Trab determination in newly detected patients with hyperthyroidism and their prognostic importance

Abstract

Introduction. In more than 50 years since the first demonstration of the immune basis for thyroiditis was done, the autoimmune disease has been identified as a major cause of disfunction of all endocrine organs. Identification of the antithyroid with the radio-receptor assay is widespread in clinical use for differential diagnosis of other thyroid disorders manifesting with the hyperthyroidism. Material and methods. Our study included 44 patients with new onset Graves disease which was primarily verified according to the objective status of the patients (signs of hyperthyroidism), biochemical parameters (which included thyroid hormones) and detection of the TRAb (TSAb-thyreotropin-stimulanting antibodies) at the beginning of diagnosis and in the first, second and after the third month since the introduction of antithyroid therapy (propiltiouracil). RESULTS. On the basis of the TSAb concentration level, we found that the response to the therapy was positive in 65.9% ('responders') of the patients and negative in 22.7% ('non responders') of the patients and without therapeutic effect were 11.4% of the patients. During the therapy (after the first month), in the group of non responders we found increased values of the TSAb (p<0.05) and in the group of responders we found reduction of the TSAb levels (p<0.05). Conclusion. Our study demonstrated that the therapy with propiltiouracil, after the first month divide patients with positive and negative response, which could change the therapeutic, options in the future.Odredjivanje autoantitela usmerenih protiv TSH receptora sa radio-receptorskim esejom u sirokoj je upotrebi u klinickoj praksi za dijagnostikovanje Gravesove bolesti i njenom diferenciranju u odnosu na druga oboljenja tiroidne zlezde. U studiju su ukljucena 44 novootkrivena pacijenta sa Gravesovom bolescu koja je primarno verifikovana putem objektivnog statusa i biohemijskih parametara koji su ukljucivali hormone stitne zlezde i odredjivanje tirotropin-stimulisucih antitela. U toku terapije u grupi pacijenata sa negativnim odgovorom na terapiju - 'neresponderi', doslo je znacajnog porasta vrednosti tirotropin-stimulisucih antitela (p<0,05) a u grupi koja je pozitivno odgovorila na terapiju - 'responderi', doslo je do statisticki znacajnog pada vrednosti tirotropin-stimulisucih antitela (p<0,05). Ovom studijom smo pokazali da antitiroidna terapija primenom propiltiouracila, vec nakon mesec dana utice na izmenu nivoa tirotropin-stimulisucih antitela u serumu, sto moze da nas usmeri u daljem terapijskom pristupu.