[Diagnostic criteria in terminating therapy in Basedow hyperthyroidism]

Hyperthyroidism due to Graves disease is characterized by the presence of Thyroid stimulating antibodies (TBI Ab). The time course of the disease shows periods of remissions followed by exacerbations. In principle, treatment with antithyroid drugs is a symptomatic therapy, although there is evidence for an influence of the underlying immunologic disease. In any case there is a need for controlled long term therapy if antithyroid drugs are used. Therefore, it is important to have criteria for the evaluation of a remission during treatment and for the prediction of continuing remission or recurrence of the disease after therapy. Among the function tests which are able to answer these questions two groups can be distinguished. The first group consists of tests for the evaluation of the thyroid feed back mechanism. This group comprises the Thyroid suppression test, the Tc-99m Uptake test (TcTU test) and the TRH-stimulation test. With exception of the TcTU test, the use of these tests is reserved for patients with antithyroid monotherapy. The other group comprises tests by which the underlying immunphenomena are examined. These tests are the TSH-receptor antibody test (TRAK), the determination of Thyroglobulin antibodies (TAK) and of microsomal antibodies (MAK). In addition, recent findings demonstrate the importance of an examination of the HLA status for therapeutical decisions. At present, the recurrence of a positive Thyroid suppression or TRH stimulation test, the normalisation of the antibodies against TSH-receptor, against Thyroglobulin and microsomal antigen as well as lacking HLA-DR 3 frequency is estimated as a strong evidence for long term remission of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)