Development of Spontaneous Hypothyroidism in Patients with Graves' Disease Treated with Antithyroidal Drugs: Clinical, Immunological, and Histological Findings in 26 Patients

Abstract

Graves' disease may result eventually in hypothyroidism in approximately 5-20% of patients. In a few such patients hypothyroidism was associated with TSH-blocking antibodies, but whether the frequency of TSH-blocking antibodies in such patients is as high as it is (21%) in patients with primary myxedema is not known. This study was undertaken to determine the presence of various immunoglobulins [TSH binding inhibitor immunoglobulins, thyroid-stimulating antibodies (TSAb), and TSH-blocking antibodies] in 26 patients with Graves' disease who developed hypothyroidism from 0.5-10 yr or more after discontinuation of antithyroid drug therapy. Eight of the 26 patients (31%) had TSH-blocking antibodies, 16 (61%) had TSAb, and 14 (54%) had thyroid hormone binding inhibitor immunoglobulins. Thyroid needle biopsies were performed in 9 patients. Three of 5 patients who had subclinical hypothyroidism had chronic lymphocytic thyroiditis, and all had positive TSAb titers. Three patients had the fibrous variant of chronic lymphocytic thyroiditis; their TSAb values were 902%, 431%, and 1290%. One patient had follicular hyperplasia. We conclude that TSH-blocking antibodies may account for hypothyroidism in approximately one third of patients with Graves' disease who were previously treated with antithyroid drugs, and that autoimmune thyroiditis is comparable for the hypothyroidism in the remaining two thirds of Graves' disease patients.

A Singular Case of Graves’ Disease in Congenital Thyroid Hemiagenesis

“…Clinically evident ophthalmopathy occurs in about 50% of patients, in 75% of which the eye problems appear within a year before or after diagnosis of hyperthyroidism. Probably in relation to the activity of the underlying autoimmune process, Graves’ hyperthyroidism is characterized by an unpredictable course; in about 15% of cases, autoimmune hypothyroidism develops 10 to 15 years after presentation [5, 6]. Consistent with literature data, in a previous study we observed spontaneous evolution to hypothyroidism in almost 10% (10 of 105) of Graves’ patients [7].…”

Thyrotropin-Blocking Autoantibodies and Thyroid-Stimulating Autoantibodies: Potential Mechanisms Involved in the Pendulum Swinging from Hypothyroidism to Hyperthyroidism or Vice Versa

“…The relatively sparse available information for this unusual group of patients is related to age, sex, and ethnicity (5,(29)(30)(31)(32)(33)(36)(37)(38)(47)(48)(49)(50)74). The majority of patients with TBAb/TSAb switches (or the reverse) are women, and they have the same age range as other patients with thyroid autoimmune disease (Table 4).…”

Graves Hastaligi Tedavisinde Sabit 10 Mci Ve 15 Mci Iyot-131 Dozlarinin Karsilastirilmasi: 11 Yillik Tecrube

“…Hipotiroidi radyasyonun bir etkisidir ve lenfositik infiltrasyon ile tiroid dokusu harabiyetine bağlıdır 16 . Bizim çalışmamızda, 10 mCi ile %78.2 hastada RAI tedavisinden ortalama yaklaşık 5 ay sonra hormon replasmanı gerektiren hipotiroidi gelişirken, bu oran 15 mCi için ortalama 4. ayda %100'e ulaştı.…”