title: Graves hyperthyroidism after stopping immunosuppressive therapy in type 1 diabetic Islet cell recipients with pretransplant TPO autoantibodies.
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.
  
  
  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.
authors: Department of Endocrinology, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium.
authors: Pieter
authors: P
authors: Gillard
authors: Volkert
authors: V
authors: Huurman
authors: Bart
authors: B
authors: Van der Auwera
authors: Brigitte
authors: B
authors: Decallonne
authors: Kris
authors: K
authors: Poppe
authors: Bart O
authors: BO
authors: Roep
authors: Frans
authors: F
authors: Gorus
authors: Chantal
authors: C
authors: Mathieu
authors: Daniel
authors: D
authors: Pipeleers
authors: Bart
authors: B
authors: Keymeulen
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000276:immunology*; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D006111:Graves Disease / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007453:Iodide Peroxidase / Q000276:immunology*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged
chemical_list: D001323:Autoantibodies; D007166:Immunosuppressive Agents; D007453:Iodide Peroxidase