Determinants of Extraocular Muscle Volume in Patients with Graves' Disease

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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The Relationship between Third-generation TSH Receptor Antibody Positivity and Cumulative Methimazole Dose Used until Remission in Graves' Disease

Journal of College of Physicians And Surgeons Pakistan ◽

10.29271/jcpsp.2021.05.517 ◽

2021 ◽

Vol 31 (5) ◽

pp. 517-522

Keyword(s):

Tsh Receptor ◽

Graves Disease ◽

Third Generation ◽

Receptor Antibody ◽

Tsh Receptor Antibody ◽

Antibody Positivity ◽

The Relationship

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Changes in Serum TSH Receptor Antibody (TRAb) Values in Patients with Graves' Disease after Total or Subtotal Thyroidectomy

Endocrine Journal ◽

10.1507/endocrj.50.595 ◽

2003 ◽

Vol 50 (5) ◽

pp. 595-601 ◽

Cited By ~ 23

Author(s):

Yuuki TAKAMURA ◽

Keiichi NAKANO ◽

Takashi URUNO ◽

Yasuhiro ITO ◽

Akihiro MIYA ◽

...

Keyword(s):

Subtotal Thyroidectomy ◽

Tsh Receptor ◽

Graves Disease ◽

Receptor Antibody ◽

Tsh Receptor Antibody ◽

Serum Tsh

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Long-Term Antithyroid Drug Treatment: Trends in Serum TSH and TSH Receptor Antibody Changes in Patients with Graves’ Disease

International Journal of Endocrinology and Metabolism ◽

10.5812/ijem.101139 ◽

2020 ◽

Vol 18 (Suppl) ◽

Cited By ~ 2

Author(s):

Ken Okamura ◽

Sachiko Bandai ◽

Megumi Fujikawa ◽

Kaori Sato ◽

Hiroshi Ikenoue ◽

...

Keyword(s):

Drug Treatment ◽

Antithyroid Drug ◽

Tsh Receptor ◽

Free T4 ◽

Receptor Antibody ◽

Tsh Receptor Antibody ◽

Antithyroid Drug Treatment ◽

Long Term Prognosis ◽

Serum Tsh

Objectives: Trends in serum thyroid-stimulating hormone (TSH) and TSH receptor antibody (TRAb) changes during antithyroid drug treatment, and long-term prognosis were evaluated in Graves’ hyperthyroidism (GD). Methods: In 609 GD patients initially treated with 15 mg of methyl-mercapto imidazole (MMI), the changes in serum TRAb and long-term prognosis were compared in the TSH-normalized group (A) and the TSH-suppressed group (B and C) during the initial 180 days of treatment. Results: Early responses to MMI during 180 days of treatment were as follows: 48 cases (7.9%) became hypothyroid with elevated TSH (A1), and 188 cases (30.9%) became euthyroid with normal TSH (A2). Among patients with continuously suppressed TSH, the free T4 (fT4) level was low in 31 cases (5.1%) (B1-inappropriately suppressed TSH), fT4 and fT3 were normal in 185 cases (30.4%) (B2), fT4 was normal, but fT3 remained high in 84 cases (13.8%) (B3), and fT4 remained high in 73 cases (12.0%) (C-refractory). Serum TRAb became negative after < 5 years then remained negative in 25% - 51% of the cases (smooth type), became negative after < 5 years then became positive again in 30% - 43% of the cases (fluctuating type), and remained positive after > 5 years in 10% - 42% of the cases (smoldering type). In total, remission occurred after 6.2 (3.0 - 10.4) years of treatment in 42%, possible remission on a small maintenance dosage of antithyroid drug occurred in 13%, and spontaneous hypothyroidism occurred in 4.4% of the cases. The smoldering type was more frequent in the B1 and C groups than in others, and remission was less frequent. The difference in the long-term prognosis depending on the early response to MMI disappeared after excluding the ablated patients. Without ablation, remission or spontaneous hypothyroidism could be expected in 60% - 75% of patients after tenacious treatment for > 10 years. Conclusions: Prolonged suppression of serum TSH may suggest active TRAb activity during treatment, and continuous TRAb positivity for more than 5 years suggests persistent GD activity.

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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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