Thyroid : official journal of the American Thyroid Association
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After primary successful antithyroid drug treatment (ATDT), Graves' disease has a relapse rate of 30% to 50%. Previous studies have evaluated age, gender, goiter volume, smoking habits, and the presence of thyrotropin-receptor antibodies (TRAb) as predictive markers to facilitate an individualized patient management. Despite higher sensitivity and specificity of the new second generation human TSH-receptor assay, the predictive value of TRAb for relapse of hyperthyroidism is still controversial. In a recent prospective multicenter study we have previously shown that suppressed or low TSH values predict both early (persistence) and late relapse of Graves' disease. We now present a more detailed analysis of the predictive value of TSH and TRAb for recurrent hyperthyroidism. ⋯ Low TSH values 4 weeks after ATDT withdrawal predict relapse of Graves' disease, both early (persistence) and, to a lesser extend, within 2 years of follow-up. Also, TRAb above 10 IU/L found in a small subset of patients, correlated with a higher relapse rate.
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Some have suggested that thyroid disease is even more prevalent among patients with hyperparathyroidism (HPT) than in the general population. We sought to define the incidence and optimal management strategies of thyroid disease in patients undergoing surgery for HPT. ⋯ The high prevalence of thyroid disease, especially malignancies, among HPT patients mandates vigilant diagnosis and preparation for possible simultaneous parathyroid-thyroid surgery. Without appropriate preoperative screening, focal explorations for HPT may be prone to delayed diagnosis of thyroid tumors. Ultrasound performed by surgeons or endocrinologists preoperatively is an excellent diagnostic tool and minimizes unnecessary thyroidectomy in patients with subclinical thyroid disease.