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Long-term remission following antithyroid drug withdrawal in patients with Graves’ hyperthyroidism: parameters with prognostic value

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Abstract

Objective

To assess the predictive value of some clinical and biochemical parameters, and of the +49 A/G polymorphism of the CTLA-4 gene, for long-term remission following the withdrawal of antithyroid drugs before starting antithyroid drug therapy.

Study design

Observational, prospective and longitudinal study.

Methods

Seventy-two patients (11 of whom were men) with newly diagnosed Graves’ hyperthyroidism who had been attended consecutively at a University Clinic in a population with sufficient iodine intake were included in the study. Exclusion criteria: patients under the age of 18, pregnant women and non-Caucasian patients. All subjects were treated following a well-defined protocol. Long-term remission was calculated at 12 and 36 months following withdrawal of the antithyroid drug.

Results

Thirty-six of the 72 study subjects experienced a remission of at least 12 months following withdrawal of methimazole, with no differences according to their age or sex. A comparison made between the remission rates seen in both groups yielded significant differences regarding the presence of Graves’ orbitopathy, the duration of the treatment with methimazole and the absence of the CTLA-4 G/G genotype. In the univariate and multivariate analyses performed, only lower frequencies of Graves’ orbitopathy and an absence of the CTLA-4 G/G genotype were considered independent predictors of long-term remission.

Conclusions

The absence of Graves’ orbitopathy and of the CTLA-4 G/G genotype are independent predictors of long-term remission following a first course of antithyroid drugs.

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Acknowledgements

The authors would like to thank Professor Juan Carlos Galofre for his critical reading of this manuscript.

Funding

This study was supported, in part, by a grant awarded by the Spanish Diabetes Society.

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Authors and Affiliations

  1. Endocrine Department, Biomedical Research Institute of Southern Galicia, University Hospital of Vigo, Vigo, Spain

    Ricardo V. García-Mayor

  2. Endocrine and Nutrition Service, University Hospital of Orense, Vigo, Spain

    Paula Álvarez-Vázquez

  3. Casco Vello Primary Care Centre, Vigo, Spain

    Enrique Fluiters

  4. Department of Biochemistry, Genetics and Immunology, University of Vigo, Vigo, Spain

    Diana Valverde

  5. Biochemisty Service, University Hospital of Vigo, Vigo, Spain

    Amalia Andrade

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  1. Ricardo V. García-Mayor
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  2. Paula Álvarez-Vázquez
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Correspondence to Ricardo V. García-Mayor.

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Ethical approval

This study was approved by the Research Ethics Committee of the Autonomous Government of Galicia.

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All participants gave their consent after being verbally informed about the nature and purpose of this study.

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García-Mayor, R.V., Álvarez-Vázquez, P., Fluiters, E. et al. Long-term remission following antithyroid drug withdrawal in patients with Graves’ hyperthyroidism: parameters with prognostic value. Endocrine 63, 316–322 (2019). https://doi.org/10.1007/s12020-018-1785-z

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  • DOI: https://doi.org/10.1007/s12020-018-1785-z

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