Prediction of relapse in drug-treated Graves' disease using thyroid stimulation indices

Thyroid stimulation indices such as high thyroidal radioactive iodine uptake, increased estimated thyroid weight, presence of TSH-binding inhibitor immunoglobulin or thyroid-stimulating antibody, and elevated serum thyroglobulin level, were evaluated in 148 patients with Graves' disease who had been treated with antithyroid drugs for two years or more before the drugs were withdrawn. In all 19 patients in whom three or more indices were positive, early relapse, within 12 months, occurred after reducing the dosage of antithyroid drugs. Other 129 patients were followed after the drug was withdrawn and in 77 patients with one or two positive indices, early relapse occurred in 65-71% and late relapse, after 12 months or later, occurred in 2-11%. In 52 patients in whom none of the indices were positive, 86% remained in remission, but 10% developed an early relapse, and 4% a late relapse. We conclude that a combined analysis of thyroid stimulation indices is useful in predicting relapse in Graves' disease whereas it remains difficult to predict permanent remission.