Dynamics of Hormonal and Immunological Indexes during Conservative Treatment of Patients with Diffuse Toxic Goiter

Abstract

The dynamics of structural and functional state of thyroid gland was studied, as well as the levels of antithyroid antibodies in patients with diffuse toxic goiter (DTG) during long-term treatment with thyrostatic agents. Objective of the study — to perform the analysis of changes in the levels of thyrotropin receptor antibodies (TRAbs), antibodies to thyreoproxidase (ATPO) at DTG manifestation and during long-term drug therapy, as well as to determine TRAbs levels in relapsing course of disease. Materials and methods. 112 patients with DTG were examined. The duration of the disease at the examination beginning was from 1 month to 15 years. All patients were divided into two groups depending on the DTG duration: the first group consisted of 46 patients with disease duration up to 1 year (3.96 months in average), the second one consisted of 66 patients with disease duration more than 1 year (3.32 years in average). This distribution was specified by desire to study the dynamics of antithyroid antibody levels at disease manifestation and during long-term course of autoimmune process. Results. On the background of thyrostatic therapy, the number of patients with focal thyroid gland formations increased. When analyzing the levels of antithyroid antibodies at baseline, it was revealed that ATPO level in both groups of patients with DTG significantly exceeded the performance of the control group (group1 — 283.33 ± 86.61 U/ml vs 35.65 ± 4.90 U/ml; group 2 — 207.34 ± 42.52 U/ml vs 35.65 ± ± 4.90 U/ml) and did not depend on disease duration and preliminary treatment duration. In 6 months of treatment, the level of ATPO in both groups was not decreased. The study of TRAbs dynamics during thyrostatic therapy revealed that in patients of the first and second groups, the decrease of TRAbs level was noted only 6–12 months after the start of thyrostatic therapy (group 1 — from 17.19 ± 2.17 IU/l to 6.95 ± 2.39 IU/l, p < 0.05; group 2 — from 14.20 ± 2.04 IU/l to 5.81 ± 2.26 IU/l, p < 0.05). In 24 months of treatment, the recurrence of thyrotoxicosis has been detected in 24 patients (21.4 %). The study of TRAbs levels in patients with relapsing course of the disease revealed their significant increase (24.27 ± 2.86 IU/l vs 12.28 ± 3.57 IU/l). In 6 months of thyrostatic therapy, the levels of TRAbs in patients with relapses do not significantly decreased and were significantly higher than similar rates in patients with DTG in remission (17.22 ± 3.37 IU/l vs 4.64 ± 1.99 IU/l). Conclusions. In patients with DTG, TRAbs level decreases in only 6–12 months after the beginning of thyrostatic therapy. The patients with relapsing course of the disease have significantly larger sizes of goiter, as well as the levels of TRAbs, which in 6 months of continuous treatment far exceeded the normal values and indicators of patients with remission.

Keywords

• diffuse toxic goiter
• the antithyroid peroxidase antibodies
• TSH receptor antibodies
• antithyroid therapy