Factors Predicting Time to TSH Normalization and Persistence of TSH Suppression After Total Thyroidectomy for Graves' Disease
Open accessAbstract
Hyperthyroidism related to Graves’ disease is associated with a suppression of TSH values which may persist after surgery in spite of a LT4 replacement therapy at non-TSH-suppressing doses. The aim of this retrospective study was to evaluate the time to TSH normalization in a group of patients who underwent total thyroidectomy for Graves’ disease receiving a LT4 therapy dose regimen based on a previously published nomogram, and to identify possible correlations between the time to normalization of post-operative TSH values and preoperative clinical and biochemical parameters. 276 patients affected by Graves’ disease who underwent surgery between 2010 and 2015, were retrospectively evaluated for clinical and biochemical parameters as well as post-surgical LT4 treatment regimen. Of the 276 subjects, 174 had initiated LT4 dosage corresponding to a previously published nomogram, and of these, 98 patients were included in our statistical analysis. TSH and FT4 were evaluated at the first post-operative assessment and during follow up until the normalization of TSH values was achieved, and then included in the analysis During the first post-operative evaluation 2 months after surgery, 59/98 patients had TSH values in the normal range (0.4 to 4.0 mcU/ml), while 39/98 patients had a TSH value < 0.4 mcU/mL. The persistence of post-operative TSH levels < 0.4 mcU/ml was significantly correlated (p=0.022) with longer duration of the disease. The value of anti-TSH receptor autoantibodies (TrAb) at the diagnosis of hyperthyroidism, significantly correlated (p=0.002) with the time to TSH normalization in the group of patients with TSH < 0.4 mcU/ml at first control. This retrospective analysis confirms that in subjects who have undergone thyroidectomy for Graves’ disease, time to normalization of TSH may be prolonged. Hence, the role of TSH as the “gold standard” to assess the appropriate LT4 replacement therapy regimen during the initial months following surgery may need to be reconsidered.
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TH measurement is required to complement TSH measurement in pregnancy, intercurrent illness when TSH can be suppressed, and the initial treatment of hypo- or hyperthyroidism because the response of the pituitary-thyroid axis can be delayed after a change in thyroid status.
“TH measurement is also required to complement TSH measurement in a number of clinical situations (Table 2) such as pregnancy,60 intercurrent illness when TSH can be suppressed (the nonthyroidal illness syndrome61,62), and the initial treatment of hypo-63 or hyperthyroidism64 as the response of the pituitary-thyroid axis can be delayed after a change in thyroid status.57”
From Thyroid Stimulating Hormone and Thyroid Hormones (Triiodothyronine and Thyroxine): An American Thyroid Association-Commissioned Review of Current Clinical and Laboratory Status (2023) · cites this paper as [64]
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References 20 · Cited by 12
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- [1]Elfenbein DM Schneider DF Havlena J Chen H Sippel RS. Clinical and socioeconomic factors influence treatment decisions in Graves' disease. Ann Surg Oncol. (2015) 22: 1196– 9. 10.1245/s10434-014-4095-6 25245130 PMC4346454 · DOI
- [2]de Carvalho GA Paz-Filho G Mesa Junior C Graf H. Management of endocrine disease: pitfalls on the replacement therapy for primary and central hypothyroidism in adults. Eur J. Endocrinol. (2018) 178: R231– 44. 10.1530/EJE-17-0947 29490937 · DOI
- [4]Spencer CA Hollowell JG Kazarosyan M Braverman LE. National health and nutrition examination survey III thyroid-stimulating hormone (TSH)-thyroperoxidase antibody relationships demonstrate that TSH upper reference limits may be skewed by occult thyroid dysfunction. J Clin Endocrinol Metab. (2007) 92: 4236– 40. 10.1210/jc.2007-0287 17684054 · DOI · Paper page
- [5]Kim HI Kim TH Kim H Kim YN Jang HW Kim JH. Delayed TSH recovery after dose adjustment during TSH-suppressive levothyroxine therapy of thyroid cancer. Clin Endocrinol. (2017) 87: 286– 91. 10.1111/cen.13344 28375573 · DOI
- [6]Ross DS. Serum thyroid-stimulating hormone measurement for assessment of thyroid function and disease. Endocrinol Metab Clin North Am. (2001) 30: 245– 64. 10.1016/S0889-8529(05)70186-9 11444162 · DOI
- [7]Yu H Farahani P. Thyroid stimulating hormone suppression post-therapy in patients with Graves' disease: a systematic review of pathophysiology and clinical data. Clin Invest Med. (2015) 38: E31– 44. 10.25011/cim.v38i1.22574 25864995 · DOI
- [8]Fischer HR Hackeng WH Schopman W Silberbusch J. Analysis of factors in hyperthyroidism, which determine the duration of suppressive treatment before recovery of thyroid stimulating hormone secretion. Clin Endocrinol. (1982) 16: 575– 85. 10.1111/j.1365-2265.1982.tb03174.x 7105429 · DOI
- [9]Scheithauer BW Kovacs KT Young WF Jr Randall RV. The pituitary gland in hyperthyroidism. Mayo Clin Proc. (1992) 67: 22– 6. 10.1016/S0025-6196(12)60272-9 1732687 · DOI
- [10]Motta M Sterescu N Piva F Martini L. The participation of “short” feedback mechanisms in the control of ACTH and TSH secretion. Acta Neurol Psychiatr Belg. (1969) 69: 501– 7. 4316589
- [11]Prummel MF Brokken LJ Wiersinga WM. Ultra short-loop feedback control of thyrotropin secretion. Thyroid. (2004) 14: 825– 9. 10.1089/thy.2004.14.825 15588378 · DOI · Paper page
- [12]Brokken LJ Wiersinga WM Prummel MF. Thyrotropin receptor autoantibodies are associated with continued thyrotropin suppression in treated euthyroid Graves' disease patients. J Clin Endocrinol Metab. (2003) 88: 4135– 8. 10.1210/jc.2003-030430 12970276 · DOI
- [13]Chung YJ Lee BW Kim JY Jung JH Min YK Lee MS. Continued suppression of serum TSH level may be attributed to TSH receptor antibody activity as well as the severity of thyrotoxicosis and the time to recovery of thyroid hormone in treated euthyroid Graves' patients. Thyroid. (2006) 16: 1251– 7. 10.1089/thy.2006.16.1251 17199435 · DOI
- [14]Brokken LJ Scheenhart JW Wiersinga WM Prummel MF. Suppression of serum TSH by Graves' Ig: evidence for a functional pituitary TSH receptor. J Clin Endocrinol Metab. (2001) 86: 4814– 7. 10.1210/jcem.86.10.7922 11600546 · DOI
- [15]Molnar I Szentmiklosi JA Somogyine-Vari E. Hyperthyroidism in patients with Graves' ophthalmopathy, and thyroidal, skeletal and eye muscle specific type 2 deiodinase enzyme activities. Exp Clin Endocrinol Diab. (2017) 125: 514– 21. 10.1055/s-0043-113831 28750432 · DOI
- [16]Uy HL Reasner CA Samuels MH. Pattern of recovery of the hypothalamic-pituitary-thyroid axis following radioactive iodine therapy in patients with Graves' disease. Am J Med. (1995) 99: 173– 9. 10.1016/S0002-9343(99)80137-5 7625422 · DOI · Paper page
- [17]Woeber KA. Relationship between thyroid stimulating hormone and thyroid stimulating immunoglobulin in Graves' hyperthyroidism. J Endocrinol Invest. (2011) 34: 222– 4. 10.1007/BF03347070 20855936 · DOI
- [18]Chiovato L Fiore E Vitti P Rocchi R Rago T Dokic D. Outcome of thyroid function in Graves' patients treated with radioiodine: role of thyroid-stimulating and thyrotropin-blocking antibodies and of radioiodine-induced thyroid damage. J Clin Endocrinol Metab. (1998) 83: 40– 6. 10.1210/jcem.83.1.4492 9435414 · DOI
- [19]Dandona P El Kabir DJ. On the effect of thyrotropin and immunoglobulins related to Graves' disease on thyrotropin synthesis and secretion. Clin Endocrinol. (1978) 9: 321– 7. 10.1111/j.1365-2265.1978.tb02217.x 581481 · DOI
- [20]Ng ML Tan TT Roslan BA Rajna A Khalid BA. Usefulness and limitations of thyrotropin measurements as a first-line test for follow-up of Graves' patients. Ann Acad Med Singapore. (1993) 22: 569– 72. 7504901
- Authors
- Paragliola, R. M., Di Donna, V., Locantore, P., Papi, G., Pontecorvi, A., & Corsello, S. M.
- Affiliations
- Università Cattolica del Sacro Cuore (IT)
- Corresponding author
- Corsello, Salvatore Maria
- ORCID
- Venue
- Frontiers in Endocrinology
- Publisher
- Frontiers Media SA
- Published
- 2019-03-01
- Volume
- 10
- Pages
- 95-95
- ISSN
- 1664-2392 (ISSN-L)
- PMC
- PMC6405427
- OpenAlex
- W2920258612
- Cited by
- 12
- References
- 20
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 1 · 2021: 1 · 2020: 2
- FWCI
- 0.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Endocrinology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- Graves' disease, total thyroidectomy, TSH suppression, TSH normalization, levothyroxine replacement, disease duration, thyroid-stimulating hormone
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