Parameters affecting the period for being euthyroid in newly-diagnosed Graves’ disease treated with antithyroid agent

Background: There are limited data about the factors affecting the response time to medical treatment in Graves’ disease (GD) although many studies examined the predictors of the relapse after drug withdrawal. The aim of the current study was to evaluate the time for becoming euthyroid under antithyroid drug (ATD) therapy and the parameters influencing this period in patients diagnosed as GD.Methods: Patients with newly-diagnosed GD and decided to treat with ATD initially between March 2017 and September 2018 were retrieved retrospectively. Sociodemographic features as well as laboratory parameters like thyroid function tests and thyroid-stimulating hormone-receptor antibody (TRab) at the time of diagnosis were recorded.Results: Out of 41 patients, 63.4% (n=26) were female. The mean age was 36.1±11.7 years and 43.9% (n=18) of them were smoking. The time between the initiation of treatment and the duration of becoming euthyroid was 2.4±1.8 months. No significant difference was noted between age, gender, and smoking status and the time to become euthyroid under ATD treatment. This period was significantly positively correlated with levels of free triiodothyronine, free thyroxine, and negatively correlated with thyroid-stimulating hormone. Response to ATD therapy was higher in patients with pre-treatment TRab levels <10 IU/l than TRab ≥10 IU/l (p=0.011).Conclusions: Pretreatment thyroid function tests and TRab levels may be taken into consideration before deciding treatment in patients with newly diagnosed GD. It would be useful to design more comprehensive studies so that this proposal can find a response in clinical practice.

Comparison of Patient Characteristics in Thyroid-Associated Ophthalmopathy with and without Strabismus

PURPOSE: To determine immunochemical and clinical differences in thyroid-associated ophthalmopathy (TAO) patients with restrictive strabismus and without strabismus. METHODS: A retrospective chart review of 15 TAO patients with strabismus (25 eyes) and 24 TAO patients without strabismus (39 eyes) who presented to the Ophthalmology Clinic between August 2011 and December 2013 was performed. Visual acuity, intraocular pressure (IOP), Hertel exophthalmometry, soft tissue score, and enlargement of extraocular muscles on computed tomography (CT) were obtained and compared in each group. Thyroid related autoantibody (thyroid-stimulating hormone receptor antibody, TRAb; thyroid peroxidase antibody, TPOAb; anti-thyroglobulin antibody, TgAb) titers and positive rates were obtained at the time of diagnosis or before treatment and analyzed. RESULTS: The gender and smoking proportion were not significantly different between the 2 groups. The mean age of TAO patients with strabismus was 52.53 years and of TAO patients without strabismus 40.33 years (p = 0.004). The differences in visual acuity and IOP between the 2 groups were not significant. Hertel exophthalmometry showed less proptotis in the TAO with strabismus group than the TAO without strabismus group (16.84 mm versus 18.67 mm). The soft tissue score was not significantly different. The extraocular muscle enlargement rate of TAO with strabismus was significantly higher than in TAO without strabismus group. In the TAO with strabismus group, TRAb level was higher than in the TAO without strabismus group (p = 0.021). CONCLUSIONS: The TAO with strabismus group was older and had higher positive rate, level of TRAb, and extraocular muscle enlargement rate on CT than the TAO without strabismus group. Furthermore, proptosis was less definite in the TAO with strabismus group.

Association Between Thyroid Associated Ophthalmopath and Thyroid Autoantibody

PURPOSE: The same autoimmune process is thought to cause thyroid associated ophthalmopathy (TAO) and Graves' disease. The aim of this study is to determine hether thyroid autoantibody is related to the development of thyroid associated ophthalmopathy. METHODS: A retrospective chart analysis was performed on patients with a newly diagnosed Graves' disease, who presented to our ophthalmology clinic between January 2006 and December 2009. Thyroid autoantibody titers were obtained at the time of diagnosis and were used to determine the presence or absence of TAO. In addition, any correlations between thyroid autoantibodies were analyzed in patients with TAO. RESULTS: Thyroid autoantibody levels correlated with the development of TAO. Fifty-eight (69%) out of 84 patients with positive thyroid-stimulating hormone receptor antibody (TRAB) levels at the time of diagnosis had TAO. Only 50 (51%) of the 99 patients with negative TRAB levels had TAO. This difference between the two groups was statistically significant (odds ratio, OR=2.2, p=0.013). A statistically significant correlation with the development of TAO was also found in thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb), respectively (OR=0.5, p=0.317; OR=0.3, p=<0.001). In patients with TAO, the correlation between TPOAb and TgAb levels was very high (r=0.64, p=<0.001). CONCLUSIONS: A significant association was determined to exist between the development of TAO and thyroid autoantibody level. This result demonstrates the clinical utility of thyroid autoantibody for the diagnosis of TAO in patients with newly diagnosed Graves' disease.