THYROID STIMULATING ANTIBODIES: AN AID TO THE STRATEGY OF TREATMENT OF GRAVES' DISEASE?

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Abstract
The usefulness of thyroid stimulating antibody (TSAb) determinations in predicting the outcome of post-antithyroid drug treatment for Graves'' disease was examined in 55 patients, who were either treated for 6 (n = 16) or 18 mo. (n = 39) and followed up for an additional 2-yr period. TSAb was determined on whole serum in 29 patients before and at the end of treatment, and in 26 patients at the end of treatment only. These determinations were carried out using a sensitive and reproducible microassay based on cAMP accumulation in human thyroid cell cultures. Before treatment, TSAb, 170-1529%, was present in 28/29 patients and reached significantly low levels at the end of treatment whatever its duration. TSAb was undetectable in 24/55 patients at the end of treatment; 8/16 short-treated and 18/39 long-treated patients remained in remission. As expected, initial TSAb levels had no predictive value. End-treatment TSAb values, when low (< 350%) or negative did not correlate with later evolution: in these 39 patients, relapse rate was 41%. In contrast, 13/16 patients with end-treatment TSAb > 350% relapsed. Relapses tended to occur earlier in patients with the highest TSAb levels. TSAb determined again during follow-up was negative in each of the 18 patients in remission, and positive in 8/10 patients at the time of relapse, whatever its level at the end of the drug course. Only high end-treatment TSAb levels are predictive of relapse. In the other cases, TSAb had no prognostic value. TSAb levels appear to reflect only partially the activity of the underlying disturbances of Graves'' disease.

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