Objective: Patients with low thyroid peroxidase antibodies (anti-TPO) and increased TSH-receptor antibodies (TRAb) at diagnosis of Graves disease (GD) have been suggested to have an increased risk to develop Graves ophthalmopathy (GO). The aim was to evaluate if GO development can be predicted.
Design: Observational study with registration of possible GD and GO risk factors.
Methods: Three hundred and ninety nine patients with GD were registered 20032008 in Malmö, Sweden and out of these 310 were retrospectively followed up to 6 years. The main outcome measures were anti-TPO titer, TRAb titer, smoking habits, radioiodine treatment, and GO development.
Results: TRAb was assessed with a third generation assay at GD diagnosis in 231 patients. The proportion of patients with GO increased above the median 6.3 IU/l both at diagnosis of GD (P=0.001) and at follow-up (P=0.0001).
The distribution of GO patients anti-TPO above or below 20 kIU/l at diagnosis of GD was similar between groups (P=0.239). However at follow-up anti-TPO <20 kIU/l was associated with an increased proportion of newly developed GO as compared to the cohort with anti-TPO >20 kIU/l (P=0.018).
Eighty seven percentage of patients who developed GO after GD diagnosis had TRAb above 6.3 IU/l and/or anti-TPO below 20 kIU/l. The proportion of GO was doubled in GD patients treated with radioiodine but could not explain the described findings.
Conclusions: Anti-TPO <20 kIU/l and/or TRAb >6.3 IE/l at the time of GD diagnosis were associated with an increased risk to develop GO after diagnosis of GD.
27 Apr - 01 May 2013
European Society of Endocrinology