Endocrine Abstracts

Introduction: Graves’ disease (GD) management in Indonesia are generally preceded by administration of antithyroid drugs. Antithyroid drug delivery requires a long time to achieve remission, even more than 50% of patients who had remission can recur after antithyroid medication is stopped. The purpose of this study was to determine the role of CTLA-4 gene and regulatory T cells against recurrence in patients GD in Indonesia.

Methods: The study was conducted using a case-control in 144 patients GD, comparing patients who relapse and recurrence. Definition of relapse if the patient is declared remission after antithyroid treatment for at least 18 months, but relapsed after 12 months of antithyroid medication is stopped. Examination of CTLA-4 gene polymorphism of exon1 by the method of PCR RFLP, and the number of regulatory T cells was checked by flow cytometry.

Results: Research shows that patients with GD have higher risk of relapse if they have family history (P 0.01), degree two of ophtalmopathy (P 0.011) and enlargement of the thyroid gland exceeded the lateral edge of the sternocleidomastoideus muscle (P 0.044). GD patients with polymorphisms of CTLA-4 gene exon1 genotype GG and GA have higher risk of relapse than the AA genotype (P 0.003 and OR6.545). The number of regulatory T cells in patients with relapsed is lower than non-recurrence (P<0.005). GD patients with the G allele in the gene CTLA-4 exon1 has had lower regulatory T cells than the A allele (P<0.005).

Conclusion: The risk of relapse in patients with GD can be determined prior to administration of antithyroid therapy based on clinical factors, genetics and immunology.