Clinical Relevance of Thyroid-Stimulating Immunoglobulins in Graves' Ophthalmopathy

Ponto, Katharina A.; Kanitz, Michael; Olivo, Paul D.; Pitz, Susanne; Pfeiffer, Norbert; Kahaly, George J.

doi:10.1016/j.ophtha.2011.03.030

Cited by 115 publications

(75 citation statements)

References 29 publications

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“…17,18 A previous report conducted in Singapore 31 showed that TSI was Abbreviations: CAS, clinical activity score; CI, confidence interval; GD, Graves' disease; M, anti-thyroid drug; OR, odds ratio; R, radioiodine treatment; S, thyroidectomy; TBII, thyrotropin-binding inhibitory immunoglobulin; TSI, thyroid-stimulating immunoglobulin. TBII and TSI assays were entered into the models I and II, respectively.…”

Section: Discussionmentioning

confidence: 99%

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

Jang

Shin

Lee

et al. 2013

Eye

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Aims To investigate if TSH-receptor antibody (TRAb) levels measured in early Graves' orbitopathy (GO) stages are predictive of clinical disease course beyond 1 year after initial GO diagnosis and to compare performance of two newly developed TRAb assays (third-generation thyrotropin-binding inhibitor immunoglobulin (TBII) assay vs Mc4-thyroid-stimulating immunoglobulin (TSI) bioassay) in predicting disease course. Methods Newly diagnosed, untreated GO patients whose duration of ocular symptoms was less than 6 months were included. One year after initial diagnosis, all patients were classified as presenting either a mild (Group 1) or severe course (Group 2) according to their clinical manifestations. The measurements of two TRAb assays at initial GO diagnosis were used for analysis. Results Data from 112 patients were available for analysis. Seventy-three patients (65.2%) were designated as Group 1, and 39 patients (34.8%) as Group 2. Patients with higher initial TRAb levels demonstrated a higher risk of severe disease course upon multiple regression analysis (Po0.01). The cutoff values for the prediction of severe course of the third-generation TBII and Mc4-TSI assays were 10.67 IU/l and 555.10%, respectively, with assay specificities of 84.9 and 89.0%. The TBII assay predictive power

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Section: Discussionmentioning

confidence: 99%

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

Jang

Shin

Lee

et al. 2013

Eye

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“…Susceptibility genes search have provided only a small contribution to genetic susceptibility [34,35], indicating that many genes must be involved [4]. In addition, TSHR has been identified as an important antigen expressed on fibroblasts and adipocytes in the orbit of GD patients [41] and values of TSHR antibodies correlate with the GO [42]. TSHR has been demonstrated to act as the primary autoantigen for both GD and GO [43].…”

Section: Discussionmentioning

confidence: 99%

TSHR intronic polymorphisms (rs179247 and rs12885526) and their role in the susceptibility of the Brazilian population to Graves’ disease and Graves’ ophthalmopathy

Bufalo

Santos

Marcello

et al. 2014

J Endocrinol Invest

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“…In contrast, the highly sensitive cell-based bioassays [26][27][28][29][30][31][32][33] exclusively differentiate between the TSH-R-stimulating Ab (TSAb) and TSH-R-blocking Ab [34,35]. Also, TSAb is a highly sensitive and predictive biomarker for the extrathyroidal manifestations of GD [36][37][38][39][40][41][42] as well as a useful predictive measure of fetal or neonatal hyperthyroidism [43,44]. Finally, the incorporation and early utilization of TSAb into current diagnostic algorithms conferred a 46% shortened time to diagnosis of GD and a cost saving of 47% [45].…”

Section: Serologymentioning

confidence: 99%

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

Kahaly¹,

Bartalena²,

Hegedüs³

et al. 2018

Eur Thyroid J

678

650

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Graves’ disease (GD) is a systemic autoimmune disorder characterized by the infiltration of thyroid antigen-specific T cells into thyroid-stimulating hormone receptor (TSH-R)-expressing tissues. Stimulatory autoantibodies (Ab) in GD activate the TSH-R leading to thyroid hyperplasia and unregulated thyroid hormone production and secretion. Diagnosis of GD is straightforward in a patient with biochemically confirmed thyrotoxicosis, positive TSH-R-Ab, a hypervascular and hypoechoic thyroid gland (ultrasound), and associated orbitopathy. In GD, measurement of TSH-R-Ab is recommended for an accurate diagnosis/differential diagnosis, prior to stopping antithyroid drug (ATD) treatment and during pregnancy. Graves’ hyperthyroidism is treated by decreasing thyroid hormone synthesis with the use of ATD, or by reducing the amount of thyroid tissue with radioactive iodine (RAI) treatment or total thyroidectomy. Patients with newly diagnosed Graves’ hyperthyroidism are usually medically treated for 12–18 months with methimazole (MMI) as the preferred drug. In children with GD, a 24- to 36-month course of MMI is recommended. Patients with persistently high TSH-R-Ab at 12–18 months can continue MMI treatment, repeating the TSH-R-Ab measurement after an additional 12 months, or opt for therapy with RAI or thyroidectomy. Women treated with MMI should be switched to propylthiouracil when planning pregnancy and during the first trimester of pregnancy. If a patient relapses after completing a course of ATD, definitive treatment is recommended; however, continued long-term low-dose MMI can be considered. Thyroidectomy should be performed by an experienced high-volume thyroid surgeon. RAI is contraindicated in Graves’ patients with active/severe orbitopathy, and steroid prophylaxis is warranted in Graves’ patients with mild/active orbitopathy receiving RAI.

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Clinical Relevance of Thyroid-Stimulating Immunoglobulins in Graves' Ophthalmopathy

Cited by 115 publications

References 29 publications

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

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

TSHR intronic polymorphisms (rs179247 and rs12885526) and their role in the susceptibility of the Brazilian population to Graves’ disease and Graves’ ophthalmopathy

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

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