Analysis of the markers related with relapse after withdrawal of antithyroid drug in patients with Graves' disease / 대한내과학회지

ABSTRACT

BACKGROUND: Graves' disease is an organ-specific autoimmune disease that is characterized by thyrotoxicosis, and this is caused by TSH receptor stimulating autoantibody. Antithyroid drugs have been a mainstay of treatment for Graves' patients. Unfortunately, over 50% of patients relapse after their first antithyroid drug treatment and the likelihood of remission cannot be foreseen. Some HLA genes are associated with disease susceptibility, but the association between HLA genes and relapse after drug withdrawal is unclear. In this study, we investigated the association between the HLA genes and the clinical parameters for predicting the clinical outcome of Graves' disease patients. METHODS: We enrolled the patients (n=191) with Graves' disease who were treated by antithyroid drug and who had previously undergone studies for their genetic susceptibility (HLA-DQB1, -DRB1). The success group included patients who maintained a euthyroid state for at least 12 months after withdrawal of drugs. The failure group was defined as the patients who relapsed within 1 year after discontinuation of drug or who could not discontinue their antithyroid drug treatment within 24 months. RESULTS: The rate of treatment failure was 75.4%. There was no significant association between the clinical outcome and the HLA genotyping. The genes that were associated with susceptibility to Graves' disease showed no association with the outcome. A few clinical parameters, such as male patients, severe thyrotoxicosis and high TSH-binding inhibitory immunoglobulin value were related to treatment failure. CONCLUSIONS: Genetic markers such as HLA-DQB1 and DRB1 can not be used, instead of the clinical parameters, to predict relapse after drug withdrawal.