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

Patients with Graves' hyperthyroidism (GH) treated with a combination of thyrostatic drugs and T-4, i.e., 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) T-4 correlated positively with REE (r = 0.433, P = 0.044) and negatively with body fat % (r = -0.450, P = 0.035). Plasma FT3 and FT3/FT4 ratio showed an increase 12 w after cessation of BRT (20%, P <0.0001 and 16%, P = 0.007, resp.). Moreover, the relative change in FT3/FT4 ratio showed a significant, positive correlation with the relative change in REE between the 2 visits (r = 0.465, P = 0.029). In conclusion, serum FT4 determines REE in euthyroid patients with GH treated with BRT. Twelve weeks after BRT cessation, BW and energy homeostasis are unaltered. However, as serum FT3/FT4 ratio increases after cessation of BRT, which is a positive determinant of changes in REE, a longer term BW decrease is likely to occur.