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Remission and Recurrence of Hyperthyroid Graves’ Disease during and after Methimazole Treatment When Assessed by IgE and Interleukin 13

Second Department of Internal Medicine (I.K., T.K., N.T.), University of the Ryukyus School of Medicine, Okinawa 903-0215; Department of Medicine (T.Y., T.N.), Kashiwa City Hospital, Chiba 277-0825; and Department of Medicine (A.S.), Dokkyo Koshigaya Hospital, Dokkyo University School of Medicine Koshigaya, Saitama 343-8555, Japan

Address all correspondence and requests for reprints to: Ichiro Komiya, M.D., Associate Professor of Internal Medicine, Second Department of Internal Medicine, University of the Ryukyus School of Medicine, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. E-mail: ikomiya{at}med.u-ryukyu ac.jp.

Abstract

We analyzed the relationship between serum IgE concentrations and the remission or recurrence of Graves’ disease. One hundred seven patients with Graves’ disease were treated with methimazole (MMI). Serum IgE concentration greater than 170 IU/ml was found in 41 of 107 untreated patients (38.3%). However, the presence of TSH-binding inhibiting immunoglobulin or thyroid-stimulating antibody did not correlate with the IgE concentrations. Remission was found in 20 of 41 patients with elevated IgE concentrations (48.8%) after 18 months of MMI treatment, as opposed to 53 of 66 patients with normal concentrations (80.3%) (P = 0.0014). MMI treatment was discontinued in 73 patients who were followed for 26–48 months. The recurrence of Graves’ disease was found in 13 patients, whereas the remaining 60 were still in remission. The rate of long-standing remission was lower in patients with elevated than normal IgE concentration (34.1% vs. 69.7%, P = 0.0007). We also analyzed serum levels of interleukin (IL)-13. Although IL-13 was not detected in all patients, the detection rate was higher in patients without remission and in those with recurrence than in those with long-standing remission (47.1%, 38.5%, and 13.3%, respectively; P = 0.0012). More patients with elevated IgE were positive for allergic diseases and for family history of allergic diseases in their first-degree relatives. We conclude that the elevation of IgE and the higher detection rate of IL-13 are associated with both remission and recurrence of Graves’ disease.

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