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The following is a summary of “Thyroid peroxidase antibodies and their role in predicting outcomes in Graves’ disease treatment,” published in the April 2025 issue of Frontiers in Endocrinology by Gewert et al. 

Graves’ disease (GD) the leading cause of hyperthyroidism, treated with antithyroid drugs (ATD), surgery, or radioactive iodine ablation (RI), while the role of thyroid peroxidase antibodies (anti-TPO) in relapse or hypothyroidism remained unclear.  

Researchers conducted a retrospective study to examine whether individuals with anti-TPO at GD diagnosis had a higher likelihood of relapse after antithyroid drug or RI treatment and an increased risk of hypothyroidism following ATD treatment.  

They used data from the GD 2002 study (individuals with newly diagnosed GD at Malmö University Hospital from 2003 to 2018) (14). A database included information on age, sex, place of birth, smoking status, ophthalmopathy at diagnosis, and levels of thyroid-stimulating hormone receptor antibodies (TRAb), anti-TPO, free triiodothyronine (free T3), free thyroxine (free T4), and thyroid-stimulating hormone (TSH). Additional data on treatment type, outcomes (including GD relapse and hypothyroidism post-ATD treatment), ATD treatment duration, follow-up duration, and coexisting autoimmune conditions were extracted.  

The results showed no significant difference in relapse rates after ATD therapy between individuals with anti-TPO (37.0%) and those without (38.4%) at GD diagnosis. Age below 40 years was a risk factor for relapse after ATD (P <0.0001). Anti-TPO presence at diagnosis was linked to a lower relapse rate after RI (13.9% vs 24.6%; P =0.049). Development of hypothyroidism after ATD discontinuation was similar regardless of anti-TPO status (with anti-TPO: 17.3%; without anti-TPO: 20.8%), ATD treatment exceeding 2 years was associated with an increased risk of hypothyroidism (P <0.05).  

Investigators concluded that anti-TPO positivity at GD diagnosis did not influence relapse after ATD treatment but potentially improved long-term RI effects and did not increase hypothyroidism risk post-ATD. 

Source: frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2025.1517283/full