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Outcomes assessed TRAb dynamics, treatment duration, and relapse. Results: Higher TRAb titers required longer treatment, showed slower TSH normalization, and had lower TRAb negativity rates. High-titer patients had increased persistent TRAb positivity and relapse risks, with predictive thresholds provided. Conclusion: High TRAb titers strongly forecast persistence and relapse after ATD withdrawal, guiding prognosis and management.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/high-trab-titer-at-diagnosis-predicts-persistent-positivity-and-relapse-in-graves-disease-after-prolonged-antithyroid-therapy/433970/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/high-trab-titer-at-diagnosis-predicts-persistent-positivity-and-relapse-in-graves-disease-after-prolonged-antithyroid-therapy/433970.png","ImageObject",300,407,{"name":42,"@type":43},"Rowan","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"How were patients with different TRAb titers defined at diagnosis?","Question",{"text":63,"@type":64},"Initial TRAb levels were stratified as low-titer (\u003C5.25 IU/L), intermediate-titer (5.25–10.5 IU/L), and high-titer (>10.5 IU/L), using the upper normal limit (UNL) reference.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What outcomes differed most between high-titer and lower-titer patients after prolonged ATD therapy?",{"text":68,"@type":64},"High-titer patients required longer therapy, had slower TSH normalization, showed lower TRAb negativity rates over time, and had decreased remission rates compared with low- and intermediate-titer groups.",{"name":70,"@type":61,"acceptedAnswer":71},"Which TRAb thresholds predicted persistent positivity and relapse?",{"text":72,"@type":64},"The study reported cut-offs of 10.90 IU/L for predicting persistent TRAb positivity and 16.01 IU/L for predicting relapse after ATD withdrawal.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},433970,1790765125,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & 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2025;40:950-960 [https://doi.org/10.3803/EnM.2025.2405](https://doi.org/10.3803/EnM.2025.2405)[ ](https://doi.org/10.3803/EnM.2025.2405)[pISSN 2093-596X](pISSN 2093-596X) · eISSN 2093-5978  \nHigh TRAb Titer at Diagnosis Predicts Persistent Positivity and Relapse in Graves’Disease after Prolonged Antithyroid Therapy  \nZimiao Chen1, *, Jinglu Xu 1, *, Wenrui Kang2, Yang Zhang2, Rujun Chen3, Xiaohua Gong1,4  \n1Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University; 2The First School of Medicine,Wenzhou Medical University; 3Department of Burns, 906 Hospital of the Joint Logistics Team, PLA; 4National Key Clinical Specialty (Wound Healing), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China  \nBackground: The association between high thyrotropin receptor antibody (TRAb) titers at diagnosis and long-term outcomes following prolonged antithyroid drug (ATD) therapy in Graves’ disease (GD) remains unclear. This study examined TRAb dynamicsand outcomes in high-titer patients receiving prolonged ATD.  \nMethods: In this retrospective cohort (2018–2021), 1,148 of 3,052 newly diagnosed GD patients met inclusion criteria (≥18-month ATD course, TRAb negativity before withdrawal, and ≥12-month follow-up). Initial TRAb levels were defined as low-titer (\u003C5.25 IU/L, 3×upper normal limit [UNL]), intermediate-titer (5.25–10.5 IU/L), and high-titer (> 10.5 IU/L, 6×UNL) . Outcomes included TRAb dynamics, treatment duration, and relapse.  \nResults: High-titer patients required longer therapy (50 months vs. 30 months vs. 22 months, P\u003C0.001) and slower thyroid-stimulating hormone normalization (6 months vs. 4 months vs. 2 months, both P\u003C0.001) . TRAb negativity at 24/48 months occurred in 91.85%/99.26%(low-titer), 52.38%/75.24%(intermediate-titer), and 12.70%/52.68%(high-titer) (P\u003C0.001) . High-titer patients showed fluctuant (46.20%) or smoldering (28.89%) trends. Remission rates declined with higher TRAb titer (60.45% vs. 42.70% vs. 30.47%, P\u003C0.001). High-titer patients showed increased risk of persistent TRAb positivity (2.17-fold; 95% confidence interval [CI], 1.55 to 3.05) and relapse (1.66-fold; 95% CI, 1.45 to 3.22) . Thresholds of 10.90 IU/L and 16.01 IU/L predicted positivity and relapse, respectively. Definitive therapy post-relapse was more common in high-titer patients (38.29% vs. 16.98% in low-titer, P\u003C0.001) . Conclusion: High TRAb titers strongly predict persistent TRAb positivity and relapse after ATD withdrawal. Cut-off at 10.90 and 16.01 IU/L may guide prognosis and treatment.  \n\n| Keywords: Graves disease; High TRAb titers at diagnosis; Prolonged course of antithyroid drugs; Long-term follow-up; Relapse |  |\n| --- | --- |\n| Received: 7 April 2025, Revised: 25 May 2025, Accepted: 7 July 2025\u003Cbr>Corresponding authors: Rujun Chen\u003Cbr>Department of Burns, 906 Hospital of the Joint Logistics Team, PLA, Fanglekang Street, Wenzhou 325000, China\u003Cbr>Tel: +86-13868844888, Fax: +86-057788288168, E-mail: [519973491@qq.com](519973491@qq.com)\u003Cbr>Xiaohua Gong\u003Cbr>Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Shangcaicun Street, Wenzhou 325000, China Tel: +86-13758872020, Fax: +86-057755579381, E-mail: [gxh1204@163.com](gxh1204@163.com)\u003Cbr>*These authors contributed equally to this work. | Copyright © 2025 Korean Endocrine Society\u003Cbr>This is an Open Access article distributed under the terms of\u003Cbr>the Creative Commons Attribution Non-Commercial License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.\u003Cbr>|\n\n950 [www.e-enm.org](www.e-enm.org)  \nHigh TRAb Titer at Diagnosis Predicts Outcomes  \nINTRODUCTION  \nGraves’ disease (GD) is a common organ-specific autoimmune disorder with an annual incidence of ","cbCaiqGzACBMIzzy","https://ap.wps.com/l/cbCaiqGzACBMIzzy","pdf",356113,11,"English","# Introduction\n## Background and clinical context\n# Methods\n## Retrospective cohort design and inclusion criteria\n## TRAb titer stratification and outcome measures\n# Results\n## Treatment duration and thyroid function normalization\n## TRAb negativity dynamics and trend patterns\n## Remission rates, persistent positivity, relapse, and predictive thresholds\n# Conclusion","[{\"question\":\"How were patients with different TRAb titers defined at diagnosis?\",\"answer\":\"Initial TRAb levels were stratified as low-titer (\\u003c5.25 IU/L), intermediate-titer (5.25–10.5 IU/L), and high-titer (\\u003e10.5 IU/L), using the upper normal limit (UNL) reference.\"},{\"question\":\"What outcomes differed most between high-titer and lower-titer patients after prolonged ATD therapy?\",\"answer\":\"High-titer patients required longer therapy, had slower TSH normalization, showed lower TRAb negativity rates over time, and had decreased remission rates compared with low- and intermediate-titer groups.\"},{\"question\":\"Which TRAb thresholds predicted persistent positivity and relapse?\",\"answer\":\"The study reported cut-offs of 10.90 IU/L for predicting persistent TRAb positivity and 16.01 IU/L for predicting relapse after ATD withdrawal.\"}]","High TRAb Titer at Diagnosis Predicts Persistent Positivity and Relapse in Graves’ Disease after Prolonged Antithyroid Therapy | PDF",1790666435,28]