TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study
Abstract
Introduction: 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 ≥35 years of age). l -thyroxine ( l -T 4 ) 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 Anti-thyroid drugs were withdrawn after 18 months of therapy.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. Conclusion: 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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In the group with elevated TRAb, relapse rates approach 80%-100%, while in the group with low or undetectable TRAb, relapse rates are in the 20%-30% range.
“In the group with elevated TRAb, relapse rates approach 80%-100%, while in the latter group, relapse rates are in the 20%-30% range (171,172).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [172]
TRAb assessment at the end of the course of ATD therapy is a useful method of dividing patients into two groups: one with persistent elevations who are unlikely to be in remission, and another group with low or undetectable TRAb, who have a higher probability of permanent remission.
“TRAb assessment at the end of the course of ATD therapy is a useful method of dividing patients into two groups: one with persistent elevations who are unlikely to be in remission, and another group with low or undetectable TRAb, who have a higher probability of permanent remission (171,172).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [172]
Monitoring of TRAb levels while on ATDs has been shown to be useful in adult patients for predicting the likelihood of remission or relapse of GD after stopping the medication.
“Whereas monitoring of TRAb levels while on ATDs has been shown to be useful in adult patients for predicting the likelihood of remission or relapse of GD after stopping the medication (172), this approach has yet to be validated in children.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [172]
The higher risk of GO development after RAI therapy in the majority of studies may be related to the unique increase in TRAb levels observed following this therapy.
“The higher risk of GO development after RAI therapy in the majority of studies may be related to the unique increase in TRAb levels observed following this therapy (172).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [172]
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- Authors
- Laurberg, P., Wallin, G., Tallstedt, L., Abraham-Nordling, M., Lundell, G., & Tørring, O.
- Affiliations
- Aalborg University Hospital (DK)
- Karolinska University Hospital (SE)
- Karolinska Institutet (SE)
- Corresponding author
- Laurberg, Peter
- ORCID
- Wallin, Göran
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-01
- Volume
- 158
- Issue
- 1
- Pages
- 69-75
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2161176285
- Cited by
- 428
- References
- 36
- Citations by year
- 2026: 7 · 2025: 32 · 2024: 22 · 2023: 19 · 2022: 30 · 2021: 31 · 2020: 30 · 2019: 28 · 2018: 30 · 2017: 19 · 2016: 19 · 2015: 29 · 2014: 28 · 2013: 21 · 2012: 27
- FWCI
- 8.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- Graves' disease, TSH receptor antibodies, antithyroid drugs, thyroid surgery, radioiodine therapy, hyperthyroidism treatment, levothyroxine
- MeSH terms
- Adult, Autoantibodies, Graves Disease, Humans, Iodine Radioisotopes, Middle Aged, Prospective Studies, Receptors, Thyrotropin, Antithyroid Agents, Thyroidectomy, Thyroxine, Time Factors, Triiodothyronine, Autoimmunity, Treatment Outcome, Immunoglobulins, Thyroid-Stimulating
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