Post-Operative Thyroid Status of Patients with Graves' Disease Is Determined by the Responsiveness of Thyrocyte to TSH under the Present Thyroid Gland Remnant.

Yamashita, Hiroto; Noguchi, Shiro; Murakami, Nobuo; Watanabe, Shin; Kawamoto, Hitoshi

doi:10.1507/endocrj.45.513

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…ST is usually chosen for Graves' disease therapy, but 5-15% of patients have recurrent thyrotoxicosis after surgery [1], which is more likely to occur in patients with high serum TRAb values before surgery [15] and severe eye involvement [5]; such patients should therefore undergo TT rather than ST [1]. Although the surgical outcomes and their relation to serum TRAb values have been demonstrated by several authors [3,4,[14][15][16][17][18][19][20][21][22][23][24], there have been only a few reports concerning the surgical outcome of TT for Graves' disease [5,[25][26][27]. In addition, the changes in the TRAb value after TT over a long period of time have never been studied.…”

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confidence: 99%

Changes in Serum TSH Receptor Antibody (TRAb) Values in Patients with Graves' Disease after Total or Subtotal Thyroidectomy

et al. 2003

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Abstract. TSH receptor antibodies (TRAb) are generally regarded as mediators of thyroid stimulation in Graves' disease. In addition, a high serum TRAb value during pregnancy is one of the risk factors for intrauterine death, prematurity, and fetal or neonatal hyperthyroidism. Recently, correlations between a high serum TRAb value and endocrine opthalmopathy were also suggested. Surgical resection of the thyroid is usually followed by a reduction of serum TRAb levels in variable degrees. The relation between the extent of the thyroidectomy and the degree of reduction is still controversial. In addition, the changes in the TRAb value after total thyroidectomy (TT) over a long period of time have never been studied. We studied the changes in serum TRAb values after TT and subtotal thyroidectomy (ST) for more than 7 years. Forty-one patients with Graves' disease underwent TT, and 99 patients underwent ST. The serum TRAb values and the ratio of the patients who achieved normal values among each group (normalization rates of TRAb) at 3 and 6 months, 1, 3, 5 and 7 years after surgery were compared between the TT group and ST group. The mean preoperative TRAb values were not significantly different between the TT and ST groups, and the mean TRAb values measured 3, 6 and 12 months after surgery were not significantly different between the groups. However, the TRAb values measured 3, 5 and 7 years after surgery were significantly (p<0.05) lower in the TT group than in the ST group (16.7 ± 3.3% vs 28.0 ± 2.6%, 12.6 ± 3.4% vs 29.3 ± 3.8%, 5.6 ± 0.9% vs 25.4 ± 4.1%, respectively). The normalization rates of TRAb were not significantly different between the groups until 1 year after surgery. However, the normalization rates 3, 5 and 7 years after surgery were significantly (p<0.05) higher in the TT group than in the ST group (65.7% vs 42.4%, 77.3% vs 46.7%, 100% vs 59.1%, respectively). The surgical complication rates of TT were similar to ST except for permanent hypoparathyroidism. TT is a treatment option for Graves' disease, especially in patients with a high TRAb value who wish to have children or who have Graves' opthalmopathy.

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Changes in Serum TSH Receptor Antibody (TRAb) Values in Patients with Graves' Disease after Total or Subtotal Thyroidectomy

et al. 2003

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“…Vitti et al [2] reported that the relapse rate is dependent on the size of the goiter and the level of anti-TSHR antibody. We reported previously that the postoperative thyroid status of Graves' disease patients is determined by the responsiveness of thyrocytes to TSH in vitro [27]. Whether downregulation of TSHR is caused by continuous stimulation by anti-TSHR anti- body during Graves' disease progress is unclear.…”

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NIS mRNA Expression Level in Resected Thyroid Tissue as a Marker of Postoperative Hypothyroidism after Subtotal Thyroidectomy in Patients with Graves' Disease

et al. 2008

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Abstract. Subtotal thyroidectomy for Graves' disease sometimes leads to hypothyroidism or relapse during long-term follow-up in a significant proportion of patients. Factors predictive of postoperative hypothyroidism after subtotal thyroidectomy are not known. The objective of this study was to determine the relation between clinical features and expression of transcripts associated with thyroid hormone synthesis in resected thyroid tissues of patients with Graves' disease. Thyroid tissues were obtained from 65 patients with Graves' disease who underwent subtotal thyroidectomy. Expression of mRNAs from thyroglobulin (Tg), TSH receptor (TSHR), thyroid peroxidase (TPO), sodium/iodide symporter (NIS), and the Pendred's syndrome (PDS) genes were analyzed by quantitative reverse transcriptionpolymerase chain reaction. Uni-and multivariate analyses were performed to identify for postoperative hypothyroidism. We detected significant correlations between the NIS mRNA level and levels of free T 3 (fT 3 ) and free T 4 (fT 4 ) and between the Tg mRNA level and goiter weight before initial drug treatment. Mean levels of expression of all five mRNAs were significantly higher in patients who did not require L-thyroxine replacement therapy than in those who required replacement therapy at 6 months after surgery. In patients who did not require replacement therapy, a significant correlation was found between NIS mRNA expression and fT 4 levels. Univariate analysis revealed that decreased NIS mRNA expression (NIS/PGK<1.69) and low TBII levels before initial treatment were significant of postoperative hypothyroidism. Multivariate analysis showed decreased expression of NIS mRNA (NIS/PGK<1.69) to be an independent risk factor for L-thyroxine replacement after surgery (risk ratio, 3.26, confidence interval, 1.36-9.08, p<0.01). NIS expression reflects the level of thyroid hormone synthesis in Graves' disease patients. Evaluation of NIS mRNA expression in thyroid tissues may help determine prognoses of Graves' disease patients, and therefore an appropriate treatment can be determined for each patient.

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Post-Operative Thyroid Status of Patients with Graves' Disease Is Determined by the Responsiveness of Thyrocyte to TSH under the Present Thyroid Gland Remnant.

Cited by 2 publications

References 13 publications

Changes in Serum TSH Receptor Antibody (TRAb) Values in Patients with Graves' Disease after Total or Subtotal Thyroidectomy

Changes in Serum TSH Receptor Antibody (TRAb) Values in Patients with Graves' Disease after Total or Subtotal Thyroidectomy

NIS mRNA Expression Level in Resected Thyroid Tissue as a Marker of Postoperative Hypothyroidism after Subtotal Thyroidectomy in Patients with Graves' Disease

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