Abstract
Previous studies have indicated pre-existing subclinical Graves' disease (GD) in many
patients with the scintigraphic diagnosis of disseminated thyroid autonomy (DISA)
or toxic multinodular goitre (TMG) type A. After radioiodine (RAI) treatment, an increase
or the induction of TSH-receptor antibodies (TRAbs) in patients with GD or TMG has
been repeatedly reported.
In the present study, we investigated whether RAI could induce TRAbs in patients with
TMG in whom pre-existing GD was excluded with highly sensitive TBII and TSAB assays.
Therefore, TRAbs, anti-thyroperoxidase antibodies (anti-TPO-Abs) and anti-thyroglobulin
antibodies (anti-TG-Abs) were determined in 43 consecutive patients at the nuclear
medicine outpatient clinic with the scintigraphic diagnosis of toxic adenoma (TA;
n = 20) or TMG type A (n = 11) or type B (n = 12) before and after RAI treatment.
After RAI therapy, we detected TRAbs in 36 % (4 of 11) of patients with TMG type A
only, whereas TRAbs were not detectable in patients with TMG type B or in patients
with TA. Furthermore, 3 of the 4 patients with detectable TRAbs after RAI showed positive
anti-TPO-Abs before RAI therapy. These findings provide further evidence for pre-existing
GD in patients with TMG type A or DISA as previously suggested. Therefore, patients
with TMG type A and high anti-TPO-Abs seem to be at increased risk of developing TRAbs
or side-effects such as relapse of hyperthyroidism or thyroid associated ophthalmopathy.
These patients therefore require more frequent evaluation after RAI treatment.
Key words
Radioiodine Treatment - TSH-Receptor Antibodies - Toxic Adenoma - Toxic Multinodular
Goitre - Graves' Disease
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1-8
Prof. Dr. med. R. Paschke
Universität Leipzig · Zentrum für Innere Medizin · Medizinische Klinik und Poliklinik
III
Phillip-Rosenthal-Str. 27 · 04103 Leipzig · Germany
Phone: + 49 (341) 97-13200
Fax: + 49 (341) 97-13209
Email: pasr@medizin.uni-leipzig.de