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Ratio of Serum Triiodothyronine to Thyroxine and the Prognosis of Triiodothyronine-Predominant Graves' Disease

JUNTA TAKAMATSU, M.D.; MASAHIRO SUGAWARA, M.D.; KANJI KUMA, M.D.; AKIRA KOBAYASHI, M.D.; FUMIO MATSUZUKA, M.D.; TOSHIJI MOZAI, M.D.; and JEROME M. HERSHMAN, M.D.
[+] Article and Author Information

Presented at the 65th Annual Meeting of the Endocrine Society, San Antonio, Texas, June 1983.

Grant support: in part by Veterans Administration Medical Research Funds.

▸Requests for reprints should be addressed to Masahiro Sugawara, M.D. Wadsworth VA Medical Center (691/111M), Wilshire and Sawtelle Boulevards; Los Angeles, CA 90073.


Takatsuki, Osaka, and Kobe, Hyogo, Japan; and Los Angeles, California


© 1984 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1984;100(3):372-375. doi:10.7326/0003-4819-100-3-372
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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.

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