Serum Thyroid-Stimulating Antibody, Thyroglobulin Levels, and Thyroid Suppressibility Measurement as Predictors of the Outcome of Combined Methimazole and Triiodothyronine Therapy in Graves' Disease

Werner, R. S.; Romaldini, João Hamilton; Farah, Chady S.; Werner, M. C.; Bromberg, N.

doi:10.1089/thy.1991.1.293

Cited by 18 publications

(9 citation statements)

References 28 publications

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“…Hyperthyroidism in adults follows a more benign course than in children, with 49 -75% of adults achieving remission after short courses (Յ24 months) of antithyroid medication, compared with only 25% of children (3,4,9,17,18,25,26). Therefore, it may not be appropriate to apply results of adult studies to pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Early Remission of Hyperthyroidism in Children1

Glaser

Styne

1997

The Journal of Clinical Endocrinology &Amp; Metabolism

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Children with hyperthyroidism often require prolonged courses of antithyroid medication to achieve remission, and long-term compliance is problematic. To determine which clinical and laboratory features predict early remission, we reviewed the records of 191 patients less than 19 yr old with Graves' disease. We compared patients achieving remission within 2 yr (group 1, n ϭ 27) with those who completed more than 2 yr of medical therapy but did not achieve a remission (group 2, n ϭ 79). Patients who were in neither of the above categories (n ϭ 85) were excluded from the statistical analysis. Variables that were measurable at the time of diagnosis, recorded in more than 50% of the study population and associated with early remission in the univariate analysis (P Յ 0.05), were entered into a stepwise multiple logistic regression analysis. Variables retaining a significant association with early remission (P Ͻ 0.05) were considered independent predictors of early remission. Patients achieving early remission were older (mean, 12.5 vs. 10.9 yr, P ϭ 0.039) and had higher body mass indexes (BMI, 19.0 vs. 16.6, P ϭ 0.002), higher BMI SD scores (Ϫ0.03 vs. Ϫ0.60, P ϭ 0.004), lower heart rates (110 vs. 121, P ϭ 0.023), smaller goiters (group 1: 60% with moderate/large goiter; group 2: 83%, P ϭ 0.050), lower platelet counts (272 vs. 339 K/L, P ϭ 0.006), lower serum T 4 and T 3 concentrations at presentation (T 4 : 18.3 vs. 22.5 g/dL, P ϭ 0.015; T 3 : 439 vs. 613 ng/dL, P ϭ 0.008), and were less likely to have a positive test for thyroid stimulating Igs (group 1: 50% vs. group 2: 93%, P ϭ 0.008). Regression analysis identified BMI SD score and goiter size as independent predictors of early remission (P Ͻ 0.05). Eighty-six percent of patients with BMI SD score above Ϫ0.5 SD and minimal/small goiters achieved early remission, compared with 13% of those with BMI SD score below Ϫ0.5 SD and moderate/large goiters. We conclude that, of multiple clinical and laboratory variables associated with early remission, BMI SD score and goiter size are independent predictors. Algorithms employing these two variables can be used to facilitate counseling of patients and expedite therapeutic decisions. (J Clin Endocrinol Metab 82: 1719 -1726, 1997) T HE OPTIMAL treatment of hyperthyroidism in children is a subject of controversy. The three therapeutic options (antithyroid medications, subtotal thyroidectomy, and ablation with radioactive iodine) all carry a risk of serious complications (1). In children, medical therapy frequently is chosen as the initial treatment to avoid surgery and possible long-term teratogenic or carcinogenic effects of radioiodine (2). Most children require relatively long periods of medical therapy, as only 25% of children achieve remission with every 2 yr of medical treatment (3, 4). It is frequently difficult, however, to achieve long-term compliance. Therefore, elucidation of prognostic factors for the outcome of medical therapy would improve patient counseling and expedite appropriate therapeutic decisio...

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Section: Discussionmentioning

confidence: 99%

Predictors of Early Remission of Hyperthyroidism in Children1

Glaser

Styne

1997

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…The remission of GD also seems to be associated with the return of the thyrotropin (TSH) concentration to normal and maintenance of euthyroidism throughout treatment (14). Furthermore, it has been shown that patients with continuing thyrotropin suppression have low remission rates and need prolonged therapy (15,16), while hypothyroidism during methimazole treatment is a favorable indicator of long term remission (17,18).…”

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confidence: 99%

The Time to Thyroid-Stimulating Hormone Recovery During Medical Treatment in Graves’ Disease and Autonomous Hyperthyroidism

Martin¹

2013

Acta Endo (Buc)

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Context. In medically treatedGraves' disease (GD) patients, prolonged low serum TSH levels represent an independent risk factor for relapse. The predictors of this prolonged TSH suppression are still debatable.Objectives. The primary endpoint of this study was to identify predictors of the time to TSH recovery (TTR), in GD patients, at diagnosis and during ATDs treatment. The secondary endpoint was to compare the TTR between patients with GD and autonomous hyperthyroidism.Subjects and Methods. We retrospectively analyzed 109 newly diagnosed hyperthyroid patients (90 with GD and 19 with autonomous hyperthyroidism), consecutively evaluated in a tertiary center. The main features recorded were: TSH and thyroid hormone levels at diagnosis and follow-up visits, the TTR and the mean dose of ATDs/day.Results. There was no significant difference regarding the TTR between patients with GD and autonomous hyperthyroidism. In GD patients, age at diagnosis, gender, goiter size, smoking status, thyroid antibody titers and ophtalmopathy presence did not seem to influence the TTR. GD patients with higher FT3, TT3 at diagnosis and higher TT3 at the first visit after ATDs administration (V1) needed longer TTR, after adjusting for the mean dose of ATDs/day. FT3 at diagnosis and TT3 at V1 are significant predictors for the TTR in GD patients.Conclusions. The time to TSH recovery was not significantly different between patients with GD and autonomous hyperthyroidism. In GD patients, the time to TSH recovery is longer in patients with more severe T3 hyperthyroidism at diagnosis and at the first visit after ATDs administration.

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“…The model therefore predicts that serum TSH in thyrotoxicosis, particularly in the context of Graves' disease, would be exquisitely sensitive to any increase in serum TSHRAb, and may partially account for the common observation of the very prolonged suppression of TSH in this form of thyrotoxicosis also demonstrated recently by a group of investigators (Chung et al, 2006). Serum TSH indeed may only normalize after TSHRAb has declined sufficiently following ATD therapy, possibly through the indirect immunomodulatory actions of chronic ATD use (Volpe, 2001;Cooper, 2005;Werner et al, 1991). In recent years, another contributory factor to the persistently suppressed TSH has been proposed to be due to the prolonged suppression of TSH secretion in Graves' disease via putative TSH receptors found in the pituitary gland itself (Brokken et al, 2001;Ando et al, 2004).…”

Section: Application Of Model To Analyze Tsh Responses In Hyperthyroimentioning

confidence: 78%

A mathematical model of pituitary–thyroid interaction to provide an insight into the nature of the thyrotropin–thyroid hormone relationship

Leow

2007

Journal of Theoretical Biology

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Serum Thyroid-Stimulating Antibody, Thyroglobulin Levels, and Thyroid Suppressibility Measurement as Predictors of the Outcome of Combined Methimazole and Triiodothyronine Therapy in Graves' Disease

Cited by 18 publications

References 28 publications

Predictors of Early Remission of Hyperthyroidism in Children1

Predictors of Early Remission of Hyperthyroidism in Children1

The Time to Thyroid-Stimulating Hormone Recovery During Medical Treatment in Graves’ Disease and Autonomous Hyperthyroidism

A mathematical model of pituitary–thyroid interaction to provide an insight into the nature of the thyrotropin–thyroid hormone relationship

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