A TSHR-LH/CGR Chimera that Measures Functional Thyroid-Stimulating Autoantibodies (TSAb) Can Predict Remission or Recurrence in Graves' Patients Undergoing Antithyroid Drug (ATD) Treatment

Giuliani, Cesidio; Cerrone, D.; Harii, Norikazu; Thornton, Mark; Kohn, Leonard D.; Dagia, Nilesh M.; Bucci, Ines; Carpentieri, Maria; Nenno, Barbara Di; Blasio, Andrea Di; Vitti, Paolo; Monaco, Fabrizio; Napolitano, Giorgio

doi:10.1210/jc.2011-2897

Cited by 45 publications

(43 citation statements)

References 21 publications

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“…A functional TRAb assay, utilizing a chimeric TSH receptor (Mc4), has shown superior efficacy in predicting relapse following thionamide withdrawal, in 33 patients, in whom thionamide withdrawal was attempted. However, pending confirmation of these promising early data, the Mc4 assay is unlikely to be widely available for clinical use (15). The findings in our cohort are difficult to reconcile with previous reports suggesting no predictive value of cessation TRAbs (16) but are congruent with the findings of a number of other investigators (8, 17,18).…”

Section: Discussioncontrasting

confidence: 50%

Thyrotropin Receptor Antibody Levels at Diagnosis and After Thionamide Course Predict Graves' Disease Relapse

Tun

Beckett

Zammitt

et al. 2016

Thyroid

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Section: Discussioncontrasting

confidence: 50%

Thyrotropin Receptor Antibody Levels at Diagnosis and After Thionamide Course Predict Graves' Disease Relapse

Tun

Beckett

Zammitt

et al. 2016

Thyroid

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“…Measurement of TSH-R-Ab levels prior to stopping ATD therapy is recommended, as it aids in predicting which patients can be weaned from the medication, with normal levels indicating a greater chance of remission [5,22]. Monitoring the titers of functional stimulatory and blocking TSH-R-Ab during treatment help in predicting the outcome [58,59]. Patients with persistently high TSH-R-Ab at 12-18 months can continue MMI therapy, repeating the TSH-R-Ab measurement after an additional 12 months, or opt for RAI or thyroidectomy (Fig.…”

Section: Medical Treatmentmentioning

confidence: 99%

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

Kahaly¹,

Bartalena²,

Hegedüs³

et al. 2018

Eur Thyroid J

678

650

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Graves’ disease (GD) is a systemic autoimmune disorder characterized by the infiltration of thyroid antigen-specific T cells into thyroid-stimulating hormone receptor (TSH-R)-expressing tissues. Stimulatory autoantibodies (Ab) in GD activate the TSH-R leading to thyroid hyperplasia and unregulated thyroid hormone production and secretion. Diagnosis of GD is straightforward in a patient with biochemically confirmed thyrotoxicosis, positive TSH-R-Ab, a hypervascular and hypoechoic thyroid gland (ultrasound), and associated orbitopathy. In GD, measurement of TSH-R-Ab is recommended for an accurate diagnosis/differential diagnosis, prior to stopping antithyroid drug (ATD) treatment and during pregnancy. Graves’ hyperthyroidism is treated by decreasing thyroid hormone synthesis with the use of ATD, or by reducing the amount of thyroid tissue with radioactive iodine (RAI) treatment or total thyroidectomy. Patients with newly diagnosed Graves’ hyperthyroidism are usually medically treated for 12–18 months with methimazole (MMI) as the preferred drug. In children with GD, a 24- to 36-month course of MMI is recommended. Patients with persistently high TSH-R-Ab at 12–18 months can continue MMI treatment, repeating the TSH-R-Ab measurement after an additional 12 months, or opt for therapy with RAI or thyroidectomy. Women treated with MMI should be switched to propylthiouracil when planning pregnancy and during the first trimester of pregnancy. If a patient relapses after completing a course of ATD, definitive treatment is recommended; however, continued long-term low-dose MMI can be considered. Thyroidectomy should be performed by an experienced high-volume thyroid surgeon. RAI is contraindicated in Graves’ patients with active/severe orbitopathy, and steroid prophylaxis is warranted in Graves’ patients with mild/active orbitopathy receiving RAI.

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“…The recurrence risk was higher in TRAb-positive GD patients at the time of drug withdrawal [41, 43, 50]. In addition, TRAb can be distinguished from the stimulating (TSAb) and blocking (TBAb) properties by using new assay techniques [53]. Antibodies of GD patients are predominantly TSAb [1].…”

Section: Influencing Factors For the Recurrence In Gd Patientsmentioning

confidence: 99%

“…Antibodies of GD patients are predominantly TSAb [1]. Recently, TSAb has been demonstrated to have a superior predictive value for recurrence risk than TRAb in GD patients treated with ATD [53–55]. …”

Section: Influencing Factors For the Recurrence In Gd Patientsmentioning

confidence: 99%

Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

Liu

et al. 2017

International Journal of Endocrinology

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Graves' disease (GD) is the most common cause of hyperthyroidism worldwide. Current therapeutic options for GD include antithyroid drugs (ATD), radioactive iodine, and thyroidectomy. ATD treatment is generally well accepted by patients and clinicians due to some advantages including normalizing thyroid function in a short time, hardly causing hypothyroidism, and ameliorating immune disorder while avoiding radiation exposure and invasive procedures. However, the relatively high recurrence rate is a major concern for ATD treatment, which is associated with multiple influencing factors like clinical characteristics, treatment strategies, and genetic and environmental factors. Of these influencing factors, some are modifiable but some are nonmodifiable. The recurrence risk can be reduced by adjusting the modifiable factors as much as possible. The titration regimen for 12–18 months is the optimal strategy of ATD. Levothyroxine administration after successful ATD treatment was not recommended. The addition of immunosuppressive drugs might be helpful to decrease the recurrence rate of GD patients after ATD withdrawal, whereas further studies are needed to address the safety and efficacy. This paper reviewed the current knowledge of ATD treatment and mainly focused on influencing factors for recurrence in GD patients with ATD treatment.

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A TSHR-LH/CGR Chimera that Measures Functional Thyroid-Stimulating Autoantibodies (TSAb) Can Predict Remission or Recurrence in Graves' Patients Undergoing Antithyroid Drug (ATD) Treatment

Abstract: The Mc4 assay is a clinically useful index of remission and relapse in patients with GD. Larger studies are required to confirm these findings.

Cited by 45 publications

References 21 publications

Thyrotropin Receptor Antibody Levels at Diagnosis and After Thionamide Course Predict Graves' Disease Relapse

Thyrotropin Receptor Antibody Levels at Diagnosis and After Thionamide Course Predict Graves' Disease Relapse

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

Antithyroid Drug Therapy for Graves’ Disease and Implications for Recurrence

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