JUNTA TAKAMATSU, M.D.; MASAHIRO SUGAWARA, M.D.; KANJI KUMA, M.D.; AKIRA KOBAYASHI, M.D.; FUMIO MATSUZUKA, M.D.; TOSHIJI MOZAI, M.D.; JEROME M. HERSHMAN, M.D.
Triiodothyronine (T3)-predominant Graves' disease is characterized by persistently high serum T3 level, normal serum thyroxine (T4) level, and high (> 20) serum T3/T4 ratio (nanograms/micrograms) during thionamide drug therapy. We studied the clinical course of 30 patients with T3-predominant Graves' disease. After receiving drug therapy for 1 to 4 years, 24 patients with T3-predominant Graves' disease had relapses, whereas only 9 control patients with Graves' disease whose serum T3/T4 ratio had become persistently normal (< 20) had relapses. The T3-predominant patients had greater serum TSH receptor antibody activity, thyroid T4 5′-deiodinase activity, and decreased T3 content of thyroglobulin when compared with the control patients. Our findings show that patients with T3-predominant Graves' disease are unlikely to have a long-term remission with drug therapy. The cause of high serum T3/T4 ratio is due, in part, to the more active thyroid T4 5′-deiodinase that may be mediated by high levels of Graves' immunoglobulin.
TAKAMATSU J, SUGAWARA M, KUMA K, KOBAYASHI A, MATSUZUKA F, MOZAI T, et al. Ratio of Serum Triiodothyronine to Thyroxine and the Prognosis of Triiodothyronine-Predominant Graves' Disease. Ann Intern Med. 1984;100:372–375. doi: 10.7326/0003-4819-100-3-372
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Published: Ann Intern Med. 1984;100(3):372-375.
Endocrine and Metabolism, Thyroid Disorders.
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