A RARE CASE OF THYROID ASSOCIATED ORBITOPATHY IN A PATIENT WITH ANTI-TSH RECEPTOR ANTIBODY NEGATIVE HASHIMOTO’S THYROIDITIS

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

Eye ◽

10.1038/s41433-018-0242-9 ◽

2018 ◽

Vol 33 (2) ◽

pp. 212-217 ◽

Cited By ~ 9

Author(s):

Jonathan C. P. Roos ◽

Vignesh Paulpandian ◽

Rachna Murthy

Keyword(s):

Thyroid Eye Disease ◽

Tsh Receptor ◽

Eye Disease ◽

Receptor Antibody ◽

Tsh Receptor Antibody ◽

Antibody Levels ◽

The Impact

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Inhibition of thyrotropin-stimulated adenylate cyclase activation and growth of rat thyroid cells, FRTL-5, by immunoglobulin G from patients with primary myxedema: comparison with activities of thyrotropin-binding inhibitor immunoglobulins

Acta Endocrinologica ◽

10.1530/acta.0.1200099 ◽

1989 ◽

Vol 120 (1) ◽

pp. 99-106 ◽

Cited By ~ 17

Author(s):

B. Y. Cho ◽

Y. K. Shong ◽

H. K. Lee ◽

C.-S. Koh ◽

H. K. Min

Keyword(s):

Hashimoto’S Thyroiditis ◽

Thymidine Incorporation ◽

Tsh Receptor ◽

Hashimoto's Thyroiditis ◽

Thyroid Cells ◽

Rat Thyroid ◽

Receptor Antibodies ◽

Tsh Receptor Antibodies ◽

Growth Inhibiting ◽

Blocking Type

Abstract. We studied the blocking type TSH receptor antibodies in 28 patients with primary myxedema and 21 patients with goitrous Hashimoto's thyroiditis by measuring the ability of their IgGs to inhibit TSH binding to its receptor, and to inhibit TSH-stimulated cAMP increase and [3H] thymidine incorporation in a rat thyroid cell line, FRTL-5. The incidences of TSH binding inhibitor immunoglobulin, thyroid stimulation inhibiting immunoglobulin and thyroid growth inhibiting immunoglobulin in patients with primary myxedema were 54.6, 75 and 65.2%, respectively, against 14.3,0 and 17.7%, respectively, in goitrous Hashimoto's thyroiditis. The antibodies inhibited dose-dependently not only TSH stimulated but also Graves' IgG-stimulated cAMP increase and [3H] thymidine incorporation. The TSH binding inhibitor immunoglobulin activities in patients with primary myxedema were significantly correlated with both the thyroid stimulation inhibiting immunoglobulin (r = 0.665; P<0.01) and the thyroid growth inhibiting immunoglobulin (r = 0.618; P<0.01) activity. Thirteen patients whose TSH binding inhibitor immunoglobulin activities were more than 50% had both strong thyroid stimulation inhibiting immunoglobulin (75.1–100%) and thyroid growth inhibiting immunoglobulin (57.4–100%) activities. These data suggest that the vast majority of patients with primary myxedema have potent blocking type TSH receptor antibodies. These might play a role in primary myxedema causing hypothyroidism and thyroid atrophy through inhibiting TSH-stimulated cAMP generation.

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Erratum: Relevance of TSH-receptor antibody levels in predicting disease course in Graves’ orbitopathy: comparison of the third-generation TBII assay and Mc4-TSI bioassay

Eye ◽

10.1038/eye.2013.193 ◽

2013 ◽

Vol 27 (10) ◽

pp. 1231-1231

Author(s):

S Y Jang ◽

D Y Shin ◽

E J Lee ◽

S Y Lee ◽

J S Yoon

Keyword(s):

Tsh Receptor ◽

Third Generation ◽

Disease Course ◽

Receptor Antibody ◽

The Third ◽

Tsh Receptor Antibody ◽

Graves Orbitopathy ◽

Antibody Levels

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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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