Prediction of outcome in Graves' disease after carbimazole treatment. 1986

A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor

In a prospective study to determine which factors would predict remission or relapse, 65 patients with hyperthyroid Graves' disease were treated for six months with a blocking replacement regimen of carbimazole, 40 mg daily, and triiodothyronine (T3). They were followed for one year after stopping treatment, by which time 32 (49 per cent) had relapsed. Although the treatment protocol, relapse rate and frequency of the HLA-DR3 antigen in this population were similar to those of a regionally separate Graves' population investigated previously, the predictive value of HLA-DR3 status together with thyroid stimulating antibody (TSAB) levels was strikingly different. In the present study there was no significantly abnormal distribution of any HLA antigen in the relapse group compared with those patients who achieved remission. Thyroid stimulating antibodies were detected in 62 patients (95 per cent) and fell significantly (p less than 0.05) after carbimazole treatment, irrespective of DR3 status or outcome; TSAB levels only became undetectable in nine patients (28 per cent) who subsequently relapsed and in nine patients (30 per cent) who maintained remission. T3-suppressed 20 min 123I uptake fell equally after treatment in the relapse and remission groups but continued to fall thereafter in the group which maintained remission. In these patients, 123I uptake was significantly lower at the end of the study period than at the end of treatment (p less than 0.05). Serum free T4 levels were higher before treatment in the patients who later relapsed than in those whose disease remitted (p less than 0.02). This proved the only significant marker associated with outcome but was of little predictive value in any patient. This study highlights the problem in predicting the outcome of antithyroid drug treatment, since even within the same country under similar conditions, divergent results have been obtained. It appears that the loci controlling the immune response in Graves' disease are likely to include genes lying outside the HLA-DR region. The results also suggest that the immunological effects of antithyroid drugs are maintained after stopping treatment in those patients whose disease remits.

UI MeSH Term Description Entries
D007074 Immunoglobulin G The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of IgG, for example, IgG1, IgG2A, and IgG2B. Gamma Globulin, 7S,IgG,IgG Antibody,Allerglobuline,IgG(T),IgG1,IgG2,IgG2A,IgG2B,IgG3,IgG4,Immunoglobulin GT,Polyglobin,7S Gamma Globulin,Antibody, IgG,GT, Immunoglobulin
D007457 Iodine Radioisotopes Unstable isotopes of iodine that decay or disintegrate emitting radiation. I atoms with atomic weights 117-139, except I 127, are radioactive iodine isotopes. Radioisotopes, Iodine
D008297 Male Males
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D002231 Carbimazole An imidazole antithyroid agent. Carbimazole is metabolized to METHIMAZOLE, which is responsible for the antithyroid activity. Carbimazole Henning,Neo Tomizol,Neo-Mercazole,Neo-Thyreostat,Neomercazole
D004359 Drug Therapy, Combination Therapy with two or more separate preparations given for a combined effect. Combination Chemotherapy,Polychemotherapy,Chemotherapy, Combination,Combination Drug Therapy,Drug Polytherapy,Therapy, Combination Drug,Chemotherapies, Combination,Combination Chemotherapies,Combination Drug Therapies,Drug Polytherapies,Drug Therapies, Combination,Polychemotherapies,Polytherapies, Drug,Polytherapy, Drug,Therapies, Combination Drug
D005260 Female Females
D006111 Graves Disease A common form of hyperthyroidism with a diffuse hyperplastic GOITER. It is an autoimmune disorder that produces antibodies against the THYROID STIMULATING HORMONE RECEPTOR. These autoantibodies activate the TSH receptor, thereby stimulating the THYROID GLAND and hypersecretion of THYROID HORMONES. These autoantibodies can also affect the eyes (GRAVES OPHTHALMOPATHY) and the skin (Graves dermopathy). Basedow's Disease,Exophthalmic Goiter,Goiter, Exophthalmic,Graves' Disease,Basedow Disease,Hyperthyroidism, Autoimmune,Basedows Disease,Disease, Basedow,Disease, Basedow's,Disease, Graves,Disease, Graves',Exophthalmic Goiters,Goiters, Exophthalmic
D006684 HLA-DR Antigens A subclass of HLA-D antigens that consist of alpha and beta chains. The inheritance of HLA-DR antigens differs from that of the HLA-DQ ANTIGENS and HLA-DP ANTIGENS. HLA-DR,Antigens, HLA-DR,HLA DR Antigens

Related Publications

A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor
January 1981, Journal of endocrinological investigation,
A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor
January 1988, Endocrinologie,
A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor
May 2009, JAMA,
A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor
March 1990, Diabetes research and clinical practice,
A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor
March 2013, Indian journal of endocrinology and metabolism,
A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor
June 1979, Clinical endocrinology,
A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor
August 1980, The New England journal of medicine,
A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor
June 2019, The Medical journal of Australia,
A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor
February 1988, The Quarterly journal of medicine,
A P Weetman, and S Ratanachaiyavong, and G W Middleton, and W Love, and R John, and G M Owen, and C Darke, and J H Lazarus, and R Hall, and A M McGregor
September 1998, Journal of the Formosan Medical Association = Taiwan yi zhi,
Copied contents to your clipboard!