Energy Homeostasis and Body Weight before and after Cessation of Block and Replacement Therapy in Euthyroid Patients with Graves' Disease

[摘要] Patients with Graves' hyperthyroidism (GH) treated with a combination of thyrostatic drugs and T4, that is, block and replacement therapy (BRT), often report body weight (BW) gain. We aimed to determine changes in BW and energy metabolism upon cessation of BRT in these patients, and to identify possible endocrine determinants. We analysed 22 patients with GH (i) during BRT, and (ii) 12 weeks after BRT cessation. Patients were euthyroid at both visits.There were no differences in BW or resting energy expenditure (REE) between visits. At visit 1, after 13.5 (9.5–48.0) months of BRT, serum free (F)T4correlated positively with REE (r=0.433,P=0.044) and negatively with body fat % (r=-0.450,P=0.035). Plasma FT3and FT3/FT4ratio showed an increase 12 w after cessation of BRT (20%,P<0.0001and 16%,P=0.007, resp.). Moreover, the relative change in FT3/FT4ratio showed a significant, positive correlation with the relative change in REE between the 2 visits (r=0.465,P=0.029). In conclusion, serum FT4determines REE in euthyroid patients with GH treated with BRT. Twelve weeks after BRT cessation, BW and energy homeostasis are unaltered. However, as serum FT3/FT4ratio increases after cessation of BRT, which is a positive determinant of changes in REE, a longer term BW decrease is likely to occur.

[学科分类] 内分泌与代谢学