Clinical value of functional thyrotropin receptor antibodies in Serbian patients with Graves’ orbitopathy

Matutinović, Marija Sarić; Diana, Tanja; Beleslin, Biljana; Ćirić, Jasmina; Žarković, Miloš; Kahaly, George J.; Ignjatović, Svetlana

doi:10.1007/s40618-021-01652-y

Cited by 10 publications

(4 citation statements)

References 41 publications

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“…From a clinical standpoint, circulating TSHR antibodies (TSHR-Ab) correlate with GO activity [28][29][30]. In a prospective study of consecutive GO patients, novel cell-based TSHR-Ab bioassays measuring stimulatory TSHR-Ab showed higher sensitivity and specificity than commonly used immunoassays in differentiating clinically active from inactive, and mild from moderate-tosevere, GO [31]. Finally, TSHR-Ab is an independent risk factor for GO and may predict GO severity and outcome [32].…”

Section: Pathogenesismentioning

confidence: 99%

Current concepts regarding Graves’ orbitopathy

Bartalena

Tanda

2022

J Intern Med

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Section: Pathogenesismentioning

confidence: 99%

Current concepts regarding Graves’ orbitopathy

Bartalena

Tanda

2022

J Intern Med

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“…Recent studies have also demonstrated the utility of a few newer methods for the measurement of TSHrAb such as one-step third-generation radioimmunoassay and dot-blot method are useful, albeit with modestly lower diagnostic accuracy of the latter method [24,25]. Thyroid stimulating antibody (TSI), the best method for assessment of autoimmunity in Graves' disease, may have better diagnostic performance in diagnosing Graves' disease, and offer a better prediction of thyroidassociated orbitopathy and response to antithyroid therapy [26][27][28]; however, the reports are variable and advantages in clinical practice are minimal [29]. Moreover, this assay is not currently available in India.…”

Section: Discussionmentioning

confidence: 99%

High Diagnostic Accuracy of Thyroid-Stimulating Hormone (TSH) Receptor Antibodies in Distinguishing Graves’ Disease and Subacute Thyrotoxicosis in the Indian Population

Naga Nitin,

Lakkundi,

S L

et al. 2024

Cureus

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Background and objective: Thyrotoxicosis is a common clinical condition encountered in endocrine practice. Graves’ disease and subacute thyroiditis are the two common causes of thyrotoxicosis and often have overlapping clinical and biochemical features. 99mTc thyroid scintigraphy is the most commonly used confirmatory test to differentiate the two conditions but is not available in the majority of the second-tier cities of India. However, obtaining thyroid stimulating hormone (TSH) receptor antibodies (TSHrAb), another accurate test to differentiate the two conditions, in second-tier cities by outsourcing to labs in major cities is a feasible option nowadays. However, the data on the performance of TSHrAb to differentiate the two conditions in Indian patients is limited. Hence, we have evaluated the diagnostic accuracy of TSHrAb in the Indian population to differentiate Graves’ disease and subacute thyroiditis. Materials and methods: This prospective study was conducted on 115 consecutive newly diagnosed thyrotoxicosis patients presenting to the Department of Endocrinology at a tertiary health care centre in India. Clinical parameters like throat pain, duration of symptoms, and grade of goitre were noted. Measurement of total tri-iodothyronine (TT3), total thyroxine (TT4), TSH, TSHrAb, and 99mTc thyroid scintigraphy were performed in all participants. All participants were followed up at least for six months after the recruitment. Increased tracer uptake (>4%) and/or increased thyroid to parotid trace uptake ratio (>2.5) were used to diagnose Graves’ disease. Results: Eighty-one and 34 patients were diagnosed with Graves’ disease and subacute thyroiditis, respectively. TT3/TT4 ratio had low diagnostic accuracy (area under the curve (AUC): 0.6, best cut-off: 15.6, sensitivity: 53.1%, specificity: 79.4%). TSHrAb had the best AUC (0.9) to distinguish Graves’ disease from subacute thyroiditis (cut-off: 2.0 IU/L, sensitivity: 97.5%, specificity: 100%). In contrast, the kit manufacturer’s reference range (1.75 IU/L) was slightly more sensitive (98.8%), but less specific (94%). Conclusion: The TT3/TT4 ratio is not a good test to differentiate Graves’ disease and subacute thyroiditis. TSHrAb is accurate in distinguishing Graves’ disease from subacute thyroiditis and a level of 2.0 may be a more accurate cut-off to differentiate the two conditions in the Indian population.

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“…The sensitivity rates for differentiating between clinically active versus inactive and mild versus moderate-to-severe GO are both 100% for TSAbs. This finding suggests that TSAbs are highly prevalent in patients with GO and exhibit superior clinical features and predictive potential ( 77 ). One study showed a shift from TSAbs to TBAbs in 8 GD patients with/without GO during methimazole treatment that led to remission ( 78 ).…”

Section: Autoantibodies In Go Pathogenesismentioning

confidence: 99%

A review of TSHR- and IGF-1R-related pathogenesis and treatment of Graves’ orbitopathy

2023

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Graves’ orbitopathy (GO) is an organ-specific autoimmune disease, but its pathogenesis remains unclear. There are few review articles on GO research from the perspective of target cells and target antigens. A systematic search of PubMed was performed, focusing mainly on studies published after 2015 that involve the role of target cells, orbital fibroblasts (OFs) and orbital adipocytes (OAs), target antigens, thyrotropin receptor (TSHR) and insulin-like growth factor-1 receptor (IGF-1R), and their corresponding antibodies, TSHR antibodies (TRAbs) and IGF-1R antibodies (IGF-1R Abs), in GO pathogenesis and the potentially effective therapies that target TSHR and IGF-1R. Based on the results, OFs may be derived from bone marrow-derived CD34+ fibrocytes. In addition to CD34+ OFs, CD34- OFs are important in the pathogenesis of GO and may be involved in hyaluronan formation. CD34- OFs expressing Slit2 suppress the phenotype of CD34+ OFs. β-arrestin 1 can be involved in TSHR/IGF-1R crosstalk as a scaffold. Research on TRAbs has gradually shifted to TSAbs, TBAbs and the titre of TRAbs. However, the existence and role of IGF-1R Abs are still unknown and deserve further study. Basic and clinical trials of TSHR-inhibiting therapies are increasing, and TSHR is an expected therapeutic target. Teprotumumab has become the latest second-line treatment for GO. This review aims to effectively describe the pathogenesis of GO from the perspective of target cells and target antigens and provide ideas for its fundamental treatment.

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Clinical value of functional thyrotropin receptor antibodies in Serbian patients with Graves’ orbitopathy

Cited by 10 publications

References 41 publications

Current concepts regarding Graves’ orbitopathy

Current concepts regarding Graves’ orbitopathy

High Diagnostic Accuracy of Thyroid-Stimulating Hormone (TSH) Receptor Antibodies in Distinguishing Graves’ Disease and Subacute Thyrotoxicosis in the Indian Population

A review of TSHR- and IGF-1R-related pathogenesis and treatment of Graves’ orbitopathy

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