Metabolite Changes during the Transition from Hyperthyroidism to Euthyroidism in Patients with Graves Disease '

Background: An excess of thyroid hormones in Graves' disease (GD) has profound effects on systemic energy metabolism that are currently partially understood. In this study, we aimed to provide a comprehensive understanding of the metabolite changes that oc-cur when patients with GD transition from hyperthyroidism to euthyroidism with methimazole treatment.Methods: Eighteen patients (mean age, 38.6 +/- 14.7 years; 66.7% female) with newly diagnosed or relapsed GD attending the endo-crinology outpatient clinics in a single institution were recruited between January 2019 and July 2020. All subjects were treated with methimazole to achieve euthyroidism. We explored metabolomics by performing liquid chromatography-mass spectrometry analysis of plasma samples of these patients and then performed multivariate statistical analysis of the metabolomics data.Results: Two hundred metabolites were measured before and after 12 weeks of methimazole treatment in patients with GD. The levels of 61 metabolites, including palmitic acid (C16:0) and oleic acid (C18:1), were elevated in methimazole-naive patients with GD, and these levels were decreased by methimazole treatment. The levels of another 15 metabolites, including glycine and creatinine, were increased after recovery of euthyroidism upon methimazole treatment in patients with GD. Pathway analysis of metabolomics data showed that hyperthyroidism was closely related to aminoacyl-transfer ribonucleic acid biosynthesis and branched-chain amino acid biosynthesis pathways.Conclusion: In this study, significant variations of plasma metabolomic patterns that occur during the transition from hyperthyroid-ism to euthyroidism were detected in patients with GD via untargeted metabolomics analysis.