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TPO antibody status prior to first radioactive iodine therapy as a predictive parameter for hypothyroidism in Graves' disease.

ABSTRACT: Objective We investigated if a positive thyroid peroxidase antibody (TPO Ab) status before radioactive iodine (RAI) therapy in patients with Graves' hyperthyroidism is a predictive factor for developing hypothyroidism post RAI. Methods We performed a retrospective study of patients with Graves' hyperthyroidism with known TPO Ab status, receiving a first administration of RAI. Patients from 4 thyroid outpatient centres in Belgium receiving a first RAI therapy between the years 2011 and 2019 were studied. Clinical, laboratory, imaging, and treatment data were recorded from medical charts. Hypothyroidism and cure (defined as combined hypo- and euthyroidism) were evaluated in period 1 (≥2 and ≤9 months, closest to 6 months post RAI) and period 2 (>9 months and ≤ 24 months post RAI, closest to 12 months post RAI). Results One hundred fifty-two patients were included of which 105 (69%) were TPO Ab positive. Compared to TPO Ab negative patients, TPO Ab positive patients were younger, had a larger thyroid gland, and had more previous episodes of hyperthyroidism. In period 1, 89% of the TPO Ab positive group developed hypothyroidism versus 72% in the TPO Ab negative group (p=0.007). In period 2, the observation was similar: 88% vs. 72% (p=0.019). In the multivariate logistic regression analysis, a positive TPO Ab status was associated with hypothyroidism in period 2 (adjusted OR 4.78 (95% CI 1.27-20.18;p=0.024). In period 1, the aOR was 4.16 (95% CI 1.0-18.83; p=0.052). Conclusion A positive TPO Ab status in patients with Graves' hyperthyroidism receiving a first administration of RAI is associated with a higher risk of early hypothyroidism.

SUBMITTER: Verdickt S

PROVIDER: S-EPMC9254270 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Liver dysfunction is a common complication of Graves' disease (GD) that may be caused by excessive thyroid hormone (TH) or anti-thyroid drugs (ATDs). Radioactive iodine (RAI) therapy is one of the first-line treatments for GD, but it is unclear whether it is safe and effective in patients with liver dysfunction. 510 consecutive patients with GD receiving first RAI were enrolled in the study, and followed up at 3-, 6- and 12-month. Liver dysfunction was recorded in 222 (43.5%) patients. GD patients with liver dysfunction had higher serum levels of free triiodothyronine (FT3) (median 27.6 vs. 20.6 pmol/L, p < 0.001) and free thyroxine (FT4) (median 65.4 vs. 53.5 pmol/L, p < 0.001) levels than those with normal liver function. Binary logistic regression analysis showed that duration of disease (OR = 0.951, 95% CI: 0.992-0.980, p = 0.001) and male gender (OR = 1.106, 95% CI: 1.116-2.384; p = 0.011) were significant differential factors for liver dysfunction. Serum TSH levels were higher in patients with liver dysfunction at all 3 follow-up time points (p = 0.014, 0.008, and 0.025 respectively). FT3 level was lower in patients with liver dysfunction at 3-month follow-up (p = 0.047), but the difference disappeared at 6 and 12 months (p = 0.351 and 0.264 respectively). The rate of euthyroidism or hypothyroidism was higher in patients with liver dysfunction than in those with normal liver function at 3 months (74.5% vs 62.5%; p = 0.005) and 6 months (82.1% vs 69.1%; p = 0.002) after RAI treatment, but the difference did not persist at 12-month follow-up (89.6% vs 83.2%, p = 0.081).There were no statistically significant differences in treatment efficacy (94.48% vs 90.31%, p = 0.142), incidence of early-onset hypothyroidism (87.73% vs 83.67%, p = 0.277), and recurrence rate (4.91% vs 7.14%, p = 0.379) between the 2 groups at 12-month follow-up. In conclusion, the efficacy of RAI was comparable in GD patients with liver dysfunction and those with normal liver function.

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TPO antibody status prior to first radioactive iodine therapy as a predictive parameter for hypothyroidism in Graves' disease.

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