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Iwanaga H, Fujita N, Abe S, Naganawa S, Kato K. Correlation between the thyroid computed tomography value and thyroid function in hyperthyroidism: a retrospective study. Ann Nucl Med 2024; 38:659-665. [PMID: 38787504 PMCID: PMC11282127 DOI: 10.1007/s12149-024-01938-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Radioiodine (I-131) therapy for hyperthyroidism is a well-established and safe treatment option. This study aimed to investigate the relationship between the computed tomography (CT) value and the function and volume of the thyroid gland by identifying the factors that induce changes in the CT value of patients with hyperthyroidism. METHODS This retrospective study evaluated 38 patients with Graves' disease and 10 patients with Plummer disease. To obtain the mean CT value and volume of the thyroid gland, the entire thyroid gland was set as the region of interest. A test dose of 3.7 MBq I-131 was administered before initiating I-131 therapy, and the radioiodine uptake (RIU) rate was assessed after 3, 24, 96, and 168 h. An approximate curve was plotted based on the RIU values obtained, and the effective half-life (EHL) was calculated. The correlation between the mean CT value and the volume of the thyroid gland, 24-h RIU, EHL, and the free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), and TSH receptor antibody (TRAb) levels was evaluated. RESULTS The CT value exhibited a significant positive correlation with EHL in patients with Graves' disease (r = 0.62, p < 0.0001) as well as patients with Plummer disease (r = 0.74, p < 0.05). However, it did not display any correlation with the remaining parameters. CONCLUSION The CT value is significantly correlated with EHL, suggesting that it reflects thyroid function and is mainly related to the factors associated with iodine discharge.
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Affiliation(s)
- Haruna Iwanaga
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
- Department of Radiological and Medical Laboratory Sciences, Department of Integrated Health Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naotoshi Fujita
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Shinji Abe
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Shinji Naganawa
- Functional Medical Imaging, Biomedical Imaging Sciences, Division of Advanced Information Health Sciences, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsuhiko Kato
- , 1-20, Daikominami 1‑Chome, Higashi-Ku, Nagoya, 461-8673, Japan.
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2
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Wang X, Li T, Li Y, Wang Q, Cai Y, Wang Z, Shi Y, Yang T, Zheng X. Enhanced predictive validity of integrative models for refractory hyperthyroidism considering baseline and early therapy characteristics: a prospective cohort study. J Transl Med 2024; 22:318. [PMID: 38553734 PMCID: PMC10979605 DOI: 10.1186/s12967-024-05129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/23/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND A subset of Graves' disease (GD) patients develops refractory hyperthyroidism, posing challenges in treatment decisions. The predictive value of baseline characteristics and early therapy indicators in identifying high risk individuals is an area worth exploration. METHODS A prospective cohort study (2018-2022) involved 597 newly diagnosed adult GD patients undergoing methimazole (MMI) treatment. Baseline characteristics and 3-month therapy parameters were utilized to develop predictive models for refractory GD, considering antithyroid drug (ATD) dosage regimens. RESULTS Among 346 patients analyzed, 49.7% developed ATD-refractory GD, marked by recurrence and sustained Thyrotropin Receptor Antibody (TRAb) positivity. Key baseline factors, including younger age, Graves' ophthalmopathy (GO), larger goiter size, and higher initial free triiodothyronine (fT3), free thyroxine (fT4), and TRAb levels, were all significantly associated with an increased risk of refractory GD, forming the baseline predictive model (Model A). Subsequent analysis based on MMI cumulative dosage at 3 months resulted in two subgroups: a high cumulative dosage group (average ≥ 20 mg/day) and a medium-low cumulative dosage group (average < 20 mg/day). Absolute values, percentage changes, and cumulative values of thyroid function and autoantibodies at 3 months were analyzed. Two combined predictive models, Model B (high cumulative dosage) and Model C (medium-low cumulative dosage), were developed based on stepwise regression and multivariate analysis, incorporating additional 3-month parameters beyond the baseline. In both groups, these combined models outperformed the baseline model in terms of discriminative ability (measured by AUC), concordance with actual outcomes (66.2% comprehensive improvement), and risk classification accuracy (especially for Class I and II patients with baseline predictive risk < 71%). The reliability of the above models was confirmed through additional analysis using random forests. This study also explored ATD dosage regimens, revealing differences in refractory outcomes between predicted risk groups. However, adjusting MMI dosage after early risk assessment did not conclusively improve the prognosis of refractory GD. CONCLUSION Integrating baseline and early therapy characteristics enhances the predictive capability for refractory GD outcomes. The study provides valuable insights into refining risk assessment and guiding personalized treatment decisions for GD patients.
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Affiliation(s)
- Xinpan Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China
| | - Tiantian Li
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China
| | - Yue Li
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China
| | - Qiuyi Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China
| | - Yun Cai
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China
| | - Zhixiao Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China
| | - Yun Shi
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China.
| | - Xuqin Zheng
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, Jiangsu, China.
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3
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Weng H, Tian WB, Xiao ZD, Xu L. Prediction for recurrence following antithyroid drug therapy for Graves' hyperthyroidism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000609. [PMID: 37252698 PMCID: PMC10665073 DOI: 10.20945/2359-3997000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/31/2022] [Indexed: 05/31/2023]
Abstract
Objective A common problem with antithyroid drugs (ATD) treatment in patients with Graves' disease (GD) is the high recurrence rate after drug withdrawal. Identifying risk factors for recurrence is crucial in clinical practice. We hereby prospectively analyze risk factors for the recurrence of GD in patients treated with ATD in southern China. Subjects and methods Patients who were newly diagnosed with GD and aged > 18 years were treated with ATD for 18 months and followed up for 1 year after ATD withdrawal. Recurrence of GD during follow-up was assessed. All data were analyzed by Cox regression with P values < 0.05 considered statistically significant. Results A total of 127 Graves' hyperthyroidism patients were included. During an average follow-up of 25.7 (standard deviation = 8.7) months, 55 (43%) had a recurrence within 1 year after withdraw of anti-thyroid drugs. After adjustment for potential confounding factors, the significant association remained for the presence of insomnia (hazard ratio (HR) 2.94, 95% confidence interval (CI) 1.47-5.88), greater goiter size (HR 3.34, 95% CI 1.11-10.07), higher thyrotrophin receptor antibody (TRAb) titer (HR 2.66, 95% CI 1.12-6.31) and a higher maintenance dose of methimazole (MMI) (HR 2.14, 95% CI 1.14-4.00). Conclusion Besides conventional risk factors (i.e., goiter size, TRAb and maintenance MMI dose) for recurrent GD after ATD withdraw, insomnia was associated with a 3-fold risk of recurrence. Further clinical trials investigating the beneficial effect of improving sleep quality on prognosis of GD are warranted.
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Affiliation(s)
- Huan Weng
- Department of Endocrinology, Shantou Central Hospital, Shantou, China
| | - Wen Bo Tian
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zi Dong Xiao
- Department of Endocrinology, Shantou Central Hospital, Shantou, China
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, China,
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Watanabe S, Okamoto S, Akikawa K, Miyamoto N, Okamura-Kawasaki M, Uchiyama Y, Takenaka J, Toyonaga T, Hirata K, Kudo K. Identification of patients with Graves' disease who benefit from high-dose radioactive iodine therapy. Ann Nucl Med 2022; 36:923-930. [PMID: 35972673 DOI: 10.1007/s12149-022-01781-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Radioactive iodine (RAI) therapy is a useful treatment for Graves' disease (GD). Most RAI sessions administer ≤ 500 MBq of iodine (I)-131. Sometimes patients require repeated RAI, often for longer periods of remission. We investigated the characteristics of patients for whom high dose (mostly 1110 MBq of I-131) RAI was effective as RAI therapy for GD. METHODS We retrospectively analyzed the cases of 79 patients who underwent RAI for GD in a multicenter setting. We divided the patients into two groups based on the I-131 dose administered: the low dose (LD) group who received ≤ 500 MBq (n = 44) and the high dose (HD) group who received > 500 MBq (n = 35). The therapeutic effect was defined as achieving remission and reaching the point of participating in thyroid hormone replacement therapy within 1 year after RAI. We compared the LD and HD groups' remission rates and conducted a multivariate logistic regression analysis of predictive factors for remission. In a simulation, using the formula for predicting the probability of remission obtained from the analysis results, we estimated how much the remission rate would change if the I-131 dose is increased from 500 to 1110 MBq. RESULTS The mean ± standard deviation I-131 dose administered in the LD group was 480 ± 6 MBq, and that of the HD group was 1054 ± 265 MBq. Thirty-five patients (80%) in the LD group and 26 patients (74%) in the HD group achieved remission; this difference in the remission rate was not significant. The multivariate analysis results demonstrated that the absorbed dose and thyroid-stimulating antibody (TSAb) were independent predictors of remission. Seven patients (8.9%) showed an increased probability of remission from < 50% to > 50% when the higher RAI dose was applied (1110 MBq instead of 500 MBq). The thyroid volume and TSAb values in these patients were relatively large at 54.7 ± 34.2 mL and 1378.4 ± 586.3%, respectively. CONCLUSION Although the overall remission rate was not significantly different between the patients who received high- or low-dose I-131, treatment with high-dose RAI may improve the probability of remission in patients with a massive thyroid volume and/or high-TSAb Graves' disease.
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Affiliation(s)
- Shiro Watanabe
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
| | - Shozo Okamoto
- Department of Radiology, Obihiro Kosei Hospital, Minami 10-1, Nishi 14, Obihiro City, Hokkaido, 080-0024, Japan
| | - Kazumasa Akikawa
- Department of Internal Medicine, Hokkaido Medical Center of Rheumatic Diseases, 1-1-45, Kotoni 1-jo 3-chome, Nishi-ku, Sapporo, Hokkaido, 063-0811, Japan
| | - Noriyuki Miyamoto
- Department of Radiology, Obihiro Kosei Hospital, Minami 10-1, Nishi 14, Obihiro City, Hokkaido, 080-0024, Japan
| | - Miyuki Okamura-Kawasaki
- Department of Radiology, Tomakomai City Hospital, 1-5-20 Shimizu-cho, Tomakomai, 053-8567, Japan
| | - Yuko Uchiyama
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Junki Takenaka
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Takuya Toyonaga
- Positron Emission Tomography (PET) Center, Radiology and Biomedical Imaging, Yale School of Medicine, 801 Howard Ave., P.O. Box 208048, New Haven, CT, 06520, USA
| | - Kenji Hirata
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Kita-14, Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
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Abdalaziz A, Vanka R, Bartholomew P, Vennart N, Vernazza J, Stewart K, Tsatlidis V, Narayanan K, Weaver JU, Razvi S. The prevalence and significance of nonuniform thyroid radio-isotope uptake in patients with Graves' disease. Clin Endocrinol (Oxf) 2022; 97:100-105. [PMID: 35244288 PMCID: PMC9313567 DOI: 10.1111/cen.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the prevalence and clinical significance of nonuniform technetium (99m Tc) uptake among patients with Graves' disease (GD). DESIGN, PATIENTS AND MEASUREMENTS Patients with GD, referred between July 2005 and March 2018, had Tc99 - uptake scans and TSH-receptor antibody (TRAb) measured before antithyroid drug (ATD) therapy. Risk of relapse after ATD cessation was monitored until June 2021 and compared between GD patients based on uptake patterns. RESULTS Of the 276 GD patients (mean age, 49.8 years; 84% female), 25 (9.0%) had nonuniform Tc99 uptake. At diagnosis, individuals with nonuniform uptake were older (mean age of 61.8 vs. 48.5 years, p < .001), had lower mean thyroid hormone levels (free thyroxine: 36.3 vs. 45.4 pmol/L, p = .04 and free triiodothyronine: 10.0 vs. 17.8 pmol/L, p < .001) and median TRAb levels (4.2 vs. 6.6 U/L, p = .04) compared with those with a uniform uptake. Older age was a significant predictor for the presence of nonuniform uptake in GD patients; odds ratio (95% confidence intervals) of 1.07 (1.03 - 1.10). The risk of relapse was similar in both groups after a median (IQR) follow-up of 41 (13-74) months after ATD cessation (56.0% vs. 46.3%, respectively); hazard ratio (95% confidence intervals) of 1.74 (0.96-3.15). CONCLUSIONS Nonuniform radio-isotope uptake is seen in 1 in 11 patients with GD which could be misdiagnosed as toxic multinodular goitre if TRAb levels are not measured. Treatment of GD patients with nonuniform radio-isotope uptake with ATD therapy as first-line appears to be equally effective as compared with those with uniform uptake. TRAb testing should be the main diagnostic test for patients with suspected GD with radio-labelled uptake scans being reserved for those who are TRAb negative.
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Affiliation(s)
- Altayeb Abdalaziz
- Department of EndocrinologyGateshead Health NHS Foundation TrustGatesheadUK
| | - Ramesh Vanka
- Department of EndocrinologyGateshead Health NHS Foundation TrustGatesheadUK
| | - Peter Bartholomew
- Department of Medical PhysicsSunderland and South Tyneside Hospitals NHS Foundation TrustSunderlandUK
| | - Nicholas Vennart
- Department of Medical PhysicsSunderland and South Tyneside Hospitals NHS Foundation TrustSunderlandUK
| | - Jonathan Vernazza
- Department of EndocrinologyGateshead Health NHS Foundation TrustGatesheadUK
| | - Kathryn Stewart
- Department of EndocrinologyGateshead Health NHS Foundation TrustGatesheadUK
| | | | | | - Jolanta U Weaver
- Department of EndocrinologyGateshead Health NHS Foundation TrustGatesheadUK
- Centre for Life, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Salman Razvi
- Department of EndocrinologyGateshead Health NHS Foundation TrustGatesheadUK
- Centre for Life, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
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Baek HS, Lee J, Jeong CH, Lee J, Ha J, Jo K, Kim MH, Cho JH, Kang MI, Lim DJ. The Prediction Model Using Thyroid Stimulating Immunoglobulin Bioassay For Relapse of Graves’ Disease. J Endocr Soc 2022; 6:bvac023. [PMID: 35441120 PMCID: PMC9012332 DOI: 10.1210/jendso/bvac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Thyroid-stimulating immunoglobulin (TSI) bioassay has a better ability to predict the relapse rate of Graves’ disease (GD) than the thyroid-stimulating hormone (TSH)-binding inhibitory immunoglobulin method in terms of measuring the TSH receptor antibody. However, the optimal TSI bioassay cutoff for predicting relapse after antithyroid drug (ATD) withdrawal is not well evaluated. Methods This retrospective study enrolled GD patients who had been treated with ATD and obtained their TSI bioassay <140% from January 2010 to December 2019 in a referral hospital. Results Among 219 study subjects, 86 patients (39.3%) experienced relapse. The TSI bioassay value of 66.5% significantly predicted the relapse of GD (P = 0.049). The group with a TSI bioassay value > 66.5% were expected to show a 23.8% relapse rate at 2 from ATD withdrawal, and the group with a TSI < 66.5% had a 12.7% relapse rate based on Kaplan-Meier curves analysis. The TSI bioassay showed a good ability to predict relapse GD in the female group (P = 0.041) but did not in the male group (P = 0.573). The risk scoring based on the nomogram with risk factors for GD relapse, which was constructed to overcome the limitation, increased the predictive ability of GD relapse by 11.5% compared to the use of the TSI bioassay alone. Conclusions The cutoff value of the TSI bioassay to predict GD relapse should be lower than that for diagnosing GD. However, as the single use of the TSI bioassay has limitations, a nomogram with multiple risk factors including TSI bioassay could be helpful to predict GD relapse.
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Affiliation(s)
- Han-Sang Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaejun Lee
- Department of Internal Medicines, Armed Forces Goyang Hospital, Goyang, Republic of Korea
| | - Chai-Ho Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwanhoon Jo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moo Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Sharma P. The Unlikely Suspect: A Case Report of New-Onset Hyperthyroidism Due to Graves' Disease in an 89-Year-Old Gentleman and Review of Literature. Cureus 2022; 14:e21546. [PMID: 35106261 PMCID: PMC8788900 DOI: 10.7759/cureus.21546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 12/03/2022] Open
Abstract
Thyroid dysfunction in the elderly commonly manifests as hypothyroidism. With advancing age, toxic nodules are the more common cause of hyperthyroidism as compared to Graves' disease. Due to the lack of classical symptoms of hyperthyroidism in the elderly, the diagnosis can often be delayed. Previously, an 82-year-old gentleman with oropharyngeal dysphagia due to Graves' disease was the oldest reported case with atypical symptoms. We report a case of an 89-year-old gentleman with no prior history of thyroid disease, who presented with non-specific gastrointestinal symptoms that ultimately led to the diagnosis of hyperthyroidism secondary to Graves' disease. We also review the available literature regarding the pathophysiology, clinical presentation, and management of hyperthyroidism and Graves' disease in the elderly.
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Cappellani D, De Marco G, Ferrarini E, Torregrossa L, Di Certo AM, Cosentino G, Urbani C, Marconcini G, Mattiello A, Manetti L, Agretti P, Basolo F, Tonacchera M, Bartalena L, Bogazzi F. Identification of Two Different Phenotypes of Patients with Amiodarone-Induced Thyrotoxicosis and Positive Thyrotropin Receptor Antibody Tests. Thyroid 2021; 31:1463-1471. [PMID: 34271828 DOI: 10.1089/thy.2021.0118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Serum thyrotropin (TSH) receptor antibodies (TRAbs) are occasionally found in patients with amiodarone-induced thyrotoxicosis (AIT), and usually point to a diagnosis of type 1 AIT (AIT1) due to Graves' disease (GD). However, the TRAb role and function in AIT have not been clarified. Methods: A retrospective cohort study of 309 AIT patients followed at a single academic center over a 30-year period. AIT TRAb-positive patients (n = 21, 7% of all cases) constituted the study group; control groups consisted of type 2 AIT (AIT2) TRAb-negative patients (n = 233), and 100 non-AIT patients with GD. Clinical and biochemical data at diagnosis and during the course of disease were compared. Histological samples of patients who had total thyroidectomy were reviewed. Stored serum samples were used for a functional assay of TRAb class G immunoglobulins (IgGs) in Chinese hamster ovary (CHO) cells stably transfected with complementary DNA encoding for the TSH receptor. Results: TRAb-positive patients were grouped according to color flow Doppler sonography, radioactive iodine thyroid uptake, and duration of amiodarone therapy before thyrotoxicosis in type 1 (n = 9, 43%; TRAb1) or type 2 (n = 12, 57%; TRAb2) AIT. TRAb1 patients had clinical and biochemical features indistinguishable from GD controls, and were responsive to methimazole. Conversely, TRAb2 patients had clinical features similar to AIT2 controls, and were responsive to glucocorticoids, but not to methimazole. The CHO cell functional assay demonstrated that TRAb1 IgGs had a stimulatory effect on cyclic AMP production, which was absent in TRAb2 IgGs. Pathology in TRAb1 showed hyperplastic thyroid follicles and mild lymphocyte infiltration, reflecting thyroid stimulation. On the contrary, TRAb2 samples revealed follicle destruction, macrophage infiltration, and sometimes fibrosis, consistent with a destructive process. Conclusions: Almost 60% of TRAb-positive AIT patients had a destructive thyroiditis. TRAb-positive tests in AIT patients do thus not necessarily imply a diagnosis of GD and AIT1, and should be evaluated in the clinical and biochemical setting of each AIT patient and confirmed by measuring thyroid-stimulating immunoglobulins.
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Affiliation(s)
- Daniele Cappellani
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppina De Marco
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eleonora Ferrarini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liborio Torregrossa
- Pathology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Agostino Maria Di Certo
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giada Cosentino
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Urbani
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Marconcini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mattiello
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Manetti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Patrizia Agretti
- Laboratory of Chemistry and Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Pathology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Massimo Tonacchera
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luigi Bartalena
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Fausto Bogazzi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Guo K, Ling H, Zhou X, Ying C. Age Moderates the Impact of TRAbs on Thyroid Hormones and Hepatic Function in Patients with Graves' Disease. Horm Metab Res 2021; 53:453-460. [PMID: 34282596 DOI: 10.1055/a-1510-9100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Thyrotropin receptor antibodies (TRAbs) play a significant role in the course of hepatic dysfunction (HDF) in patients with Graves' disease (GD). However, few studies have considered the factors that influence the relationships among TRAbs, thyroid hormone levels, and hepatic function in subjects with newly diagnosed GD. Here we investigated the associations of TRAbs with thyroid hormones and hepatic function and assessed potential factors that can influence these associations among patients with GD. A total of 368 patients newly diagnosed with GD were collected in this cross-sectional study. Patients who had received antithyroid drugs, radioactive iodine, or surgery were excluded. Levels of TRAbs and thyroid hormones and hepatic function were recorded. Linear and binary logistic regression analysis models were applied to investigate associations among these variables after adjusting for confounding characteristics. There was a significant difference in TRAbs indices between the HDF and normal hepatic function groups (p <0.05). After adjusting for confounders, the relationship between TRAbs and thyroid hormones was nonlinear, showing a curve with an initial positive slope and a subsequent flattening (p <0.05). Higher TRAbs were associated with HDF [odds ratio (OR) 1.036, 95% confidence interval (CI) 1.018-1.053 per 1-IU/l increase]. These associations were modified by age, but not by gender, smoking status, Graves' orbitopathy, thyroid-peroxidase antibody levels, or thyroglobulin antibody levels. In younger patients, increasing TRAbs were correlated with higher thyroid hormones and HDF (OR 1.034, 95% CI 1.017-1.052) per1-IU/l increase). In older patients, TRAbs were not correlated with thyroid hormones or HDF (OR 1.024, 95% CI 0.993-1.056) per 1-IU/l increase. Age can affect the impact of TRAbs on thyroid hormone levels and hepatic function in GD. TRAb measurement can have good predictive value in younger patients.
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Affiliation(s)
- Kai Guo
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hongwei Ling
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaoyan Zhou
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Changjiang Ying
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Masuda S, Yoshida S, Kudo C, Tsujimoto Y, Yasui S, Endo F, Mitsui Y, Kurahashi K, Endo I, Todoroki T, Abe M. [A delayed diagnosis of thyroid storm in an elderly patient: A case report]. Nihon Ronen Igakkai Zasshi 2021; 58:158-163. [PMID: 33627553 DOI: 10.3143/geriatrics.58.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 70-year-old woman was hospitalized for diarrhea, vomiting, loss of appetite, fatigue, and dyspnea on exertion for the past 3 weeks and treated with intravenous fluid for dehydration. She was receiving prednisolone for polymyositis. She did not have a history of thyroid disease. On day 4 of hospitalization, the patient was diagnosed with congestive heart failure and tachycardiac atrial fibrillation, and treatment with a diuretic agent was initiated. On day 7 of hospitalization, a clinical laboratory evaluation revealed that the level of free thyroxine was 9.95 ng/dL, free triiodothyronine was >30 pg/mL, and thyroid-stimulating hormone was <0.01 μU/mL, and the patient was initially diagnosed with thyrotoxicosis because of Graves' disease. She showed restlessness and had a fever of 39 °C, tachycardia of ≥140 beats/min, pulmonary edema, and frequent diarrhea, all of which were consistent with the symptoms of thyroid storm. Her general condition gradually improved with comprehensive treatment of thyroid storm comprising thiamazole, potassium iodide, hydrocortisone, and landiolol. A reassessment revealed that the patient had already had thyrotoxicosis and thyroid storm on admission. Thyroid storm is a potentially fatal disease that must be urgently addressed; however, its symptoms are difficult to distinguish from those caused by other diseases. Furthermore, elderly individuals may not exhibit typical symptoms of thyroid storm, so the diagnosis is difficult. In this case, the diagnosis was delayed because of the absence of typical symptoms of thyroid storm and the influence of a pre-existing medical condition and medication.
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Affiliation(s)
- Shiho Masuda
- Department of Endocrinology and Metabolism, Tokushima University Hospital
| | - Sumiko Yoshida
- Department of Endocrinology and Metabolism, Tokushima University Hospital
| | - Chiaki Kudo
- Department of Endocrinology and Metabolism, Tokushima University Hospital
| | - Yoshimi Tsujimoto
- Department of Endocrinology and Metabolism, Tokushima University Hospital
| | - Saya Yasui
- Department of Endocrinology and Metabolism, Tokushima University Hospital
| | - Furi Endo
- Department of Endocrinology and Metabolism, Tokushima University Hospital
| | - Yukari Mitsui
- Department of Endocrinology and Metabolism, Tokushima University Hospital
| | - Kiyoe Kurahashi
- Department of Endocrinology and Metabolism, Tokushima University Hospital
| | - Itsuro Endo
- Department of Endocrinology and Metabolism, Tokushima University Hospital
| | - Takafumi Todoroki
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Masahiro Abe
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences
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Lu L, Gao C, Zhang N. Age moderates the associations between TRAbs, free T3 and outcomes of Graves' disease patients with radioactive iodine treatment. Clin Endocrinol (Oxf) 2021; 94:303-309. [PMID: 32734611 PMCID: PMC7818480 DOI: 10.1111/cen.14301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/19/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aimed to explore whether age moderates the associations between TSH receptor antibodies (TRAbs) with thyroid hormones and remission in patients with Graves' disease (GD) who undergo radioactive iodine (RAI) treatment. DESIGN A single-centre retrospective study. PATIENTS A total of 435 eligible consecutive patients diagnosed with GD and treated with RAI therapy were included. METHODS TRAbs and thyroid hormones prior to RAI were recorded. Pearson's correlation, t tests and analysis of covariance were conducted to identify the associations between TRAbs, thyroid hormones and remission. Moderation analyses were conducted to test age as a moderator. RESULTS Overall, 75.4% of the patients achieved remission with a single dose of iodine-131. TRAb levels before RAI were positively correlated with the circulating thyroid hormones (ps < 0.001). Age moderated the association between TRAbs and free T3 (FT3) (P = .01), but did not moderate the association between TRAbs and free T4 (FT4) (P = .07). TRAb levels before RAI only significantly predicted remission status in young patients (P = .03), but not in middle-aged (P = .36) or older patients (P = .74), after adjusting for covariates. When age was included as a continuous variable, moderation analyses revealed that the association between TRAbs and remission status was stronger in younger patients (P = .03). CONCLUSIONS The majority of Graves' disease patients experienced a long-term remission following a single dose of iodine-131. Associations between TRAbs, FT3 and remission are moderated by age. TRAb level prior to RAI is a significant remission in younger patients, but not in middle-aged or older patients.
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Affiliation(s)
- Lusi Lu
- Department of EndocrinologySchool of MedicineSir Run Run Shaw HospitalZhejiang UniversityHangzhouChina
| | - Chenlu Gao
- Department of Psychology and NeuroscienceBaylor UniversityWacoTXUSA
| | - Nan Zhang
- Department of EndocrinologySchool of MedicineSir Run Run Shaw HospitalZhejiang UniversityHangzhouChina
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Chen L, Zhang M, Xiang S, Jiang X, Gu H, Sha Q, Qu M, Xu T. Association Between Thyroid Function and Body Composition in Type 2 Diabetes Mellitus (T2DM) Patients: Does Sex Have a Role? Med Sci Monit 2021; 27:e927440. [PMID: 33387440 PMCID: PMC7786834 DOI: 10.12659/msm.927440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The relationship between thyroid hormones and body anthropometric measures in type 2 diabetes mellitus (T2DM) patients with normal thyroid function is unclear. The purpose of this study was to evaluate the association between thyroid hormones and body composition in euthyroid T2DM patients in men and women. MATERIAL AND METHODS This was a cross-sectional study that included 561 euthyroid T2DM patients. Fasting venous blood was collected to test laboratory indexes. Bioelectric impedance analysis (BIA) was used to measure body composition. Propensity score matching (PSM) was used to enroll patients with similar baseline characteristics. The least absolute shrinkage and selection operator (LASSO) algorithm was used to establish a linear regression model of thyroid hormone and body composition. PSM was performed to match 159 men and 159 women. RESULTS The LASSO regression analysis suggested that thyroid-stimulating hormone (TSH) level was not correlated with body composition parameters in females. In females, free triiodothyronine (FT3) level was positively correlated with body mass index (BMI), fat-free mass index (FFMI), and skeletal muscle index (SMI), and was negatively correlated with extracellular water fraction (EWF). In males, FT3 level was positively correlated with waist circumference (WC) and SMI and negatively correlated with EWF. Free thyroxine (FT4) level in both women and men was positively correlated with body fat mass (BFM) and left lower-limb muscle mass (LLLMM). Moreover, in males, FT4 level was correlated with more body composition parameters. In euthyroid T2DM patients, FT3 level was positively correlated with SMI and negatively correlated with EWF, while FT4 level was positively correlated with BFM and LLLMM. CONCLUSIONS Thyroid function can affect body composition in euthyroid T2DM patients. Thyroid function is more likely to affect the fat and muscle distribution of males than females.
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Affiliation(s)
- Lu Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland).,Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Min Zhang
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Shoukui Xiang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Xiaohong Jiang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Hongliu Gu
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Qi Sha
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Meidi Qu
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Ting Xu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
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Lan C, Hu L, Liao C, Shi Y, Wang Y, Cheng S, Huang W. Thyroid-Stimulating Hormone Receptor Autoimmunity and Local Factors in Multiple Risk Factors Are Mainly Involved in the Occurrence of Pretibial Myxedema. J Clin Med Res 2020; 12:711-723. [PMID: 33224373 PMCID: PMC7665869 DOI: 10.14740/jocmr4352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/07/2020] [Indexed: 01/26/2023] Open
Abstract
Background Pretibial myxedema (PTM) is a local mucinous dermopathy associated with thyroid diseases. Since the etiology of PTM is unclear, the aim of this study is to identify the risk factors for PTM and their etiological roles in PTM occurrence. Methods A large-scale case-control study (n = 1,200) was performed to identify risk factors for PTM by calculating odds ratio (OR) values and 95% confidential intervals. The PTM group entered a glucocorticoid treatment trial. Patients with complete response were followed up to the first relapse in a cohort study. The relative risk (RR) values of the main risk factors were calculated for PTM relapse to test their etiological roles. Results Among the 19 factors, six risk factors were identified: thyroid-stimulating hormone (TSH) receptor antibody (TRAb) (OR 42.93), autoimmune thyroid disease (AITD) or AITD history (OR 10.30), local trauma (OR 6.55), venous stasis posture (OR 6.16), cigarette smoking (OR 4.48), and age (OR 1.05). Serum TRAb levels were positively correlated with the severity of PTM. Of note, 371/400 patients received glucocorticoid treatment, and 330 achieved complete response. The serum TRAb levels after treatment decreased dramatically compared with those before treatment. After stopping glucocorticoid treatment, serum TRAb levels increased significantly when PTM relapsed (P < 0.001). In 165 relapse cases, an increase in serum TRAb levels occurred first, followed by persistent venous stasis posture or local trauma and finally PTM. The RR of elevated serum TRAb levels was 6.73 in PTM relapse cases. In the elevated serum TRAb level group, the RRs of local trauma, venous stasis posture, and local trauma plus venous stasis posture were 8.81, 6.5, and 8.84, respectively, for PTM relapse cases. Conclusions TSHR autoimmunity and local factors in the six identified risk factors are the main causes of PTM occurrence.
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Affiliation(s)
- Changgui Lan
- Department of Dermatology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Liping Hu
- Department of Dermatology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Chengqi Liao
- Department of Dermatology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Yuhong Shi
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Yi Wang
- Department of Dermatology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Shuanghua Cheng
- Department of Pathology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
| | - Wei Huang
- Department of Health Checkup Center, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation (CNNC) 416 Hospital, Chengdu, China
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Chen X, Zheng X, Ding Z, Su Y, Wang S, Cui B, Xie Z. Relationship of gender and age on thyroid hormone parameters in a large Chinese population. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:52-58. [PMID: 31576967 PMCID: PMC10522289 DOI: 10.20945/2359-3997000000179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 08/15/2019] [Indexed: 11/23/2022]
Abstract
Objective This study aimed to present the impact of age and gender on thyroid hormone levels in a large Chinese population with sufficient iodine intake. Subjects and methods A total of 83643 individuals were included and were stratified by age and gender. The median, 2.5th and 97.5th of thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and FT3/FT4 ratio were calculated for both genders for every decade from 18 to over 80 years. TSH, FT3, FT4, FT3/FT4 distribution in each age group was evaluated for females and males using smoothing splines in the generalized additive models (GAM). TSH concentrations were compared in the different age groups in gender. Results In the over 80s age group, the TSH level (median: 2.57 mIU/L, 2.5th-97.5th: 0.86-7.56 mIU/L) was significantly higher than other age groups, irrespective to gender (P<0.001). Females had a higher TSH value than males in all age groups (P<0.001). Results of the smoothing curves showed that TSH increased with age, FT3 concentration was higher in males than in females and the tendency of the FT3/FT4 ratio was basically similar to that of FT3. TSH concentration in the 50s age group (median 2.48 mIU/L for females versus 2.00 mIU/L for males) was significantly higher than that in the 30s age group (median 2.18 mIU/L for females versus median 1.85 mIU/L for males). Conclusions In accord with increasing TSH values during aging, females and older adults have lower FT3 values and lower FT3/FT4 ratios, while the FT4 values remain stable.
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Affiliation(s)
- Xinxin Chen
- Ruijin HospitalShanghai Jiao Tong UniversitySchool of MedicineShanghaiChina Clinical Center for Endocrine and Metabolic Diseases, Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xulei Zheng
- Shanghai Xuhui Central HospitalZhongshan-Xuhui HospitalFudan UniversityShanghaiChina Department of Endocrinology, Shanghai Xuhui Central Hospital/Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - Zhaojun Ding
- Ruijin HospitalShanghai Jiao Tong UniversitySchool of MedicineShanghaiChina Clinical Center for Endocrine and Metabolic Diseases, Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Su
- Clinical LaboratorySichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChinaClinical Laboratory, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences SichuanTranslational Medicine Research HospitalChengduChinaChinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Shu Wang
- Ruijin HospitalShanghai Jiao Tong UniversitySchool of MedicineShanghaiChina Clinical Center for Endocrine and Metabolic Diseases, Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Cui
- Ruijin HospitalShanghai Jiao Tong UniversitySchool of MedicineShanghaiChina Clinical Center for Endocrine and Metabolic Diseases, Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Xie
- Chinese Academy of Sciences SichuanTranslational Medicine Research HospitalChengduChinaChinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Department of DermatologySichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChinaDepartment of Dermatology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Le Moli R, Malandrino P, Russo M, Lo Giudice F, Frasca F, Belfiore A, Vigneri R. Corticosteroid Pulse Therapy for Graves' Ophthalmopathy Reduces the Relapse Rate of Graves' Hyperthyroidism. Front Endocrinol (Lausanne) 2020; 11:367. [PMID: 32595602 PMCID: PMC7301650 DOI: 10.3389/fendo.2020.00367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/11/2020] [Indexed: 01/11/2023] Open
Abstract
Background: A course of anti-thyroid drugs (ATD) is the most common first line treatment for Graves' hyperthyroidism. However, hyperthyroidism relapse is frequent (30-70%). Due to the autoimmune nature of Graves' disease, the immunosuppressive treatment used for active Graves' orbitopathy (GO) may reduce the relapses after ATD discontinuation. Objective: To evaluate the recurrence rate in Graves' patients who, in addition to standard ATD, were treated or not treated with parenteral methylprednisolone (MPDS) for GO. Methods: Single-center retrospective study in a continuous series of 162 newly diagnosed Graves' patients, with or without GO, all gone into remission and followed-up until hyperthyroidism recurrence or at least 4 years after ATD discontinuation. Patients with moderate-severe active GO underwent middle dose MPDS treatment according to the EuGoGo guidelines. Cox proportional-hazard model was used to comparatively evaluate the risk of recurrence and the predictive factors in patients treated or not treated with MPDS pulse therapy. Results: MPDS treatment was the most significant factor that independently correlated with a reduced risk of hyperthyroidism relapse (HR = 0.53, 95% C.I. = 0.31-0.89). FT3 and female sex were also independent protective factors, while age almost reached the significance level, p = 0.062. The efficacy of MPDS was very high in patients aged <40 years (42.1% decrease in relapses, p < 0.01) but it was not significant in older patients. Discussion: Our study found that after ATD discontinuation the frequency of Graves' hyperthyroidism relapse was reduced in patients treated with MPDS pulse therapy for GO. This effect was more marked in young patients.
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Affiliation(s)
- Rosario Le Moli
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
- *Correspondence: Rosario Le Moli
| | - Pasqualino Malandrino
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Marco Russo
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Fabrizio Lo Giudice
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Francesco Frasca
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Antonino Belfiore
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Riccardo Vigneri
- Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
- Institute of Crystallography, Structural Chemistry and Biosystems, CNR-ICCSB, Catania, Italy
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Wang SY, Wang CT, Tien KJ, Chang CC, Liu TH. Thyroid-stimulating hormone receptor antibodies during follow-up as remission markers in childhood-onset Graves' disease treated with antithyroid drugs. Kaohsiung J Med Sci 2019; 36:281-286. [PMID: 31849168 DOI: 10.1002/kjm2.12167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/21/2019] [Indexed: 01/14/2023] Open
Abstract
Graves' disease is uncommon in children. The remission rate after antithyroid drugs (ATD) therapy is lower than in adults. We evaluated the clinical course of ATD therapy in children with Graves' disease in southern Taiwan to determine whether their biochemical markers could be used to predict remission in these patients. We retrospectively reviewed the clinical data of 53 children diagnosed with Graves' disease between 2009 and 2019. Clinical and biochemical parameters were analyzed for predictors of remission. About three-fourths of the patients were female. Their median age at diagnosis was 13 years. No sex differences were found in most clinical characteristics. There was no correlation between thyroid-stimulating hormone receptor antibody (TRAb) levels at diagnosis and thyroid function or adverse reactions to ATD. Relapse occurred in 62% of patients after discontinuation of first-course ATD therapy. Three variables-good initial response to ATD, a decrease in TRAb levels during the first year after diagnosis, and a decrease in TRAb levels during the second year after diagnosis-were significant predictors of remission for more than 18 months. In conclusion, children with Graves' disease who had early ATD-controlled Graves' disease and decreased TRAb levels during the first 2 years are likely to enter remission for more than 18 months.
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Affiliation(s)
- Shuo-Yu Wang
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Chia-Ti Wang
- Department of Emergency, Chi Mei Medical Center, Tainan, Taiwan
| | - Kai-Jen Tien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chao-Chun Chang
- Radioimmunoassay Laboratory, Department of Nuclear Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ting-Hsiu Liu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
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