Fig. 1Changes in (A) thyrotropin (TSH) receptor antibody (TRAb), (B) thyroid peroxidase antibody (TPOAb), and (C) thyroglobulin antibody (TgAb) during treatment with antithyroid drug in patients with Graves' disease.
Fig. 2Overall relapse free survival of study population.
Fig. 3Relapse free survival of Graves' disease patients with positive thyroid peroxidase antibody (TPOAb) at diagnosis, according to (A) TPOAb changes and (B) thyroglobulin antibody (TgAb) changes.
Table 1Baseline Characteristics
Characteristic |
Initial |
ATD withdrawal |
Age, yr |
49.7±13.6 |
Female, sex |
39 (70.9) |
TSH, μIU/mL |
0.01±0.19 |
1.87±2.87 |
Free T4, ng/dL |
3.75±1.94 |
1.17±0.20 |
Total T3, ng/dL |
337.90±144.56 |
94.21±23.05 |
Anti-TSH receptor, IU/L |
27.1±25.8 |
2.4±3.2 |
Anti-TSH receptor positivity |
50 (96.1) |
19 (44.2) |
Anti-microsome (TPO), U/mL |
1,181.0±1,415.67 |
511.5±867.9 |
Anti-microsome (TPO) positivity |
38 (69.1) |
21 (50.0) |
Anti-thyroglobulin, IU/mL |
198.8±445.78 |
147.6±430.2 |
Anti-thyroglobulin positivity |
34 (63.0) |
16 (39.0) |
Table 2Clinical and Laboratory Features Associated with Relapse of Graves' Disease
Variable |
Remission group |
Relapse group |
P value |
Number |
36 |
19 |
|
Age, yr |
47.2±14.0 |
54.4±11.9 |
0.06 |
Female sex |
26 (72.2) |
13 (68.4) |
0.77 |
Initial |
|
|
|
TSH, μIU/mL |
0.01±1.20 |
0.01±1.17 |
0.90 |
Free T4, ng/dL |
3.44±1.84 |
4.38±2.03 |
0.10 |
Total T3, ng/dL |
320.0±137.92 |
371.70±154.66 |
0.22 |
Anti-TSH receptor positivity |
32 (97.0) |
18 (94.7) |
1.00 |
Anti-microsome (TPO) positivity |
22 (61.1) |
16 (84.2) |
0.12 |
Anti-thyroglobulin positivity |
22 (61.1) |
12 (66.7) |
0.77 |
At ATD stop |
|
|
|
TSH, μIU/mL |
1.99±3.14 |
1.65±2.40 |
0.53 |
Free T4, ng/dL |
1.15±0.23 |
1.22±0.14 |
0.21 |
Total T3, ng/dL |
94.24±24.51 |
94.16±20.62 |
0.99 |
Anti-TSH receptor positivity |
12 (40.0) |
7 (53.8) |
0.51 |
Anti-microsome (TPO) positivity |
14 (48.3) |
7 (53.8) |
1.00 |
Anti-thyroglobulin positivity |
9 (31.0) |
7 (58.3) |
0.16 |
Antithyroid drug (methimazole or carbimazole) |
31 (86.1) |
17 (89.5) |
1.00 |
Table 3Clinical Features and Changes in Autoantibodies Associated with Relapse of Graves' Disease
Clinical parameter |
Univariate analysis |
Hazard ratio (95% CI) |
P value |
Age |
1.04 (1.00–1.08) |
0.07 |
Male sex |
1.08 (0.41–2.85) |
0.87 |
ATD duration, >18 mo |
0.95 (0.36–2.49) |
0.91 |
TFT at diagnosis |
|
|
Free T4 |
1.16 (0.93–1.46) |
0.19 |
Total T3 |
1.00 (1.00–1.01) |
0.32 |
TSH |
1.03 (0.00–425.15) |
0.99 |
TFT at ATD withdrawal |
|
|
Free T4 |
5.86 (0.35–97.80) |
0.22 |
Total T3 |
1.01 (0.99–1.04) |
0.33 |
TSH |
0.82 (0.27–2.44) |
0.72 |
Autoantibody status at diagnosis (positive) |
|
|
TRAb |
0.68 (0.09–5.15) |
0.71 |
TPOAb |
2.47 (0.72–8.49) |
0.15 |
TgAb |
1.30 (0.49–3.47) |
0.60 |
Autoantibody status at ATD withdrawal (positive) |
|
|
TRAb |
1.74 (0.59–5.20) |
0.32 |
TPOAb |
1.00 (0.34–2.99) |
0.99 |
TgAb |
2.11 (0.67–6.67) |
0.20 |
Autoantibody level changes (increase) |
|
|
TPOAb |
2.22 (0.75–6.64) |
0.49 |
TgAb |
2.05 (0.65–6.53) |
0.96 |
Antithyroid drug (methimazole or r carbimazole) |
1.59 (0.37–6.91) |
0.53 |
Table 4Clinical Features and Changes in Autoantibodies Associated with Relapse of Graves' Disease in Initially TPOAb Positive Patients (n=38)
Clinical parameter |
Univariate analysis |
Multivariate analysis |
Hazard ratio (95% CI) |
P value |
Hazard ratio (95% CI) |
P value |
Age |
1.03 (0.98–1.08) |
0.19 |
1.10 (0.99–1.23) |
0.06 |
Male sex |
0.88 (0.30–2.55) |
0.81 |
0.61 (0.05–7.13) |
0.69 |
ATD duration, >18 mo |
1.35 (0.49–3.73) |
0.56 |
|
|
TFT at diagnosis |
|
|
|
|
Free T4 |
1.04 (0.77–1.40) |
0.81 |
|
|
Total T3 |
1.00 (1.00–1.00) |
0.47 |
|
|
TSH |
0.55 (0.00–248.20) |
0.85 |
|
|
TFT at ATD withdrawal |
|
|
|
|
Free T4 |
23.97 (0.99–580.10) |
0.05 |
0.15 (0.00–88.79) |
0.56 |
Total T3 |
1.03 (1.00–1.06) |
0.07 |
|
|
TSH |
0.84 (0.22–3.21) |
0.80 |
|
|
Autoantibody status at diagnosis (positive) |
|
|
|
|
TRAb |
NA |
|
|
|
TPOAb |
NA |
|
|
|
TgAb |
0.74 (0.26–2.08) |
0.57 |
|
|
Autoantibody status at ATD withdrawal (positive) |
|
|
|
|
TRAb |
0.97 (0.27–3.44) |
0.96 |
|
|
TPOAb |
0.76 (0.20–2.95) |
0.69 |
|
|
TgAb |
1.49 (0.40–5.56) |
0.56 |
|
|
Autoantibody level changes (increase) |
|
|
|
|
TPOAb |
3.60 (1.00–12.98) |
0.05 |
17.99 (1.66–195.43) |
0.02 |
TgAb |
4.52 (1.14–17.96) |
0.03 |
5.73 (1.21–27.26) |
0.03 |
Antithyroid drug (methimazole or carbimazole) |
1.92 (0.43–8.50) |
0.39 |
|
|