Longitudinal association of thyroid-stimulating immunoglobulin levels with clinical characteristics in thyroid eye disease

Abstract

ObjectivesThe clinical course of thyroid eye disease (TED) is heterogeneous and predicting patients who may develop the severe sequelae of the disease is difficult. In this study, we evaluated the longitudinal association between changes in serum thyroid-stimulating hormone (TSH) receptor antibody (TRAb) levels and course of disease activity and severity over time.DesignThis was a multicentre, prospective, observational study.SettingFifteen tertiary care oculoplastic service centres in Korea.ParticipantsSeventy-six patients with newly diagnosed TED were included and followed up for 12 months.MethodsWe evaluated clinical characteristics and serum TRAb levels at baseline, 6 and 12 months of TED diagnosis. Additionally, we analysed longitudinal associations between the serum TRAb levels and clinical activity score (CAS), no signs or symptoms, only signs, soft tissue involvement, proptosis, extraocular muscle involvement, corneal involvement, sight loss (NOSPECS) score and proptosis.ResultsThyroid-stimulating immunoglobulin (TSI) and TSH-binding inhibitory immunoglobulin (TBII) levels decreased during the 1-year follow-up, whereas disease activity measured using CAS decreased mainly in the first 6 months. Disease severity measured using NOSPECS score and proptosis remained unchanged. Moreover, inter-person differences in TBII levels were associated with CAS, NOSPECS score and proptosis over time, whereas inter-person differences in TSI levels were associated with NOSPECS score. Subgroup analysis of patients with a baseline CAS≥4 demonstrated that within-person changes in TSI levels affected the CAS and NOSPECS score.ConclusionsFollow-up measurement of serum TSI and TBII levels may help evaluate TED prognosis and enable accurate clinical decision-making.

Application of an Interpretable Machine Learning for Estimating Severity of Graves’ Orbitopathy Based on Initial Finding

“…We not only analyzed the clinical features of patients with moderate-to-severe GO but also performed a comparison with mild type at initial examination and proposed predictive scores for moderate-to-severe type GO. Associations between the factors included in the scores and GO were demonstrated in previous studies [ 8 , 9 , 23 , 24 , 25 ]. However, this is the first study to present a predictive score with these factors for use at initial examination in Korea.…”

Epidemiology of thyroid-stimulating immunoglobulin in recent-onset symptomatic thyroid eye disease

“…36 Ko et al recently reported that TSI was significantly correlated with the NOSPECS score in a cohort of Korean patients. 37 Jeon et al reported a cross-sectional study included 101 patients with TED and found the TSI level was higher among males patients and smokers, and the TSI level was inversely correlated with the duration of ocular symtoms. 38 Ponto et al reported that TSI level can help to identify patients with DON of recent onset requiring urgent treatment.…”

The Role of Thyroid Antibodies in Thyroid Eye Disease

“…26,27 Ponto et al 28 reported that TSI was associated with activity and severity of TED disease. The inflammatory phase of TED reportedly correlates with changes in measured TSI levels, indicating that serial measurements of TSI levels may be an adjunct in assessing the clinical inflammatory activity of TED 29 ; Ko et al 30 demonstrated that TSI and TBII levels decrease 1 year after TED diagnosis, whereas disease activity measured using clinical activity score (CAS) decreases mainly in the first 6 months, demonstrating that the measurement of serum TSI and TBII levels may help evaluate TED prognosis. In addition, the change in TSI levels in TED patients who underwent medical and surgical interventions was found to be positively correlated with quality of life assessed by the Graves Orbitopathy Quality of Life questionnaire.…”

“…21 In addition, interperson differences in TBII levels were associated with several clinical scores including CAS, no signs or symptoms, only signs, soft tissue involvement, proptosis, extraocular muscle involvement, corneal involvement, sight loss (NO-SPECS) score, and proptosis over time. 30 Nevertheless, elevated TSI levels have been found to be better associated with clinically active TED than TBII levels. 28,36 Moreover, when comparing TSI and TBII assays' ability to identify dysthyroid and compressive optic neuropathy, TSI was found to be more sensitive and specific.…”

“…Measurements of TBII levels was shown to allow the assessment of TED prognosis in TED patients with therapy-resistant disease 21 . In addition, interperson differences in TBII levels were associated with several clinical scores including CAS, no signs or symptoms, only signs, soft tissue involvement, proptosis, extraocular muscle involvement, corneal involvement, sight loss (NOSPECS) score, and proptosis over time 30 . Nevertheless, elevated TSI levels have been found to be better associated with clinically active TED than TBII levels 28,36 .…”