Optimum duration of antithyroid drug treatment determined by assay of thyroid stimulating antibody in patients with Graves' disease.

OBJECTIVE: To determine the optimal duration of antithyroid drug treatment by monitoring serum thyroid stimulating antibody values in patients with Graves' disease. DESIGN: Prospective longitudinal trial of patients with Graves' disease followed up for 24 months after withdrawal of treatment. SETTING: Tertiary referral centre. PATIENTS: A total of 64 consecutive patients with untreated Graves' disease, eight of whom were subsequently excluded. Fifty six patients completed the study. INTERVENTIONS: All patients were treated initially with carbimazole 40 mg, then with decreasing doses that maintained a euthyroid state. Treatment was scheduled to continue for 18 months but was withdrawn earlier if serum thyroid stimulating antibody became undetectable. END POINT: Serum values of thyroid stimulating antibody (assayed by stimulation of human thyroid cells in vitro) and thyroid hormones and thyroid state every three months during treatment and afterwards every six months for 24 months. MEASUREMENTS AND MAIN RESULTS: In 44 patients serum thyroid stimulating antibody became undetectable during treatment and treatment was withdrawn (median duration of treatment nine months, range 3-18 months). In 12 patients the antibody could be detected during 18 months of treatment. Among the first group of 44 patients initial values of the antibody before treatment were significantly lower than in the second group of 12 patients (median 225% (range 138-1236%) v 570% (250-1480%), p less than 0.001); the incidence of relapse was also lower (41% v 92%, p less than 0.001); and among those who did relapse the disease free interval after treatment was longer (median 12 months v 1 month, p less than 0.001). Moreover, the initial median serum values of thyroid stimulating antibodies were not related to the occurrence of relapse or remission as these did not differ between patients who did and did not have a relapse (median 267% (range 139-1480%) v 220% (range 138-1236%). CONCLUSION: Monitoring of serum thyroid stimulating antibody was a good guide to the duration of treatment as it allowed the treatment period to be considerably shortened in a large group of patients with no loss of efficiency.

[Value of the urinary albumin/creatinine ratio in the detection of microalbuminuria]. / Intérêt et valeur du rapport albumine/créatinine urinaires dans le dépistage d'une microalbuminurie.

Microalbuminuria is currently defined as a urinary albumin excretion rate of 20 to 200 micrograms per minute, measured in the urine of 24 hours. We present an indirect approach to the urinary albumin daily excretion rate which minimizes the errors due to chronometric measurement and to the difficulty of collecting 24-hour urine. The albumin (mg/l)/creatinine (mmol/l) ratio calculated in urine collected daily indicates microalbuminuria when it is higher than 2.97 in women and 2.48 in men. The interpretation of this ratio is discussed in terms of sensitivity, specificity and predictive value.

[Comparison of 2 methods of measuring microalbuminuria. Immunonephelometry and radioimmunology]. / Comparaison de deux méthodes de dosage de la microalbuminurie. L'immunonéphélémétrie et la radioimmunologie.

The early detection of microalbuminuria in insulin dependent diabetes is considered as a sign of initial stage of nephropathy (possibly reversible if glycemic balance is well maintained). This detection requires very accurate methods as radioimmunoassays. Yet, they are so slow that they represent an obstacle to systematic detection. We report an appraisement of an immunonephelemetric method. Results reveal that immunonephelemetry is a sensitive and accurate method (threshold of sensitivity 0.5 mg/l; CV intra assay less than 5%; CV inter assays less than 10%; analytical recovery: 94-104%). Moreover, immunonephelemetry and radioimmunology are significantly well correlated (r = 0.977, p less than 0.001). As a conclusion, we can say that thanks to complete automation, immunonephelemetry is a choice method to test great lines of samples.

An HLA-All association with the hemochromatosis allele?

Two hundred and seventy-four patients with hemochromatosis and 1005 controls were HLA-typed, and HLA haplotypes were determined for 163 patients and 123 controls. The increased frequency of antigen A3 and haplotypes A3, B7 and A3, B14 in patients with hemochromatosis was confirmed. After correction for the space taken up by A3, a significant increase in All was found. This increase could not be explained by cross reaction between A3 and All. All showed a phenotype association and a haplotype link with Bw35. The genetic significance of this increased All frequency is discussed.

[Peripheral distribution of lymphocyte subpopulations in Basedow's disease. Decrease in suppressor T-lymphocytes]. / Répartition périphérique des sous-populations lymphocytaires dans la maladie de Basedow. Diminution des lymphocytes T suppresseurs.

The distribution of B- and T-lymphocyte subpopulations was studied in peripheral blood of 45 patients with untreated Graves' disease and 45 sex- and age-matched healthy controls. Blood samples were taken at the same hour in all subjects. The following tests were performed: HTLA and E (AET) for relative T-lymphocyte count, complement receptor (EAC) and surface immunoglobulins (IgS, IgG, IgM, IgA, kappa, lambda) for relative B-lymphocyte count. In 23 subjects of each group the subpopulations of T-lymphocytes were defined by their reactivity with monoclonal antibodies OKT8 (T-suppressor cells) and OKT4 (T-helper cells). Compared with the control group, patients with Graves' disease showed a decrease in the number of T-lymphocytes (HTLA: P less than 0.05: EAET: P less than 0.001) a decrease in T-suppressor cells (P less than 0.01), and no significant difference in B-lymphocytes and T-helper cells. Thus, the main lymphocyte characteristic in Graves' disease is a decrease in the relative value of T-cells, specifically affecting T-suppressor cells.