July - September 2013, Volume 9, Issue 3

Martin S, Sirbu A, Albu A., Barbu C.B., Florea S., Boscaiu V., Fica S

The Time to Thyroid-Stimulating Hormone Recovery During Medical Treatment in Graves’ Disease and Autonomous Hyperthyroidism

Acta Endo (Buc) 2013, 9 (3): 405-418
doi: 10.4183/aeb.2013.405

Context. In medically treated Graves’ disease (GD) patients, prolonged low serum TSH levels represent an independent risk factor for relapse. The predictors of this prolonged TSH suppression are still debatable. Objectives. The primary endpoint of this study was to identify predictors of the time to TSH recovery (TTR), in GD patients, at diagnosis and during ATDs treatment. The secondary endpoint was to compare the TTR between patients with GD and autonomous hyperthyroidism. Subjects and Methods. We retrospectively analyzed 109 newly diagnosed hyperthyroid patients (90 with GD and 19 with autonomous hyperthyroidism), consecutively evaluated in a tertiary center. The main features recorded were: TSH and thyroid hormone levels at diagnosis and follow-up visits, the TTR and the mean dose of ATDs/day. Results. There was no significant difference regarding the TTR between patients with GD and autonomous hyperthyroidism. In GD patients, age at diagnosis, gender, goiter size, smoking status, thyroid antibody titers and ophtalmopathy presence did not seem to influence the TTR. GD patients with higher FT3, TT3 at diagnosis and higher TT3 at the first visit after ATDs administration (V1) needed longer TTR, after adjusting for the mean dose of ATDs/day. FT3 at diagnosis and TT3 at V1 are significant predictors for the TTR in GD patients. Conclusions. The time to TSH recovery was not significantly different between patients with GD and autonomous hyperthyroidism. In GD patients, the time to TSH recovery is longer in patients with more severe T3 hyperthyroidism at diagnosis and at the first visit after ATDs administration.

Keywords: Graves’ disease, autonomous hyperthyroidism, TSH recovery, antithyroid drugs, relapse.

Correspondence: Simona Fica MD, “Carol Davila” University of Medicine and Pharmacy, Endocrinology Department, Elias University Hospital, 17th Marasti Blvd., 1st District, Bucharest, Romania, E-mail: simonafica@yahoo.com