Spontaneous hypothyroidism in the follow up of Graves hyperthyroid patients treated with antithyroid drugs.

摘要

AIM: Spontaneous hypothyroidism may follow the natural course of Graves disease (GD) after treatment with antithyroid drugs (ATD). Methods: We studied retrospectively 139 remitted Graves hyperthyroid patients treated with ATD, with a follow-up period of 17.5 years (range 6 to 25 years). Elevated serum concentration of thyroid-stimulating hormone and low serum thyroxine concentrations confirmed the diagnosis. RESULTS: Thirteen patients (median age, 41 years; 26 to 48 years) developed spontaneous hypothyroidism, 4 to 144 months (median, 48 months ) following withdrawal of ATD. The prevalence of hypothyroidism was 9.3% and the incidence was 2.3% per year (13/ 563.6 patients/year of observation). There was no association with types of drugs used or the regimens. Spontaneous hypothyroid patients showed elevated titers (P = 0.02) of serum antithyroid peroxidase antibody (TPOAb) at the end of treatment with ATD, compared with the titers found at the beginning. These patients also had higher titers of TPOAb (P= 0.01) in relation to euthyroid patients. In contrast, the changes in serum antithyroglobulin antibody titers were not significant. CONCLUSIONS: Because of the shift from euthyroidism to spontaneous hypothyroidism, GD patients demanded a strict follow up after ATD therapy. It seems that there is an effect of TPOAb on thyroid destruction.