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Age may influence the impact of TRAbs on thyroid function and relapse-risk in patients with Graves’ disease

Lookup NU author(s): Dr Arjola Bano, Dr Earn Gan, Dr Jolanta Weaver, Dr Salman Razvi



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Oxford University Press, 2018.

For re-use rights please refer to the publisher's terms and conditions.


ContextThyrotropin receptor antibodies (TRAbs) play a crucial role in the pathogenesis of Graves’ disease (GD). However, factors that influence the association of TRAbs with thyroid hormones and relapse risk in GD remain unclear.ObjectiveWe investigated: (i) the associations of TRAbs at diagnosis with thyroid hormones and relapse risk; (ii) potential factors that can influence these associations in GD.Design and SettingA prospective study in GD patients from a single endocrine centre in the north-east of England, seen between January 2008 and March 2018.Patients and Main outcome measuresConsecutive GD patients (n=384) who had measurements of TRAbs, free thyroxine and free triiodothyronine at diagnosis. The association of TRAbs with thyroid hormones and relapse risk was assessed through linear regression and Cox proportional hazard models, adjusted for potential confounders.ResultsTRAbs were non-linearly associated with thyroid hormones, following a curve with an initial positive slope and a subsequent flattening (p-values <0.0001). Higher TRAbs were also associated with greater relapse risk (Hazard ratio [HR], 1.05; 95% confidence interval [95%CI], 1.02-1.08, per 1 U/L increase in TRAb; p-value 0.001). These associations were modified by age, but not by sex, race, smoking or thyroid peroxidase antibody levels. In younger participants, increasing TRAbs were associated with higher thyroid hormones, and greater relapse risk (HR, 1.13; 95%CI, 1.04-1.23, per 1 U/L increase in TRAb; p-value 0.005). In older participants, increasing TRAbs were not associated with meaningful increases in thyroid hormones or relapse risk (HR, 0.99; 95%CI, 0.93-1.05, per 1 U/L increase in TRAb, p-value 0.7).ConclusionsIn GD, age can influence the impact of TRAbs on thyroid function and relapse risk. TRAbs at diagnosis have better predictive value in younger patients with GD.

Publication metadata

Author(s): Bano A, Gan E, Addison C, Narayanan K, Weaver JU, Tsatlidis V, Razvi S

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Endocrinology and Metabolism

Year: 2018

Volume: 104

Issue: 5

Pages: 1378-1385

Print publication date: 01/05/2019

Online publication date: 03/12/2018

Acceptance date: 28/11/2018

Date deposited: 04/12/2018

ISSN (print): 0021-972X

ISSN (electronic): 1945-7197

Publisher: Oxford University Press


DOI: 10.1210/jc.2018-01738


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