Technetium Uptake Predicts Remission and Relapse in Grave's Disease Patients on Antithyroid Drugs for at Least 1 Year in South Indian Subjects

Overview

Journal Indian J Endocrinol Metab

Specialty Endocrinology

Date 2016 Apr 5

PMID 27042408

Citations 3

Authors

Neha Singhal

V P Praveen

Nisha Bhavani

Arun S Menon

Usha Menon

Nithya Abraham

Harish Kumar

R V JayKumar

Vasantha Nair

Shanmugha Sundaram

Padma Sundaram

Affiliations

Soon will be listed here.

Abstract

Context: Most of the information on remission related factors in Grave's disease are derived from Western literature. It is likely that there may be additional prognostic factors and differences in the postdrug treatment course of Grave's disease in India.

Aim: To study factors which predict remission/relapse in Grave's disease patients from South India. Also to establish if technetium (Tc) uptake has a role in predicting remission.

Subjects And Methods: Records of 174 patients with clinical, biochemical, and scintigraphic criteria consistent with Grave's disease, seen in our Institution between January 2006 and 2014 were analyzed. Patient factors, drug-related factors, Tc-99m uptake and other clinical factors were compared between the remission and nonremission groups.

Statistical Analysis Used: Mann-Whitney U-test and Chi-square tests were used when appropriate to compare the groups.

Results: Fifty-seven (32.7%) patients attained remission after at least 1 year of thionamide therapy. Of these, 11 (19.2%) patients relapsed within 1 year. Age, gender, goiter, and presence of extrathyroidal manifestations were not associated with remission. Higher values of Tc uptake were positively associated with remission (P- 0.02). Time to achievement of normal thyroid function and composite dose: Time scores were significantly associated with remission (P - 0.05 and P - 0.01, respectively). Patients with lower FT4 at presentation had a higher chance of remission (P - 0.01). The relapse rates were lower than previously reported in the literature. A higher Tc uptake was found to be significantly associated with relapse also (P - 0.009).

Conclusion: The prognostic factors associated with remission in Graves's disease in this South Indian study are not the same as that reported in Western literature. Tc scintigraphy may have an additional role in identifying people who are likely to undergo remission and thus predict the outcome of Grave's disease.

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References

Feldt-Rasmussen U, Schleusener H, Carayon P . Meta-analysis evaluation of the impact of thyrotropin receptor antibodies on long term remission after medical therapy of Graves' disease. J Clin Endocrinol Metab. 1994; 78(1):98-102. DOI: 10.1210/jcem.78.1.8288723. View

Allahabadia A, Daykin J, Holder R, Sheppard M, Gough S, Franklyn J . Age and gender predict the outcome of treatment for Graves' hyperthyroidism. J Clin Endocrinol Metab. 2000; 85(3):1038-42. DOI: 10.1210/jcem.85.3.6430. View

Laurberg P . Remission of Graves' disease during anti-thyroid drug therapy. Time to reconsider the mechanism?. Eur J Endocrinol. 2006; 155(6):783-6. DOI: 10.1530/eje.1.02295. View

Anagnostis P, Adamidou F, Polyzos S, Katergari S, Karathanasi E, Zouli C . Predictors of long-term remission in patients with Graves' disease: a single center experience. Endocrine. 2013; 44(2):448-53. DOI: 10.1007/s12020-013-9895-0. View

Ishtiaq O, Waseem S, Haque M, Islam N, Jabbar A . Remission of Grave's disease after oral anti-thyroid drug treatment. J Coll Physicians Surg Pak. 2009; 19(11):690-3. DOI: 11.2009/JCPSP.690693. View

Vitti P, Rago T, Chiovato L, Pallini S, Santini F, Fiore E . Clinical features of patients with Graves' disease undergoing remission after antithyroid drug treatment. Thyroid. 1997; 7(3):369-75. DOI: 10.1089/thy.1997.7.369. View

McGregor A, Smith B, Hall R, Petersen M, Miller M, Dewar P . Prediction of relapse in hyperthyroid Graves' disease. Lancet. 1980; 1(8178):1101-3. DOI: 10.1016/s0140-6736(80)91551-2. View

Mohlin E, Filipsson Nystrom H, Eliasson M . Long-term prognosis after medical treatment of Graves' disease in a northern Swedish population 2000-2010. Eur J Endocrinol. 2013; 170(3):419-27. DOI: 10.1530/EJE-13-0811. View

Manohar K, Mittal B, Bhoil A, Bhattacharya A, Dutta P, Bhansali A . Factors predicting treatment failure in patients treated with iodine-131 for graves' disease. World J Nucl Med. 2014; 12(2):57-60. PMC: 4131390. DOI: 10.4103/1450-1147.136693. View

10.

Prakash R . Prediction of remission in Graves' disease treated with long-term carbimazole therapy: evaluation of technetium-99m thyroid uptake and TSH concentrations as prognostic indicators. Eur J Nucl Med. 1996; 23(2):118-22. DOI: 10.1007/BF01731833. View

11.

Nedrebo B, Holm P, Uhlving S, Sorheim J, Skeie S, Eide G . Predictors of outcome and comparison of different drug regimens for the prevention of relapse in patients with Graves' disease. Eur J Endocrinol. 2002; 147(5):583-9. DOI: 10.1530/eje.0.1470583. View

12.

Ikenoue H, Okamura K, Sato K, Kuroda T, Yoshinari M, Tokuyama T . Prediction of relapse in drug-treated Graves' disease using thyroid stimulation indices. Acta Endocrinol (Copenh). 1991; 125(6):643-50. DOI: 10.1530/acta.0.1250643. View

13.

Quadbeck B, Hoermann R, Roggenbuck U, Hahn S, Mann K, Janssen O . Sensitive thyrotropin and thyrotropin-receptor antibody determinations one month after discontinuation of antithyroid drug treatment as predictors of relapse in Graves' disease. Thyroid. 2005; 15(9):1047-54. DOI: 10.1089/thy.2005.15.1047. View

14.

Wartofsky L . Low remission after therapy for Graves disease. Possible relation of dietary iodine with antithyroid therapy results. JAMA. 1973; 226(9):1083-8. View

15.

Glaser N, Styne D . Predictors of early remission of hyperthyroidism in children. J Clin Endocrinol Metab. 1997; 82(6):1719-26. DOI: 10.1210/jcem.82.6.3986. View

16.

Okamoto Y, Tanigawa S, Ishikawa K, Hamada N . TSH receptor antibody measurements and prediction of remission in Graves' disease patients treated with minimum maintenance doses of antithyroid drugs. Endocr J. 2006; 53(4):467-72. DOI: 10.1507/endocrj.k05-121. View

17.

Benker G, REINWEIN D, Kahaly G, Tegler L, Alexander W, Fassbinder J . Is there a methimazole dose effect on remission rate in Graves' disease? Results from a long-term prospective study. The European Multicentre Trial Group of the Treatment of Hyperthyroidism with Antithyroid Drugs. Clin Endocrinol (Oxf). 1999; 49(4):451-7. DOI: 10.1046/j.1365-2265.1998.00554.x. View

18.

Schleusener H, Schwander J, Fischer C, Holle R, Holl G, Badenhoop K . Prospective multicentre study on the prediction of relapse after antithyroid drug treatment in patients with Graves' disease. Acta Endocrinol (Copenh). 1989; 120(6):689-701. DOI: 10.1530/acta.0.1200689. View

19.

Misaki T, Dokoh S, Koh T, Shimbo S, Hidaka A, Iida Y . [Prediction of remission in Graves' disease after thionamide therapy by technetium-99m early uptake]. Kaku Igaku. 1991; 28(2):157-61. View