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Impaired immune regulation after radioiodine therapy for Graves’ disease and the protective effect of Methimazole

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Abstract

Both therapies for Graves’ disease (GD), radioactive iodine (RAI) and antithyroid drugs (ATD), were reported to have specific immune effects. We aimed at investigating the effects of RAI therapy on cellular subsets involved in immune regulation. We conducted a thirty day follow-up prospective cohort study of adult patients. Patients eligible for RAI therapy at our centre were approached. Twenty seven patients with GD were recruited, among whom 11 were treated with ATD. Twenty-two healthy subjects (HS) were also studied. Over time, frequency of regulatory T cells (Treg) and of invariant natural killer T cells (iNKT), along with Treg cell-mediated suppression and underlying mechanisms, were monitored in the peripheral blood. Variance in frequency of Treg and iNKT after RAI therapy was higher in GD patients than in HS over time (p < 0.0001). Reduced Treg suppressive function was observed after RAI therapy in GD patients (p = 0.002). ATD medication prior to RAI dampened these outcomes: less variation of Treg frequency (p = 0.0394), a trend toward less impaired Treg function, and prevention of reduced levels of suppressive cytokines (p < 0.05). Shortly after RAI therapy, alterations in immunoregulatory cells in patients with GD were observed and partially prevented by an ATD pretreatment. Worsening of autoimmunity after RAI was explained in previous studies by enhanced immune activity. This study adds new highlights on immune regulation deficiencies after therapeutic interventions in thyroid autoimmunity.

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Acknowledgments

We thank all subjects and physicians at the Sherbrooke University Hospital for their contribution to the study. This work was supported by research funds of the Faculty of Medicine, the Clinical Research Center, the Department of Pediatrics at Sherbrooke University and grants from the Québec’s Health Research Funds (FRQS). Special thanks to Jana Stankova and Françoise Le Deist for excellent technical advice and to Patrick McDonald for providing healthy control samples.

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  1. Department of Pediatrics, Sherbrooke University Hospital and Faculty of Medicine, 3001, 12e Avenue Nord, Sherbrooke, QC, JIH5N4, Canada

    Sarah Côté-Bigras, Viet Tran, Sylvie Turcotte, Marek Rola-Pleszczynski & Diane Rottembourg

  2. Department of Nuclear Medicine and Radiobiology, Sherbrooke University Hospital and Faculty of Medicine, Sherbrooke, QC, JIH5N4, Canada

    Jean Verreault

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  1. Sarah Côté-Bigras
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Côté-Bigras, S., Tran, V., Turcotte, S. et al. Impaired immune regulation after radioiodine therapy for Graves’ disease and the protective effect of Methimazole. Endocrine 52, 587–596 (2016). https://doi.org/10.1007/s12020-015-0832-2

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