Predictors of Initial and Sustained Remission in Patients Treated with Antithyroid Drugs for Graves’ Hyperthyroidism: The RISG Study

Karmisholt, Jesper; Andersen, Stine Linding; Bulow-Pedersen, I; Carlé, Allan; Krejbjerg, Anne; Nygaard, Birte

doi:10.1155/2019/5945178

Cited by 14 publications

(20 citation statements)

References 39 publications

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“…Previous studies by Karmisholt et al and Vos et al has been conducted in order to predict recurrence in GD patients [ 12 , 21 ]. The Remission Induction and Sustenance in Graves’ Disease (RISG) study in Denmark found that only TRAb measured in the time of diagnosis of GD has the superiority as prognostic marker for GD remission [ 21 ]. Other study in the Netherlands successfully created GREAT Score for predicting recurrence in GD.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have been done to identify factors influencing the recurrence of GD, such as age, gender, thyroid size, antithyroid dosage, smoking history, thyroid echogenicity, thyroid volume, serum TSH level, thyrotropin receptor antibody (TRAb), and thyroxin peroxidase antibody (TPO-Ab) [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. A meta-analysis of pre-treatment GD patients found some significant risk factors associated with disease recurrence following ATD withdrawal.…”

Section: Introductionmentioning

confidence: 99%

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Serum TSH level as predictor of Graves’ disease recurrence following antithyroid drug withdrawal: A systematic review

et al. 2021

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Graves’ disease (GD) has a high recurrence rate despite various and adequate treatment. Numerous studies have been performed to identify the predictor of disease recurrence. This report aims to investigate the role of thyroid stimulating hormone (TSH) level as a thyrotropin in predicting the recurrence of Graves’ disease within 1 to 2 years following antithyroid drug (ATD) withdrawal. Literature searching was conducted on PubMed, Scopus, Cochrane, Proquest, EBSCO in August 2019 and Google Scholar in October 2020. The study criteria include the study that evaluates TSH level 4 weeks following ATD withdrawal, with subjects ≥18 years old who are retrospectively or prospectively followed up after 1 to 2 years following ATD withdrawal. Four eligible studies were selected based on inclusion/exclusion criteria, all of which measured TSH level at 4 weeks following ATD withdrawal. All studies had 1 to 2 years follow up. One study was an RCT, two studies were done in prospective cohort and another in retrospective cohort. All studies had comparable validity and applicability. Three out of four studies suggested that low TSH level measured 4 weeks following treatment withdrawal was associated with higher risk of disease recurrence. In conclusion, low TSH level obtained 4 weeks after ATD withdrawal was associated with higher rate of recurrence rate in GD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serum TSH level as predictor of Graves’ disease recurrence following antithyroid drug withdrawal: A systematic review

et al. 2021

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“…10,11,15,17,21,22,[24][25][26] In the 'Remission induction and sustenance in Graves' disease' (RISG) study, the rate of remisson was found to be 63% in patients with baseline TRab levels below 10 IU/l instead of 39% above 10 IU/l. 27 Quadbeck et al showed that when the cut-off value for TRab was taken as 1.5 IU/l or 10 IU/l, TRab had positive predictive value of 49% or 83%, negative predictive value of 54% or 62%, and specificity of 14% or 92%. 17 We took the cut-off value for TRab as 10 IU/l and we observed in newly-diagnosed patients that the time to become euthyroid was shorter with TRab<10IU/l compared to the TRab levels ≥10IU/l.…”

Section: Discussionmentioning

confidence: 99%

Parameters affecting the period for being euthyroid in newly-diagnosed Graves’ disease treated with antithyroid agent

Ekinci

Peynirci

2020

Int J Res Med Sci

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Background: There are limited data about the factors affecting the response time to medical treatment in Graves’ disease (GD) although many studies examined the predictors of the relapse after drug withdrawal. The aim of the current study was to evaluate the time for becoming euthyroid under antithyroid drug (ATD) therapy and the parameters influencing this period in patients diagnosed as GD.Methods: Patients with newly-diagnosed GD and decided to treat with ATD initially between March 2017 and September 2018 were retrieved retrospectively. Sociodemographic features as well as laboratory parameters like thyroid function tests and thyroid-stimulating hormone-receptor antibody (TRab) at the time of diagnosis were recorded.Results: Out of 41 patients, 63.4% (n=26) were female. The mean age was 36.1±11.7 years and 43.9% (n=18) of them were smoking. The time between the initiation of treatment and the duration of becoming euthyroid was 2.4±1.8 months. No significant difference was noted between age, gender, and smoking status and the time to become euthyroid under ATD treatment. This period was significantly positively correlated with levels of free triiodothyronine, free thyroxine, and negatively correlated with thyroid-stimulating hormone. Response to ATD therapy was higher in patients with pre-treatment TRab levels <10 IU/L than TRab ≥10 IU/L (p=0.011).Conclusions: Pretreatment thyroid function tests and TRab levels may be taken into consideration before deciding treatment in patients with newly diagnosed GD. It would be useful to design more comprehensive studies so that this proposal can find a response in clinical practice.

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“…Thyroid-stimulating antibodies can be used in GD for many objectives, such as diagnosis (4), as well as during follow-ups to predict which patients will relapse after stopping ATD (4,(9)(10)(11)(12)(13)(14). They also have important values in assessing the risks of developing GO (12) and fetal/neonatal hyperthyroidism (15,16).…”

Section: Contextmentioning

confidence: 99%

“…The use of ATD is accompanied by a series of markers demonstrating immune system restoration, such as decreased HLA in thyroid cells (17), and decreased markers of inflammation, such as Interleucines 1, 5, and 6 and tumor necrosis factor-alpha (18,19). There are also increases in T cell suppressors, decreases in T helper cells (20), and decreases in TRAb values over time (9,10,(21)(22)(23)(24).…”

Section: Serum Trab During Atd Therapymentioning

confidence: 99%

Remission Rate of Graves' Disease and the Trend of Changes in Serum TSH Receptor Antibodies in Prolonged Antithyroid Drug Treatment

Villagelin

Santos

Romaldini

2020

Int J Endocrinol Metab

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Context: Graves’ disease is an autoimmune disease caused by thyrotropin receptor antibodies (TRAb). These antibodies can be measured and used for the diagnosis, prediction of remission, and risk of Graves’ orbitopathy development. There are three treatments for Graves’ disease that have remained unchanged for the last 75 years: Antithyroid drugs, radioiodine, and surgery. Antithyroid drugs are the first treatment option worldwide and are usually used for 12 - 18 months. Recent reports suggest the use of antithyroid drugs for more than 18 months with better outcomes. This review focuses on two aspects of treatment with antithyroid drugs: The impact of using antithyroid drugs for more than 12 - 18 months on remission rates and the trend of TRAb during prolonged antithyroid drug treatment. Evidence Acquisition: A review was performed in Medline on the published work regarding the duration of ATD treatment and remission of Graves' disease and also ATD treatment and TRAb status during the 1990 - 2019 period. Results: Remission rates are variable (30% - 80%), and many clinical and genetic factors serve as predictors. The long-term use of antithyroid drugs appears to increase remission rates. TRAb values usually decline during ATD treatment, but the trend could occur in two ways: Becoming negative or showing a fluctuating pattern. However, approximately 10% of the patients will remain TRAb-positive after five years of treatment with antithyroid drugs. Conclusions: Antithyroid drugs can be used for long periods with an increase in remission rates, and a gradual decrease in TRAb levels, with the disappearance of TRAb in 90% of the patients after 60 months.

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Predictors of Initial and Sustained Remission in Patients Treated with Antithyroid Drugs for Graves’ Hyperthyroidism: The RISG Study

Cited by 14 publications

References 39 publications

Serum TSH level as predictor of Graves’ disease recurrence following antithyroid drug withdrawal: A systematic review

Serum TSH level as predictor of Graves’ disease recurrence following antithyroid drug withdrawal: A systematic review

Parameters affecting the period for being euthyroid in newly-diagnosed Graves’ disease treated with antithyroid agent

Remission Rate of Graves' Disease and the Trend of Changes in Serum TSH Receptor Antibodies in Prolonged Antithyroid Drug Treatment

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