[Long-term evolution of immunologic and thyroid function in Graves disease according different therapeutic options]

Area of Science:

• Endocrinology
• Thyroidology
• Immunology

Background:

• Graves disease is an autoimmune disorder affecting the thyroid gland.
• Treatment options include antithyroid drugs, radioactive iodine, and surgery.
• Monitoring thyroid hormones, thyroglobulin (Tg), and TSH receptor antibodies (TBII) is crucial for assessing treatment efficacy and disease recurrence.

Purpose of the Study:

• To compare the long-term outcomes of different Graves disease treatment modalities.
• To evaluate the evolution of thyroid hormones, Tg, and TBII levels post-treatment.
• To determine the rate of disease reactivation across treatment groups.

Main Methods:

• A prospective study involving 95 Graves disease patients.
• Patients were divided into three groups: antithyroid drugs (n=35), radioactive iodine (n=30), and subtotal thyroidectomy (n=30).
• Thyroid hormones, Tg, and TBII were measured using radioimmunoassay (RIA) at baseline and at multiple follow-up intervals up to 36 months.

Main Results:

• Disease reactivation rates at 24 months were significantly higher in the antithyroid drug group (42%) compared to radioactive iodine (16%) and surgery (13%).
• At 36 months, reactivation was 30% for antithyroid drugs versus 5% for radioactive iodine.
• Radioactive iodine treatment showed the earliest and most significant negativization of TBII levels by 24 months.

Conclusions:

• Antithyroid drug treatment for Graves disease is associated with a higher rate of reactivation compared to radioactive iodine or subtotal thyroidectomy.
• Radioactive iodine therapy facilitates the earliest negativization of TBII, indicating a favorable long-term immune response.
• Treatment choice significantly impacts disease recurrence and antibody normalization in Graves disease management.