Evidence map›Paper›PMID 40955128›Full record

ArticleEndocrinology and metabolism (Seoul, Korea)2025

High TRAb Titer at Diagnosis Predicts Persistent Positivity and Relapse in Graves' Disease after Prolonged Antithyroid Therapy.

Zimiao Chen, Jinglu Xu, Wenrui Kang, Yang Zhang, Rujun Chen, Xiaohua Gong

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Article in Endocrinology and metabolism (Seoul, Korea), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

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3 · Its place in the literature

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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Zimiao ChenDepartment of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Jinglu XuDepartment of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Wenrui KangThe First School of Medicine, Wenzhou Medical University, Wenzhou, China.
Yang ZhangThe First School of Medicine, Wenzhou Medical University, Wenzhou, China.
Rujun ChenDepartment of Burns, 906 Hospital of the Joint Logistics Team, PLA, Wenzhou, China.
Xiaohua GongDepartment of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Funding

Medical Science and Technology Project of Zhejiang Province 2024KY1249Science and Technology Project of Wenzhou Y20240216
6 · The paper itself

Abstract

backgruoundThe association between high thyrotropin receptor antibody (TRAb) titers at diagnosis and long-term outcomes following prolonged antithyroid drug (ATD) therapy in Graves' disease (GD) remains unclear. This study examined TRAb dynamics and outcomes in high-titer patients receiving prolonged ATD.

methodsIn this retrospective cohort (2018-2021), 1,148 of 3,052 newly diagnosed GD patients met inclusion criteria (≥18-month ATD course, TRAb negativity before withdrawal, and ≥12-month follow-up). Initial TRAb levels were defined as low-titer (<5.25 IU/L, 3×upper normal limit [UNL]), intermediate-titer (5.25-10.5 IU/L), and high-titer (>10.5 IU/L, 6×UNL). Outcomes included TRAb dynamics, treatment duration, and relapse.

resultsHigh-titer patients required longer therapy (50 months vs. 30 months vs. 22 months, P<0.001) and slower thyroid-stimulating hormone normalization (6 months vs. 4 months vs. 2 months, both P<0.001). TRAb negativity at 24/48 months occurred in 91.85%/99.26% (low-titer), 52.38%/75.24% (intermediate-titer), and 12.70%/52.68% (high-titer) (P<0.001). High-titer patients showed fluctuant (46.20%) or smoldering (28.89%) trends. Remission rates declined with higher TRAb titer (60.45% vs. 42.70% vs. 30.47%, P<0.001). High-titer patients showed increased risk of persistent TRAb positivity (2.17-fold; 95% confidence interval [CI], 1.55 to 3.05) and relapse (1.66-fold; 95% CI, 1.45 to 3.22). Thresholds of 10.90 IU/L and 16.01 IU/L predicted positivity and relapse, respectively. Definitive therapy post-relapse was more common in high-titer patients (38.29% vs. 16.98% in low-titer, P<0.001).

conclusionHigh TRAb titers strongly predict persistent TRAb positivity and relapse after ATD withdrawal. Cut-off at 10.90 and 16.01 IU/L may guide prognosis and treatment.

Indexed as

Antithyroid AgentsAutoantibodiesGraves DiseaseImmunoglobulins, Thyroid-StimulatingReceptors, ThyrotropinAdultBiomarkersFemaleFollow-Up StudiesHumansMaleMiddle AgedPrognosisRecurrenceRetrospective StudiesYoung AdultAntithyroid AgentsAutoantibodiesBiomarkersImmunoglobulins, Thyroid-StimulatingReceptors, Thyrotropinthyrotropin-binding inhibitory immunoglobulinGraves diseaseHigh TRAb titers at diagnosisLong-term follow-upProlonged course of antithyroid drugsRelapse

Identifiers

PMID40955128
PMCPMC12765878

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