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Thyroid peroxidase autoantibodies are associated with a lesser likelihood of late reversion to hyperthyroidism after successful non-ablative treatment of Graves’ disease in Croatian patients

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Abstract

Background

Thyroid peroxidase autoantibodies (TPOAbs) are frequently observed in Graves’ disease (GD) and tend to persist in patients even after successful treatment with antithyroid drugs. However, there is a lack of consistent data regarding the prognostic significance of TPOAbs during and after non-ablative treatment for Graves’ hyperthyroidism.

Aim

To assess the prognostic value of TPOAbs on the long-term outcome of GD patients, who were in remission after the use of antithyroid drugs (block-and-replace regimen).

Subjects

100 remitters were retrospectively investigated for factors associated with the 5-year course of disease recurrence and compared to 60 age/sex-matched patients with intractable GD.

Results

Mild hyperthyroidism, low baseline thyroid-stimulating antibodies levels, and small goiters were predictive of remission. Once attained, the remission was shorter in younger patients, patients with declining post-treatment TSH values, and negative baseline TPOAb levels. The 5-year cumulative incidence of relapse incrementally increased from 24 to 44 to 70 % across decreasing TPOAb tertiles (log-rank, p = 0.00056; the lower tertile representing TPOAb-negative cases). The age-of-onset (p = 0.034), and the baseline TPOAb value [upper tertile, hazard ratio (HR) 0.25; 95 % confidence interval, 0.11–0.59; p = 0.0014; middle tertile, HR 0.47 (0.24–0.9); p = 0.024; Cox regression] were inversely associated with late (>12 months) relapse rates in a level-dependent manner. In contrast, serum logTSH measured 6 months after drug discontinuation was inversely associated with hazard rates at all time points (p = 0.0005).

Conclusion

Baseline TPOAb positivity is an independent indicator of long-term remission in GD patients who have been successfully treated, but the mechanism of action and causal relations remain unknown.

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Acknowledgments

This work was supported by the Ministry of Science, Education and Sports of the Republic of Croatia (Grant No. 219-2190372-2068).

Conflict of interest

The authors M. Stefanic and I. Karner declare that they have no conflict of interest.

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Authors and Affiliations

  1. Clinical Institute of Nuclear Medicine and Radiation Protection, Osijek University Hospital, J. Huttlera 4, 31 000, Osijek, Croatia

    M. Stefanic & I. Karner

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  1. M. Stefanic
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  2. I. Karner
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Correspondence to M. Stefanic.

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Stefanic, M., Karner, I. Thyroid peroxidase autoantibodies are associated with a lesser likelihood of late reversion to hyperthyroidism after successful non-ablative treatment of Graves’ disease in Croatian patients. J Endocrinol Invest 37, 71–77 (2014). https://doi.org/10.1007/s40618-013-0026-9

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  • DOI: https://doi.org/10.1007/s40618-013-0026-9

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