antithyroid drugs and may go into remission if the antibodies decrease or go away. These antibodies can be measured in the blood and have become valuable in confirming the diagnosis of Graves’ disease and in determining relapse risk and duration of antithyroid drug treatment. Also, despite frequently elevated levels of other thyroid-directed antibodies such as thyroperoxidase (TPOAb) and thyroglobulin (TgAb), the role of these antibodies in the diagnosis and treatment of Graves’ disease is unclear.
In this study, the researchers investigate the association between TPOAb and TgAb concentrations and disease relapse in patients with newly diagnosed Graves’ disease managed with antithyroid drugs.
THE FULL ARTICLE TITLE
Constantinescu SM et al Significance of thyroperoxidase and thyroglobulin antibodies in medically treated Graves’ disease. Eur Thyroid J 2023;12(6):e230193; doi: 10.1530/ ETJ-23-0193. PMID: 37930957.
SUMMARY OF THE STUDY
The study was done at a single Medical Center with a review of 136 adult patients treated for their first episode of Graves’ disease. Most of these patients were on antithyroid drugs-methimazole.
Majority of the patients were white and female and their average age was 41 years. The average duration of treatment with antithyroid medications was about 18 months. The average duration of follow-up was 44 months and during this time, 54.4% of patients had a relapse. The average time to relapse was 9.0 months after stopping the antithyroid medications.
TPOAb and TgAb positivity were common at diagnosis (72% and 54%, respectively). TPOAb-positive patients were younger at diagnosis than TPOAb-negative patients and thyroid eye disease was less frequent in TgAb-positive patients than in TgAb-negative patients. TPOAb or TgAb positivity at diagnosis was not associated with average time to returning thyroid levels to normal or risk of relapse. In the total group, relapse after stopping antithyroid drugs was associated with higher TPOAb and TgAb titers at baseline and at the end of treatment, the presence of thyroid eye disease, and longer time to reach normal thyroid levels.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study demonstrates the utility of thyroid antibody testing in the management of Graves’ disease. It helps predict the occurrence of some complications such as thyroid eye disease and the risk of relapse of Graves’ disease in a patient who has been treated with antithyroid drugs. Laboratory studies would be needed to further understand the role of these antibodies in the management of patients with this diagnosis.
— Vibhaavsu Sharma,MD,FACE
ATA RESOURCES
Graves’ Disease: https://www.thyroid.org/graves-disease/
Hyperthyroidism (Overactive): https://www.thyroid.org/hyperthyroidism/
ABBREVIATIONS & DEFINITIONS
Hyperthyroidism: a condition where the thyroid gland is overactive and produces too much thyroid hormone. Hyperthyroidism may be treated with antithyroid meds (Methimazole, Propylthiouracil), radioactive iodine or surgery.
Graves’ disease: the most common cause of hyperthyroidism in the United States. It is caused by antibodies that attack the thyroid and turn it on.
Thyroid eye disease (TED): also known as Graves ophthalmopathy. TED is most often seen in patients with Graves’ disease but also can be seen with Hashimoto’s thyroiditis. TED includes inflammation of the eyes, eye muscles and the surrounding tissues. Symptoms include dry eyes, red eyes, bulging of the eyes and double vision.
TPO antibodies (TPOAb): these are antibodies that attack the thyroid instead of bacteria and viruses, they are a marker for autoimmune thyroid disease, which is the main underlying cause for hypothyroidism and hyperthyroidism in the United States.
Thyroglobulin antibodies (TgAb): these are antibodies that attack the thyroid instead of bacteria and viruses, they are a marker for autoimmune thyroid disease, which is the main underlying cause for hypothyroidism and hyperthyroidism in the United States.
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