Graves' Hyperthyroidism after Stopping Immune Suppressive Therapy in Type 1 Diabetic Islet Cell Recipients with Pretransplant TPO-Autoantibodies

  1. Pieter Gillard, M.D., PhD1,2,
  2. Volkert Huurman, M.D., PhD3,
  3. Bart Van der Auwera, PhD1,
  4. Brigitte Decallonne, M.D., PhD2,
  5. Kris Poppe, M.D., PhD1,
  6. Bart O. Roep, PhD3,
  7. Frans Gorus, M.D., PhD1,
  8. Chantal Mathieu, M.D., PhD2,
  9. Daniel Pipeleers, M.D., PhD1 and
  10. Bart Keymeulen, M.D., PhD. (Bart.Keymeulen{at}vub.ac.be)1
  1. 1. Diabetes Research Center and University Hospital Brussels, Brussels Free University-VUB, Laarbeeklaan 103, B-1090 Brussels, Belgium
  2. 2. Department of Endocrinology, University Hospital Gasthuisberg, KULeuven, Herestraat 49, B-3000 Leuven, Belgium
  3. 3. Department of Immunohematology and Blood Transfusion and Department of Surgery, Leiden University Medical Center, Albinusdreef 2, NL-2300 Leiden, The Netherlands; 1.2. JDRF Center for Beta Cell Therapy in Diabetes, Central Unit Medical Campus-VUB, Brussels 1090, Belgium

    Abstract

    Objective: After an initially successful islet cell transplantation, a number of patients return to C-peptide-negativity and are therefore discontinued in immune suppressive therapy. Some were found to develop Graves' disease.

    Research design and methods: Immune suppressive 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 4 patients clinical Graves' hyperthyroidism was observed within 21 months after discontinuation, and 30 to 71 months after start of immune suppressive therapy. All four 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 immune suppressive therapy is discontinued for a failing graft.

    Footnotes

      • Received December 31, 2008.
      • Accepted June 14, 2009.

    This Article

    1. Published online before print June 23, 2009, doi: 10.2337/dc08-2339
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