Endocrine Abstracts

Background: Thyroid stimulating receptor hormone receptor antibodies (TRAb) markers are useful in confirming diagnosis of Graves’ disease, but also recognised as a predictor of relapse. Good practice dictates that a TRAb is measured at the commencement of treatment, to confirm a diagnosis of graves’ disease. Repeating the TRAb before discontinuation of treatment can assist in guiding treatment. If TRAb remains elevated, the chances of relapse are increased. A persistently elevated TRAb is one of the predictors of relapse.

Method: 100 patients with confirmed Graves’ disease, having completed 18 months treatment on anti-thyroid medication, were selected at random using hospital data systems. Using a quantitative methodology approach, data was collated relating to TRAb at diagnosis and at the end of 18 months treatment for those receiving Anti Thyroid Drugs (ATDs).

Results: Of the 100 patients, 27= male, 73 = female. 98 patients had a TRAb checked at diagnosis. Following treatment, 61 patients had a confirmed relapse of Graves’ disease within 12 months. Of these, 22 patients had their TRAb repeated at the end of 18 months treatment. 4 of these patients returned an elevated TRAb and relapsed within 7 months. The remaining 18 patients had a normal TRAb, with 6 relapsing in the following 12 months. 78 patients had discontinuation of treatment with no TRAb repeated, 50 of which relapsed within 12 months.

Conclusion: All patients with an elevated TRAb at the end of 18 months treatment proceeded to relapse within 12 months. 50 patients also relapsed but without a repeat TRAb. We could assume that if the TRAb had been repeated in those 50 patients, found to be elevated and the 18 month treatment regimen extended, definitive treatment options could have been broached much sooner.