Prognostic Value of Serum Thyroid Function Index in Treatment Reactivity of Graves Disease

LI Jing; XU Xiaojie; XING Huijuan; ZHAO Mengmeng; GAO Shuaibin; MAO Yu; HUO Yajie; KANG Zhiqiang

doi:10.3969/j.issn.1004-437X.2025.01.007

Abstract：Objective To observe the value of serum thyroid function index in predicting treatment reactivity in patients with diffuse toxic goiter(Graves disease).Methods Seventy-three patients with Graves disease admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2020 to January 2023 were retrospectively selected as the observation group,and 73 healthy subjects who underwent physical examination in Zhengzhou Central Hospital Affiliated to Zhengzhou University at the same period and age at the same time were selected as the control group according to the 1∶1 pairing principle.Thyroid function indexes[free triiodothyronine(FT3),free thyroxine(FT4),thyroid peroxidase antibody(TPOAb),thyroid stimulating hormone(TSH),thyroglobulin antibody(TGAb)]were compared between the two groups.The levels of thyroid function indexes in patients with different disease course,thyrotropin receptor antibody(TRAb)activity and treatment responsiveness were compared.Receiver operating characteristic(ROC)area under the curve(AUC),net reclassification index(NRI),integrated discrimination improvement(IDI)were used to evaluate the predictive value of serum thyroid function indexes in patients with treatment responsiveness.Results FT4,FT3,TGAb and TPOAb in observation group were higher than those in control group,and TSH was lower than those in control group(P＜0.05).There were significant differences in FT4,FT3,TSH,TGAb and TPOAb among patients with different disease course and TRAb activity(P＜0.05).Serum FT4,FT3,TGAb and TPOAb levels were positively correlated with disease course and TRAb activity,while TSH was negatively correlated with disease course and TRAb activity(P＜0.05).FT4,FT3,TGAb,TPOAb were higher in patients with non-response than those with response,and TSH was lower than those with response(P＜0.05).FT4,FT3,TGAb and TPOAb were positively correlated with treatment reactivity,while TSH was negatively correlated with treatment reactivity(P＜0.05).Combining FT4,FT3 and TSH indicators as model 1,TGAb and TPOAb indicators as model 2,and FT4,FT3,TSH,TGAb and TPOAb indicators as model 3,the results showed that the AUC of model 3 in predicting patients'treatment response was better than that of model 1 and model 2.NRI and IDI analysis showed that compared with model 1 and model 2,the combined prediction effect of model 3 is significantly improved.Conclusion The abnormal expression of serum thyroid function indexes in patients with Graves disease is closely related to the course of disease,TRAb activity and therapeutic reactivity,and the combination of these indexes has high reference value in predicting the therapeutic reactivity of patients.