Remission of Graves’ disease during anti-thyroid drug therapy. Time to reconsider the mechanism?
Abstract
Therapy of Graves’ hyperthyroidism with thionamide anti-thyroid drugs is accompanied by a gradual remission of the autoimmune aberration in the majority of patients. The most likely mechanism behind this remission has been considered to be a direct immunosuppressive effect of thionamide drugs. However, a number of findings in clinical studies of patients with Graves’ disease indicate that remission is probably not caused by a special effect of thionamide drugs. Many studies have shown that remission is linked to restoration of the euthyroid state, and that it is independent of drug dose and type. Moreover, similar remission is observed when patients become euthyroid after thyroid surgery. In an explanatory model described, it is assumed that the autoimmune aberration of Graves’ disease is often basically quit mild and self-limiting. Patients may become ill by the running of a vicious cycle of hyperthyroidism worsening the autoimmunity, and autoimmunity worsening the hyperthyroidism. Once patients are made euthyroid by one or the other drug or by thyroid surgery, the majority of patients will gradually enter remission of the disease. The conclusion that remission is associated with restoration of the euthyroid state, and that it is not a special drug effect, highlights the importance of making and keeping patients with Graves’ disease euthyroid.
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ATD treatment itself might have a beneficial immunosuppressive role, either primarily decreasing thyroid-specific autoimmunity or secondarily ameliorating the hyperthyroid state and restoring the dysregulated immune system.
“The treatment itself might have a beneficial immunosuppressive role, either to primarily decrease thyroid specific autoimmunity, or secondarily, by ameliorating the hyperthyroid state, which may restore the dysregulated immune system back to normal (111).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [111]
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Hyperthyroidism in the personalized medicine era: the rise of mathematical optimization
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Graves'-Basedow disease in pregnancy
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Medical Management of Hyperthyroidism
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Tirotoxicosis e hipertiroidismo
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Graves’ disease: developments in first-line antithyroid drugs in the young
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Long-term monitoring of Graves’ disease in children and adolescents: a single-center experience
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- Authors
- Laurberg, P.
- Affiliations
- Aalborg University Hospital (DK)
- Corresponding author
- Laurberg, Peter
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-12
- Volume
- 155
- Issue
- 6
- Pages
- 783-786
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2134134791
- Cited by
- 139
- References
- 21
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 8 · 2022: 6 · 2021: 8 · 2020: 13 · 2019: 12 · 2018: 9 · 2017: 4 · 2016: 12 · 2015: 8 · 2014: 11 · 2013: 5 · 2012: 4
- FWCI
- 3.40
- 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, remission, antithyroid drugs, hyperthyroidism, euthyroidism, autoimmune thyroid disease, thyroid surgery, vicious circle, immunosuppression
- MeSH terms
- Graves Disease, Humans, Remission Induction, Antithyroid Agents, Thyroid Gland, Autoimmunity
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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