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TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study

Department of Endocrinology and Internal Medicine, Aalborg Hospital, Aarhus University Hospital, DK-9000 Aalborg, Denmark¹ Department of Molecular Institution of Surgery, Karolinska University Hospital, Stockholm, Sweden² Department of Ophthalmology, Karolinska Institutet, St Erik's Eye Hospital, Stockholm, Sweden³ Radiumhemmet, Department of General Oncology, Karolinska University Hospital, Stockholm, Sweden and ⁴ Department of Endocrinology and Internal Medicine and Institution of Clinical Research and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden

(Correspondence should be addressed to P Laurberg; Email: peter.laurberg{at}rn.dk)

Introduction: Autoimmunity against the TSH receptor is a key pathogenic element in Graves' disease. The autoimmune aberration may be modified by therapy of the hyperthyroidism.

Objective: To compare the effects of the common types of therapy for Graves' hyperthyroidism on TSH-receptor autoimmunity.

Methods: Patients with newly diagnosed Graves' hyperthyroidism aged 20–55 years were randomized to medical therapy, thyroid surgery, or radioiodine therapy (radioiodine was only given to patients 35 years of age). L-thyroxine (L-T₄) was added to therapy as appropriate to keep patients euthyroid. Anti-thyroid drugs were withdrawn after 18 months of therapy. TSH-receptor antibodies (TRAb) in serum were measured before and for 5 years after the initiation of therapy.

Results: Medical therapy (n=48) and surgery (n=47) were followed by a gradual decrease in TRAb in serum, with the disappearance of TRAb in 70–80% of the patients after 18 months. Radioiodine therapy (n=36) led to a 1-year long worsening of autoimmunity against the TSH receptor, and the number of patients entering remission of TSH-receptor autoimmunity with the disappearance of TRAb from serum during the following years was considerably lower than with the other types of therapy.

Conclusion: The majority of patients with Graves' disease gradually enter remission of TSH-receptor autoimmunity during medical or after surgical therapy, with no difference between the types of therapy. Remission of TSH-receptor autoimmunity after radioiodine therapy is less common.