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Predictive value of thyroid-related biomarkers in Graves’ disease – a systematic review

Zofia Marek, Szymon Ejzak, Julia Wiktorowska, Magdalena Lesisz, Katsiaryna Palitsyna, Michał Szabelski, Joanna Rymuza

Affiliation and address for correspondence
Pediatr Med Rodz 2025; 21 (4): 208–214
DOI: 10.15557/PiMR.2025.0032
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Abstract

Graves’ disease is the most common cause of hyperthyroidism and is characterised by a clinical course often difficult to predict. While some patients experience relapses, others achieve long-term remission. It is crucial to improve the accuracy of predicting disease course in order to identify patients who are most likely to benefit from antithyroid drug therapy, thereby avoiding potential complications associated with more radical treatments. The aim of this systematic review is to gather up-to-date knowledge in this field and, based on it, to determine whether commonly available thyroid-related biomarkers can predict the likelihood of remission after antithyroid drug therapy. Thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and TSH-receptor antibodies (TRAb) were evaluated. A total of 964 articles (394 from PubMed and 570 from Embase) were initially identified. After screening and eligibility assessment, 19 studies were included in the final analysis. The results of these studies were heterogenous and partly inconclusive. However, TRAb appears to be the most useful marker in predicting remission. Low baseline TRAb concentrations are associated with a higher probability of remission, while higher values correlate with a more severe clinical course and a greater risk of relapse. The predictive value of FT3 and FT4 as markers is questionable. TSH tends to be the least informative predictor of the outcome. In conclusion, looking at the nature of Graves’ disease, which may be relapsing-remitting, further research in this area is warranted to enhance the quality of life of patients with Graves’ disease.

Keywords
biomarkers, Graves’ disease, hyperthyroidism, antithyroid drugs

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