engleski

Prognostic features of thyroid peroxidase autoantibodies in remitted Graves' disease

Aim: Prognostic features that predict durability of remission in Graves’ disease (GD) after medical treatment are still a matter of controversy in the literature. The aim of the study was to relate initial TPOAb status to the clinical course in a long-term follow-up of patients with remitted GD. Methods: 60 patients with GD who had maintained euthyroidism for at least 6 months without therapy (first remission, mean age at diagnosis 40 ± 10 yr) were studied. A block-replace regimen (12-24 months) was used in all patients. No patient was lost to 6-year follow-up. Thyroid-specific autoantibodies were taken to be the maximum pretreatment readings obtained for thyroid-peroxidase (TPOAb) and TSH-receptor antibodies (TRAb). Time-to-event data [time from discontinuation of antithyroid drugs (ATD) to relapse] were summarized by Kaplan-Meier curves, log-rank test and multivariate Cox regression. Results: All TPOAb-negative patients (28%) were TRAb-positive. An overall estimated relapse rate for hyperthyroidism was 19% at 1 yr, 42% at 3 yr and 55% at 6 yr after the end of ATD. TSH values, measured at 6 months upon drug withdrawal, and inital TPOAb status, stratified by median TPOAb level (240 kIU/L), were independently associated with disease-free interval: suppressed TSH (<0.1 mU/L) at 6 months [hazard ratio (HR) 3 (1.44-6.35), P=0.003] and low/negative TPOAb titers at diagnosis were predictors of GD relapse [HR 2.8 (1.3-6), P=0.008]. In total, 21 of the 31 relapses occurred in the low/negative-TPOAb group (72 vs 32% cumulative relapse). Conclusion: The presence of TPOAb may influence the long-term prognosis of GD in individuals who attained a state of stable remission on ATD.

thyroid peroxidase; Graves' disease; antibody; remission

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