Graves Hyperthyroidism After Stopping Immunosuppressive Therapy in Type 1 Diabetic Islet Cell Recipients With Pretransplant TPO Autoantibodies
- Pieter Gillard, MD, PHD1,2,
- Volkert Huurman, MD, PHD3,
- Bart Van der Auwera, PHD2,
- Brigitte Decallonne, MD, PHD1,
- Kris Poppe, MD, PHD4,
- Bart O. Roep, PHD3,
- Frans Gorus, MD, PHD2,
- Chantal Mathieu, MD, PHD1,
- Daniel Pipeleers, MD, PHD2 and
- Bart Keymeulen, MD, PHD2
- 1Department of Endocrinology, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium;
- 2Diabetes Research Center and University Hospital, Brussels Free University, Brussels, Belgium;
- 3Department of Immunohematology and Blood Transfusion and Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands;
- 4Department of Endocrinology, University Hospital Brussels, Brussels, Belgium.
- Corresponding author: Bart Keymeulen, bart.keymeulen{at}vub.ac.be.
Abstract
OBJECTIVE After an initially successful islet cell transplantation, a number of patients return to C-peptide negativity, and therefore immunosuppressive therapy is discontinued. Some are then found to have developed Graves disease. We examined the risk of Graves disease after immunosuppression.
RESEARCH DESIGN AND METHODS Immunosuppressive therapy was stopped in 13 type 1 diabetic islet cell recipients who had received one course of antithymocyte globulin and maintenance doses of mycophenolate mofetil and a calcineurin inhibitor. None had a history of thyroid disease.
RESULTS In four patients, clinical Graves hyperthyroidism was observed within 21 months after discontinuation and 30–71 months after the start of immunosuppressive therapy. All four patients exhibited a pretransplant positivity for thyroid peroxidase (TPO) autoantibodies, while the nine others were TPO negative pre- and posttransplantation.
CONCLUSIONS Type 1 diabetic recipients of islet cell grafts with pretransplant TPO autoantibody positivity exhibit a high risk for developing Graves hyperthyroidism after immunosuppressive therapy is discontinued for a failing graft.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received December 31, 2008.
- Accepted June 14, 2009.
- © 2009 by the American Diabetes Association.
