Vai trò của TRAb và TSI trong dự đoán tái phát ở bệnh nhân cường giáp do bệnh Graves được điều trị bằng thuốc kháng giáp tổng hợp=The role of TRAb and TSI in predicting relapse in hyperthyroid patients due to Graves’ disease treated with antithyroid drugs

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Tác giả: Thy Khuê Nguyễn, Vũ Nhật Phong Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.295-300

Bộ sưu tập: Metadata

ID: 243596

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TSI is a specific antibody involved in the pathogenesis of Graves’ disease. Recently, the TSI test has been optimized for accuracy and simplified in procedure, potentially replacing the conventional TRAb test in diagnosis and management of Graves’ disease. Objective: To compare the predictive value of relapse between TSI and TRAb levels before discontinuation of medication in patients with hyperthyroidism due to Graves’ disease. Methods: This retrospective follow-up study involved 352 patients with hyperthyroidism due to Graves’ disease, treated at the Endocrinology Clinic at MEDIC Medical Center in Ho Chi Minh City from January 2000 to April 2021. TSI and TRAb were measured multiple times before discontinuation of medication (based on the attending physician's decision). Patients were planned to discontinue medication once clinical euthyroidism and normal FT4 were achieved with a low dose of antithyroid drugs for at least three months. Additionally, this decision was based on TRAb and TSI levels and other factors such as goiter characteristics and parenchymal vascularity on Doppler ultrasound. After treatment discontinuation, patients were monitored for at least one year to determine the relapse and prolonged euthyroid rates. Results: The median TSI and TRAb levels in Graves’ patients on maintenance doses of antithyroid drugs were 1,45 IU/L and 6,22 IU/L, respectively, with normalization of FT4, T3. In a subgroup analysis of patients (n=37) who had both TSI and TRAb measured before medication discontinuation, the TRAb and TSI levels in the recurrence group were significantly higher than those in the non-recurrence group. However, using the manufacturer’s cut-off (1,75 IU/L), TRAb was nearly positive in all cases (100% in the recurrence group and 96% in the nonrecurrence group), resulting in a sensitivity and negative predictive value of 100%, but specificity, positive predictive value, and overall correct classification rate were only 4%, 33,33%, and 35,14%, respectively. In contrast, using the manufacturer’s cut-off for TSI (0,55 IU/L), sensitivity, specificity, positive predictive value, negative predictive value, and overall correct classification rate were 75%, 56%, 45%, 82,35%, and 62,16%, respectively, in this population. Conclusion: Before discontinuing medication, although FT4 thyroid function tests returned to normal, TSI and TRAb levels remained relatively high, indicating an ongoing immune response. TSI provides better predictive value for Graves’ disease relapse after discontinuing antithyroid drugs compared to TRAb.TSI là một loại kháng thể đặc hiệu trong cơ chế bệnh sinh của bệnh Graves. Xét nghiệm TSI gần đây đã được tối ưu hóa về độ chính xác và đơn giản hóa về cách thực hiện, có khả năng thay thế xét nghiệm TRAb thông thường trong chẩn đoán và theo dõi bệnh lý cường giáp do Graves. Mục tiêu: So sánh giá trị dự đoán tái phát của nồng độ TSI và TRAb trước ngưng thuốc trên bệnh nhân cường giáp do Graves. Phương pháp nghiên cứu: Nghiên cứu đoàn hệ, hồi cứu trên 352 bệnh nhân cường giáp do Graves đến điều trị tại phòng khám Nội tiết tại Trung tâm Y khoa MEDIC, Thành phố Hồ Chí Minh từ tháng 01/2000 đến tháng 04/2021. TSI và TRAb được đo nhiều lần trong quá trình điều trị khi bệnh nhân chuẩn bị được ngưng thuốc (theo quyết định của bác sĩ điều trị). Bệnh nhân sẽ được lên kế hoạch ngưng thuốc khi đạt bình giáp lâm sàng và FT4 bình thường với liều thấp thuốc kháng giáp tổng hợp trong ít nhất 3 tháng. Ngoài ra, quyết định này còn dựa vào nồng độ TRAb, TSI cùng các yếu tố khác như đặc điểm bướu giáp, mức độ tăng sinh mạch máu trên siêu âm. Sau khi ngưng thuốc, bệnh nhân được tiếp tục theo dõi ít nhất 1 năm để tính tỉ lệ tái phát và bình giáp kéo dài. Kết quả: Nồng độ TSI và TRAb trung vị trên bệnh nhân Graves đang điều trị với thuốc kháng giáp tổng hợp liều duy trì lần lượt là 1,45 IU/L và 6,22 IU/L, với xét nghiệm FT4, T3 trong giới hạn bình thường, Trong phân tích một nhóm bệnh nhân (n = 37) có đo TSI và TRAb đồng thời trước ngưng thuốc, nồng độ TRAb và TSI trước ngưng thuốc ở nhóm tái phát cao hơn nhóm không tái phát có ý nghĩa thống kê. Tuy nhiên, nếu lấy ngưỡng cắt của nhà sản xuất (1,75 IU/L), TRAb gần như dương tính ở tất cả các trường hợp (100% ở nhóm tái phát và 96% ở nhóm không tái phát), cho độ nhạy và giá trị tiên đoán âm là 100% nhưng độ đặc hiệu, giá trị tiên đoán dương và tỉ lệ phân loại đúng lần lượt chỉ là 4%, 33,33% và 35,14%. Trong khi đó, nếu áp dụng ngưỡng cắt TSI của nhà sản xuất (0,55 IU/L), độ nhạy, độ đặc hiệu, giá trị tiên đoán dương, âm và tỉ lệ phân loại đúng lần lượt là 75%, 56%, 45%, 82,35%, và 62,16% trong nhóm dân số này. Kết luận: Trước khi ngưng thuốc xét nghiệm chức năng tuyến giáp FT4 đã trở về bình thường nhưng nồng độ TSI và TRAb còn khá cao, có thể phản ứng miễn dịch vẫn còn hoạt động. TSI có giá trị tốt hơn so với TRAb trong việc dự đoán tái phát bệnh Graves sau ngưng thuốc kháng giáp tổng hợp.

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