U. Feldtrasmussen et al., METAANALYSIS EVALUATION OF THE IMPACT OF THYROTROPIN RECEPTOR ANTIBODIES ON LONG-TERM REMISSION AFTER MEDICAL THERAPY OF GRAVES-DISEASE, The Journal of clinical endocrinology and metabolism, 78(1), 1994, pp. 98-102
Patients with the hyperthyroidism of Graves' disease (GDH) have a high
er risk of relapse after antithyroid drug therapy (ATD) therapy when T
SH receptor antibodies (TRAb) are positive, but the practical clinical
implication of TRAb as a predictor for relapse is still much debated.
This study was undertaken to investigate by meta-analysis the results
from the literature on the use of TRAb as predictor of long term (i.e
. at least 1 yr) relapse after ATD. Eighteen publications from 1975-19
91 fulfilled the criteria of 1) availability of TRAb at the end of ATD
treatment, 2) at least 1 yr of follow-up after ATD, 3) data presentat
ion in a form suitable for mete-analysis, and 4) no other thyroid-rela
ted therapy during the follow-up period. The 10 prospective studies, 5
of which measured TSH binding inhibiting immunoglobulins (total n = 5
97) and 5 of which measured thyroid-stimulating antibodies (n = 340),
were computed together because no significant differences were found.
In contrast, retrospective and prospective studies differed. In the pr
ospective studies, the odds reduction of relapse showed 65% less risk
of relapse when TRAb were absent compared to that in TRAb-positive pat
ients (P < 0.00001). The present mete-analysis has, thus, confirmed in
a large number of patients (n = 1524) that absence of TRAb is signifi
cantly protective against relapse of GDH after ATD treatment. However,
25% of the patients are ''misclassified,'' and the main questions ari
sing from the study are, therefore, the following. 1) Is it worthwhile
to use TRAb as predictor of relapse? 2) Should patients with GDH cont
inue ATD until TRAb becomes negative, rather than for a fixed period?
The available methods for TRAb do not allow sufficiently high predicti
on of relapse or remission after ATD for the individual patient.