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Thyroid peroxidase antibodies and their role in predicting outcomes in Graves’ disease treatment

Gewert, Klara LU ; Topi, Geriolda LU ; Planck, Tereza LU and Calissendorff, Jan (2025) In Frontiers in Endocrinology 16.
Abstract

Introduction: Graves´ disease (GD) is the predominant cause of hyperthyroidism. Treatment options include antithyroid drugs (ATD), surgery, and radioactive iodine ablation (RI). Although thyroid peroxidase antibodies (anti-TPO) are prevalent in patients with GD, their role in driving relapse or hypothyroidism after treatment in patients with GD remains unclear. This study aimed to determine if patients with anti-TPO at GD diagnosis are more likely to relapse after ATD or RI treatment, and if patients with anti-TPO are at increased risk of developing hypothyroidism post-ATD treatment. Methods: This was an observational, non-interventional retrospective registry study, which included 712 patients treated for GD at a single center in... (More)

Introduction: Graves´ disease (GD) is the predominant cause of hyperthyroidism. Treatment options include antithyroid drugs (ATD), surgery, and radioactive iodine ablation (RI). Although thyroid peroxidase antibodies (anti-TPO) are prevalent in patients with GD, their role in driving relapse or hypothyroidism after treatment in patients with GD remains unclear. This study aimed to determine if patients with anti-TPO at GD diagnosis are more likely to relapse after ATD or RI treatment, and if patients with anti-TPO are at increased risk of developing hypothyroidism post-ATD treatment. Methods: This was an observational, non-interventional retrospective registry study, which included 712 patients treated for GD at a single center in Sweden during 2002-2018. Results: After therapy with ATD, there was no difference in relapse rate between patients with (37.0%) or without (38.4%) anti-TPO at GD diagnosis. Age <40 years was a risk factor for relapse after ATD (p<0.0001). Presence of anti-TPO at diagnosis was associated with reduced relapse rate after RI (13.9% vs. 24.6%; p=0.049). Development of hypothyroidism after discontinuation of ATD did not correlate with anti-TPO status at diagnosis (with anti-TPO: 17.3%; without anti-TPO: 20.8%). Increased risk of hypothyroidism was seen with ATD treatment for >2 years, p<0.05. Conclusion: Anti-TPO positivity at diagnosis of GD did not affect the relapse rate after ATD treatment but could be associated with a better long-term effect of RI. Anti-TPO did not increase the risk of hypothyroidism post-ATD therapy. Understanding risk factors of relapse or hypothyroidism can facilitate treatment choices and help physicians individualize management and follow-up strategies for patients with GD.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
antithyroid drugs (ATD), Graves’ disease, hyperthyroidism (Graves’ disease), long-term follow-up, radioiodine, recurrence, relapse, remission
in
Frontiers in Endocrinology
volume
16
article number
1517283
publisher
Frontiers Media S. A.
external identifiers
  • pmid:40255503
  • scopus:105003014612
ISSN
1664-2392
DOI
10.3389/fendo.2025.1517283
language
English
LU publication?
yes
id
7f5fd75e-4159-478f-8412-4be8d6dcef13
date added to LUP
2025-09-01 11:18:50
date last changed
2025-10-14 11:11:47
@article{7f5fd75e-4159-478f-8412-4be8d6dcef13,
  abstract     = {{<p>Introduction: Graves´ disease (GD) is the predominant cause of hyperthyroidism. Treatment options include antithyroid drugs (ATD), surgery, and radioactive iodine ablation (RI). Although thyroid peroxidase antibodies (anti-TPO) are prevalent in patients with GD, their role in driving relapse or hypothyroidism after treatment in patients with GD remains unclear. This study aimed to determine if patients with anti-TPO at GD diagnosis are more likely to relapse after ATD or RI treatment, and if patients with anti-TPO are at increased risk of developing hypothyroidism post-ATD treatment. Methods: This was an observational, non-interventional retrospective registry study, which included 712 patients treated for GD at a single center in Sweden during 2002-2018. Results: After therapy with ATD, there was no difference in relapse rate between patients with (37.0%) or without (38.4%) anti-TPO at GD diagnosis. Age &lt;40 years was a risk factor for relapse after ATD (p&lt;0.0001). Presence of anti-TPO at diagnosis was associated with reduced relapse rate after RI (13.9% vs. 24.6%; p=0.049). Development of hypothyroidism after discontinuation of ATD did not correlate with anti-TPO status at diagnosis (with anti-TPO: 17.3%; without anti-TPO: 20.8%). Increased risk of hypothyroidism was seen with ATD treatment for &gt;2 years, p&lt;0.05. Conclusion: Anti-TPO positivity at diagnosis of GD did not affect the relapse rate after ATD treatment but could be associated with a better long-term effect of RI. Anti-TPO did not increase the risk of hypothyroidism post-ATD therapy. Understanding risk factors of relapse or hypothyroidism can facilitate treatment choices and help physicians individualize management and follow-up strategies for patients with GD.</p>}},
  author       = {{Gewert, Klara and Topi, Geriolda and Planck, Tereza and Calissendorff, Jan}},
  issn         = {{1664-2392}},
  keywords     = {{antithyroid drugs (ATD); Graves’ disease; hyperthyroidism (Graves’ disease); long-term follow-up; radioiodine; recurrence; relapse; remission}},
  language     = {{eng}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Endocrinology}},
  title        = {{Thyroid peroxidase antibodies and their role in predicting outcomes in Graves’ disease treatment}},
  url          = {{http://dx.doi.org/10.3389/fendo.2025.1517283}},
  doi          = {{10.3389/fendo.2025.1517283}},
  volume       = {{16}},
  year         = {{2025}},
}