Serial TSH-receptor antibody levels to guide the management of thyroid eye disease: the impact of smoking, immunosuppression, radio-iodine, and thyroidectomy

Abstract. Following a course of medical therapy for Graves' disease approximately 50% of patients relapse. Previous studies have tried to identify these patients by measuring antibodies to the TSH receptor using a range of assay methods. Such studies have produced widely discrepant results. The aim of the present study was to compare the accuracy with which TSH receptor binding antibodies and thyroid-stimulating antibodies could identify cases of relapse and remission. Fifty-six newly diagnosed and previously untreated Graves' disease patients were recruited into the study. At presentation 4 were negative for TSH receptor antibody and 5 negative for TS-ab. The remaining 47 were positive for TSH receptor antibody and TS-ab although correlation of the degree of abnormality between methods was poor (r = 0.13 NS). After 12 months carbimazole treatment 28 patients relapsed during the following year and 19 remained in remission. TSH receptor antibody levels obtained at the end of a 12-month course of treatment correctly identified 93% who relapsed and 95% who remained in remission. TS-ab levels could only correctly identify 68% who relapsed and 53% who remained in remission. These results have shown that the accuracy with which patients likely to relapse can be identified depends on the assay method chosen which may account for some of the discrepancies found in previously published studies.

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A case of resistant Graves’ in pregnancy – A clinical challenge

The Journal of Medical Research ◽

10.31254/jmr.2019.5205 ◽

2019 ◽

Vol 5 (2) ◽

pp. 58-60

Author(s):

Darvin V Das ◽

◽

Uma K Saikia ◽

Dipti Sarma ◽

◽

...

Keyword(s):

Maximum Dose ◽

Antithyroid Drug ◽

Well Being ◽

Tsh Receptor ◽

Graves Disease ◽

Receptor Antibody ◽

Medication Therapy ◽

Tsh Receptor Antibody ◽

Antibody Levels ◽

In Pregnancy

A 29-year-old lady presented at 16 weeks of gestation, a case of Graves’ disease on anti-thyroid drug with uncontrolled thyrotoxic symptoms despite regular medication. Therapy with methimazole and propranolol was started at 12 weeks of gestation didn’t show clinical and biochemical normalization even with the maximum dose of antithyroid drug permissible at pregnancy. At gestational week 20, T4 and T3 remained elevated with suppressed serum TSH and high levels of TSH receptor antibody levels (TRAb =39.5 U/L, Normal value <1.7U/L). Anomaly scan at 20 weeks showed normal fetal study. Definite management of surgery was considered at second trimester in view of resistant Graves’ disease not responding to medical therapy. As the patient and her family refused surgical procedure, the patient had to be followed up medically with guarded prognosis. Subsequently on follow up patient didn’t show any clinical or biochemical remission. TSH receptor antibody levels estimated at 34 weeks also showed higher values (38U/L). Fetal well-being was monitored on a regular basis. Despite high thyroid hormones levels and higher anti-TSH receptor antibody levels all throughout the gestation and with maximum dose of methimazole the patient delivered a healthy baby with no clinical symptoms of thyrotoxicosis, goitre or any stigmata of methimazole fetopathy in the neonate. Mother’s TFT was closed monitored and anti-thyroid medication was titred. Here we present a rare case of resistant Graves’ in pregnancy where we encountered many challenges to manage the case at different stages

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Changes in TSH-Receptor Antibody (TR-AB) and Thyroid Stimulating Antibody (TS-AB) after Thyroidectomy in Thyrotoxic Patients

Folia Endocrinologica Japonica ◽

10.1507/endocrine1927.66.8_727 ◽

1990 ◽

Vol 66 (8) ◽

pp. 727-736 ◽

Cited By ~ 2

Author(s):

Hiroyuki HOSOJIMA ◽

Eiji MIYAUCHI ◽

Hiroshi OKADA ◽

Sadahide AZUKIZAWA ◽

Ikuo YAMAMOTO ◽

...

Keyword(s):

Tsh Receptor ◽

Receptor Antibody ◽

Thyroid Stimulating Antibody ◽

Tsh Receptor Antibody

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TSH receptor antibody-associated thyroid dysfunction following subacute thyroiditis

Clinical Endocrinology ◽

10.1046/j.1365-2265.1998.00416.x ◽

1998 ◽

Vol 48 (4) ◽

pp. 445-453 ◽

Cited By ~ 39

Author(s):

Makoto Iitaka ◽

Naoko Momotani ◽

Toshihiko Hisaoka ◽

Jaeduk Yoshimura Noh ◽

Naofumi Ishikawa ◽

...

Keyword(s):

Thyroid Dysfunction ◽

Subacute Thyroiditis ◽

Tsh Receptor ◽

Receptor Antibody ◽

Tsh Receptor Antibody

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Determinants of Extraocular Muscle Volume in Patients with Graves' Disease

Journal of Thyroid Research ◽

10.1155/2012/368536 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Samer El-Kaissi ◽

Jack R. Wall

Keyword(s):

Extraocular Muscle ◽

Tsh Receptor ◽

Graves Disease ◽

Thyroid Function Tests ◽

Thyroid Scintigraphy ◽

Free T4 ◽

Receptor Antibody ◽

Tsh Receptor Antibody ◽

Antibody Positivity ◽

Serum Tsh

Background. To examine factors contributing to extraocular muscle (EOM) volume enlargement in patients with Graves’ hyperthyroidism.Methods. EOM volumes were measured with orbital magnetic resonance imaging (MRI) in 39 patients with recently diagnosed Graves’ disease, and compared to EOM volumes of 13 normal volunteers. Thyroid function tests, uptake on thyroid scintigraphy, anti-TSH-receptor antibody positivity and other parameters were then evaluated in patients with EOM enlargement.Results. 31/39 patients had one or more enlarged EOM, of whom only 2 patients had clinical EOM dysfunction. Compared to Graves’ disease patients with normal EOM volumes, those with EOM enlargement had significantly higher mean serum TSH (0.020±0.005versus0.007±0.002mIU/L;Pvalue 0.012), free-T4 (52.9±3.3versus41.2±1.7 pmol/L;Pvalue 0.003) and technetium uptake on thyroid scintigraphy (13.51±1.7%versus8.55±1.6%;Pvalue 0.045). There were no differences between the 2 groups in anti-TSH-receptor antibody positivity, the proportion of males, tobacco smokers, or those with active ophthalmopathy.Conclusions. Patients with recently diagnosed Graves’ disease and EOM volume enlargement have higher serum TSH and more severe hyperthyroidism than patients with normal EOM volumes, with no difference in anti-TSH-receptor antibody positivity between the two groups.

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Clinical course of euthyroid subjects with positive TSH receptor antibody: how often does Graves’ disease develop?

Journal of the Endocrine Society ◽

10.1210/jendso/bvab042 ◽

2021 ◽

Author(s):

Nami Suzuki ◽

Akiko Kawaguchi ◽

Jaeduk Yoshimura Noh ◽

Ran Yoshimura ◽

Kentaro Mikura ◽

...

Keyword(s):

Thyroid Function ◽

Clinical Course ◽

Tsh Receptor ◽

Graves Disease ◽

Normal Thyroid ◽

Receptor Antibody ◽

Female Patients ◽

Tsh Receptor Antibody ◽

Normal Thyroid Function ◽

Positive Results

Abstract Background Thyroid stimulating hormone (TSH) receptor antibody (TRAb) is detected in the serum of patients with Graves’ disease (GD). This study aims to investigate the prevalence of euthyroid individuals showing positive results for TRAb and to clarify the clinical course of thyroid function and TRAb levels in these subjects. Objective Subjects were female patients who newly visited our hospital for a screening test prior to fertility treatment and showed normal thyroid function and volume without nodules between 2014 and 2017. After excluding subjects with a history of thyroid disease, 5,622 subjects were analyzed. Results Forty-seven of the 5,622 subjects showed positive results for TRAb (reference range, < 2.0 IU/L) at the initial visit. Median initial TRAb was 2.9 IU/L (range, 2.0 -14.7 IU/L) and median follow-up was 18.3 months (range, 0- 66.5 months). Six of the 47 subjects (12.8%) developed GD and median duration until development was 6.6 months (range, 1.2 -13.2 months). Median TRAb values initially and at diagnosisof GD for those 6 patients were 3.7 IU/L (range, 2.7 -5.1 IU/L) and 7.2 IU/L (range 3.6 -21.4 IU/L), respectively. TRAb results turned negative for 20 of the 47 subjects, but remained positive despite normal thyroid function in 13 of the 47 subjects. Conclusion GD developed over time in 12.8% of euthyroid young female patients showing positive TRAb within a median of 6.6 months. A positive result for TRAb itself did not mean development of GD, so other factors must be essential for the pathogenesis of GD.

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