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Thyrotrophin receptor antibody concentration and activity, several years after treatment for Graves' disease
Preethi Nalla1, Stuart Young2, Jane Sanders2
1Section of Endocrinology and Biochemistry, Aneurin Bevan University Health Board, Caerphilly, UK.
Objective:
TSH receptor antibodies (TRAb) are responsible for autoimmune hyperthyroid disease (Graves' disease; GD) with TRAb levels tending to decrease following treatment. Measurement of TRAb activity during follow-up could prove valuable to better understand treatment effectiveness.
Study Design:
TRAb concentration and stimulating (TSAb) and blocking (TSBAb) activity of patient serum were assessed following different treatment modalities and follow-up length.
Methods:
Sixty-six subjects were recruited following treatment with carbimazole (n = 26), radioiodine (n = 27) or surgery (n = 13). TRAb, TPOAb, TgAb and GADAb were measured at a follow-up visit as well as bioassays of TSAb and TSBAb activity.
Results:
Forty-five per cent of all patients remained TRAb-positive for more than one year and 23% for more than 5 years after diagnosis, irrespective of treatment method. Overall, TRAb concentration fell from a median (IQR) of 6.25 (3.9-12.7) to 0.65 (0.38-3.2) U/L. Surgery conferred the largest fall in TRAb concentration from 11.4 (6.7-29) to 0.58 (0.4-1.4) U/L. Seventy per cent of TRAb-positive patients were positive for TSAb, and one patient (3%) was positive for TSBAb. TRAb and TSAb correlated well (r = 0.83). In addition, 38/66 patients were TgAb-positive, 47/66 were TPOAb-positive and 6/66 were GADAb-positive at follow-up.
Conclusions:
TRAb levels generally decreased after treatment but persisted for over 5 years in some patients. TRAb activity was predominantly stimulatory, with only one patient demonstrating TSBAb. A large proportion of patients were TgAb/TPOAb-positive at follow-up. All treatment modalities reduced TRAb concentrations; however, surgery was most effective.
Insights
Thyroid-stimulating hormone receptor antibodies (TRAb) decrease after Graves' disease treatment but can persist for years. Surgery most effectively reduced TRAb levels, with most patients showing stimulatory antibody activity.
Area of Science:
- Endocrinology
- Immunology
- Thyroidology
Background:
- Thyroid-stimulating hormone receptor antibodies (TRAb) are key drivers of autoimmune hyperthyroid diseases like Graves' disease (GD).
- Monitoring TRAb levels post-treatment is crucial for assessing therapeutic efficacy and disease recurrence risk.
Purpose of the Study:
- To evaluate the changes in TRAb concentration and activity (stimulating and blocking) after various GD treatments.
- To determine the long-term persistence of TRAb and its correlation with treatment modalities.
Main Methods:
- Serum TRAb concentration, stimulating (TSAb), and blocking (TSBAb) activity were measured in 66 patients post-treatment.
- Patients received carbimazole, radioiodine, or surgery.
- Thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), and GAD antibodies (GADAb) were also assessed.
Main Results:
- TRAb levels decreased across all treatment groups, with surgery showing the most significant reduction.
- Forty-five percent of patients remained TRAb-positive for over a year, and 23% for over five years.
- TRAb and TSAb showed a strong correlation (r=0.83), with 70% of TRAb-positive patients having TSAb activity.
Conclusions:
- While TRAb levels generally decline post-treatment, they can persist long-term in a significant portion of patients.
- Surgical intervention appears most effective in reducing TRAb concentrations.
- The predominant activity of TRAb is stimulatory, highlighting the ongoing autoimmune drive in Graves' disease.