World Journal of Surgery

, Volume 16, Issue 4, pp 647–652 | Cite as

Clinical course and thyroid stimulating hormone (TSH) receptor antibodies during surgical treatment of Graves' disease

  • Yoko Mori
  • Naoya Matoba
  • Shunji Miura
  • Nobumitsu Sakai
  • Yukio Taira
Article

Abstract

This study assessed the results of surgical treatment for Graves' disease in our hospital and examined the relationship between the values of thyroid stimulating hormone (TSH) receptor antibodies and postoperative thyroid function. From 1983 to 1988, subtotal thyroidectomy was performed in 313 patients with Graves' disease. The follow-up rate was 89.1% (278 of 313 patients). Thirteen (4.2%) patients required methimazole postoperatively for hyperthyroidism and 23 (7.3%) patients required L-thyroxine postoperatively for hypothyroidism. The relationship between the postoperative thyroid function and TSH receptor antibodies was examined.

The pre-operative thyrotropin binding inhibitory immunoglobulin (TBII) value had no relationship to postoperative thyroid function. Only in the patients who were hyperthyroid postoperatively did the TBII value remain elevated, but the value decreased gradually in patients who were not hyperthyroid postoperatively. In 43 of 94 patients whose pre-operative TBII values were high, the postoperative TBII value normalized. The higher the preoperative TBII value, the longer time was required for it to normalize postoperatively. The postoperative thyroid stimulating antibody (TSAb) values were higher in patients who remained hyperthyroid than in the patients who were not hyperthyroid. In the patients who remained hyperthyroid postoperatively, there was a significant correlation between the postoperative TBII value and the TSAb value. In the patients who were hypothyroid postoperatively, the TSBAb values were negative.

In patients undergoing surgical treatment of Graves' disease, the postoperative TBII and TSAb values were related to postoperative hyperthyroidism. The TSBAb value had no relationship to postoperative hypothyroidism.

Keywords

Hypothyroidism Hyperthyroidism Thyroid Stimulate Hormone Receptor Antibody Methimazole 

Résumé

Le but de cette étude est d'évaluer les résultats du traitement chirurgical de la maladie de Basedow dans notre hôpital et d'examiner les relations enre les taux d'anticorps antirécpteurs de la TSH et la fonction thyroïdienne postopératoire. De 1983 à 1988, nous avons réalisé une thyroidectomie subtotale chez 313 patients atteints de maladie de Basedow. Le pourcentage de patients suivis était de 89.1% (278/313). Treize patients ont nécessité un traitement par Methimazole en raison d'une hyperthyroïdie postopératoire et 23 patients (7.3%) ont nécessité un traitement L-thyroxine à cause d'une hypothyroïdie postopératoire. La relation entre fonction thyroïdienne postopératoire et anticorps antirécepteurs de la TSH a été étudiée. Il n'y avait aucune relation entre la valeur du TBII préopératoire et la fonction thyroïdienne postopératoire. La valeur postopératoire du TBII restait élevée dans le groupe hyperthyroïdie postopératoire seulement, mais diminuait progressivement dans le groupe sans hyperthyroïdie. Chez 43 des 94 patients qui avaient des taux préopératoires élevés de TBII, ce taux était normalisé en postopératoire. Cette normalisation du taux de TBII se faisnt sur un temps très long chez les patients ayant les valeurs préopératoires les plus élevées. Les valeurs postopératoires de TSAb étaient plus élevées dans le groupe hyperthyroïdie postopératoire que dans le groupe sans hyperthyroïdie. Dans le groupe hyperthyroïdie postopératoire, il y avait une corrélation significative entre les taux postopératoires de TBII et les taux de TSAb. Dans le groupe hypothyroïdie, les valeurs de TSBAb devenaient négatives. Les valeurs postopératoires de TBII et de TSAb étaient liées à l'hyperthyroïdie postopératoire. Les valeurs de TSBAb n'avaient pas de relation avec l'hypothyroïdie postopératoire.

Resumen

Los propósitos del presente estudio fueron la determinación de los resultados del tratamiento quirúrgico en la enfermedad de Graves en nuestro hospital, y el análisis de la relación entre los valores de los anticuerpos a receptores de TSH y la función postoperatoria de la glándula tiroides. Entre 1983 y 1988 se practicó tiroidectomía en 313 pacientes con enfermedad de Graves; la tasa de seguimiento fue de 89.1% (278/313). En 13 pacientes se hizo necesario administrar metimazol por hipertiroidismo postoperatorio y 23 requirieron L-tiroxina por hipotiroidismo postoperatorio. Se analizó la relación entre la función tiroidea postoperatoria y los anticuerpos a receptores de TSH. Los valores preoperatorios de inmunoglobulina inhibidora de la ligadura de tirotropina (TBII) no exhibió relación con la función tiroidea postoperatoria. Sólo en el grupo hipertiroideo postoperatorio permaneció elevado el nivel de TBII, pero éste disminuyó gradualmente en los groupos no hipertiroideos. En 43 de 94 pacientes cuyos valores preoperatorios de TBII eran altos, éstos descendieron a niveles normales en el postoperatorio. El tiempo de normalización de los valores de TBII resultó más prolongado en los pacientes con los máximos niveles preoperatorios de TBII. Los valores de anticuerpo estimulador de tiroides (TSAb) aparecieron más altos en el grupo hipertiroideo postoperatorio que en el no hipertiroideo. En el grupo hipertiroideo postoperatorio se observó correlación significativa entre los valores postoperatorios de TBII y los de TSAb. An el grupo hipotiroideo los valores de TSAb resultaron negativos. Los valores postoperatorios de TBII y de TSAb exhibieron correlación con el hipertiroidismo postoperatorio. Los valores del anticuerpo bloqueador de la estimulación por TSH (TSBAb) no mostró correlación con el hipotiroidismo postoperatorio.

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Copyright information

© the Société Internationale de Chirurgie 1992

Authors and Affiliations

  • Yoko Mori
    • 1
  • Naoya Matoba
    • 1
  • Shunji Miura
    • 1
  • Nobumitsu Sakai
    • 1
  • Yukio Taira
    • 1
  1. 1.Surgical DepartmentSendai City HospitalMiyagi PrefectureJapan

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