Guia Lopes Maria L, Tavares Bello Carlos, Cidade José P, Limbert Clotilde, Sequeira Duarte Joao
Department of Endocrinology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PRT.
Department of Endocrinology, Hospital da Luz Lisboa, Lisbon, PRT.
Cureus. 2023 Jun 8;15(6):e40140. doi: 10.7759/cureus.40140. eCollection 2023 Jun.
Purpose Graves' disease (GD) is an autoimmune disorder caused by the presence of antibodies to the thyroid stimulating hormone (TSH) receptor (TRAbs), usually presenting with clinical signs of hyperthyroidism. Previous evidence suggests that higher serum levels of thyroid peroxidase antibodies (TPOAbs) may lead to more sustained remission of hyperthyroidism after treatment with antithyroid drugs (AT). However, doubts about the influence of TPOAbs in Graves' disease outcomes still remain. Methods A retrospective, unicenter cohort study was performed. All patients with GD (TRAbs > 1.58U/L), biochemical primary hyperthyroidism (TSH < 0.4 µUI/mL), and TPOAbs measurement at diagnosis, treated with AT between January 2008 and January 2021, were included for analysis. Results One hundred and forty-two patients (113 women) with a mean age of 52 ± 15 years old were included. They were followed up for 65.4 ± 43.8 months. TPOAbs positivity was present in 71.10% (n=101) of those patients. Patients were treated with AT for a median of 18 (IQR (12; 24)) months. Remission occurred in 47.2% of patients. Patients with remission presented with lower TRAbs and free thyroxine (FT4) levels at the diagnosis. (p-value <0.001, p-value 0.003, respectively). No association was found in the median TPOAbs serum levels of patients who remitted and those who maintained biochemical hyperthyroidism after the first course of AT. Relapse of hyperthyroidism occurred in 54 patients (57.4%). No difference was found in TPOAbs serum levels regarding the patient's relapse. Moreover, a time-based analysis revealed no differences in the relapse rate after 18 months of AT therapy between patients with and without TPOAbs positivity at the diagnosis (p-value 0.176). It was found a weak positive correlation (r=0.295; p-value <0.05) between TRAbs and TPOAbs titters at the moment of Graves' diagnosis. Conclusion In this study, a correlation between TRAbs measurements and TPOAbs titter was described, although no significant association was found between the presence of TPOAbs and the outcomes of patients with GD treated with AT. These results do not support the use of TPOAbs as a useful biomarker to predict remission or relapse of hyperthyroidism in GD patients.
格雷夫斯病（GD）是一种自身免疫性疾病，由针对促甲状腺激素（TSH）受体的抗体（TRAbs）引起，通常表现为甲状腺功能亢进的临床症状。先前的证据表明，较高的血清甲状腺过氧化物酶抗体（TPOAbs）水平可能导致抗甲状腺药物（AT）治疗后甲状腺功能亢进更持久地缓解。然而，关于TPOAbs对格雷夫斯病结局的影响仍存在疑问。方法：进行了一项回顾性单中心队列研究。纳入2008年1月至2021年1月期间接受AT治疗的所有GD患者（TRAbs>1.58U/L）、生化原发性甲状腺功能亢进（TSH<0.4µUI/mL）且诊断时检测了TPOAbs的患者进行分析。结果：纳入142例患者（113例女性），平均年龄52±15岁。随访65.4±43.8个月。这些患者中71.10%（n = 101）TPOAbs呈阳性。患者接受AT治疗的中位时间为18（IQR（12；24））个月。47.2%的患者实现缓解。缓解的患者在诊断时TRAbs和游离甲状腺素（FT4）水平较低。（p值分别<0.001、0.003）。在接受第一个疗程AT后缓解的患者和维持生化甲状腺功能亢进的患者的TPOAbs血清中位水平之间未发现关联。54例患者（57.4%）出现甲状腺功能亢进复发。在患者复发方面，TPOAbs血清水平未发现差异。此外，基于时间的分析显示，诊断时TPOAbs阳性和阴性的患者在接受18个月AT治疗后的复发率没有差异（p值0.176）。在格雷夫斯病诊断时，TRAbs和TPOAbs滴度之间发现弱正相关（r = 0.295；p值<0.05）。结论：在本研究中，描述了TRAbs测量值与TPOAbs滴度之间的相关性，尽管在接受AT治疗的GD患者中，未发现TPOAbs的存在与患者结局之间存在显著关联。这些结果不支持将TPOAbs用作预测GD患者甲状腺功能亢进缓解或复发的有用生物标志物。
