Significance of Thyroid Stimulating Antibody and Long Term Follow Up in Patients with Euthyroid Graves' Disease.

Kashiwai, Taku; Tada, Hayato; Asahi, Kayoko; Hidaka, Yoh; Tamaki, Haruo; Iwatani, Yoshinori; Amino, Nobuyuki

doi:10.1507/endocrj.42.405

Cited by 17 publications

(10 citation statements)

References 44 publications

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“…5 Few reports state that the prevalence of TSH receptor antibodies in euthyroid ophthalmopathy exceeds 90%. 5,6 One of such studies revealed that TSH receptor antibody titers are usually low, and not associated with the severity of ophthalmopathy in euthyroid Graves' disease. 6 However, autoantibodies to TSH receptor might have a role in the pathogenesis of ophthalmopathy, even if patients are in a euthyroid state.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 One of such studies revealed that TSH receptor antibody titers are usually low, and not associated with the severity of ophthalmopathy in euthyroid Graves' disease. 6 However, autoantibodies to TSH receptor might have a role in the pathogenesis of ophthalmopathy, even if patients are in a euthyroid state. Prevalence of incidental microcarcinoma in thyroidectomy specimens of Graves disease ranges from 0.3 to 16.6% in various studies.…”

Section: Discussionmentioning

confidence: 99%

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A Rare Presentation of Euthyroid Orbitopathy in Papillary Thyroid Carcinoma

Chaturvedi¹,

Vaidya²,

Tamhankar³

2013

International Journal of Head and Neck Surgery

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Ophthalmopathy is one of the known presenting features of Grave's disease. Its due to development of antithyroid receptor antibodies. Rarely it may be associated with thyroid malignancies developing in the Grave's nodule. There are few case reports of patients with coexisting thyroid associated orbitopathy (TAO) and thyroid carcinoma. Sometimes it may be the presenting symptom of an occult thyroid malignancy. Its still rarer if the patient is euthyroid on presentation. It is associated with low titers of antithyroid receptor antibodies. Here we present a very rare case of symmetrical nonmetastatic orbitopathy in a euthyroid papillary carcinoma of thyroid.Key message: Its important to rule out coexisting thyroid cancer in patient presenting with orbitopathy even if euthyroid. Orbitopathy may regress after thyroidectomy. Association of thyroid cancer, autoimmunity and orbitopathy is still to be proven due to lack of large case series.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Euthyroid Orbitopathy in Papillary Thyroid Carcinoma

Chaturvedi¹,

Vaidya²,

Tamhankar³

2013

International Journal of Head and Neck Surgery

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“…In euthyroid Graves' ophthalmopathy, TSH receptor antibody titers are low and not associated with the severity of ophthalmopathy. 6 A thyroid and eye-muscle shared protein has been proposed as the primary autoantigen in thyroid-associated ophthalmopathy. 5,7 The primary autoantigens in ocular MG also may differ from those in generalized MG.…”

Section: Discussionmentioning

confidence: 99%

Ocular myasthenia gravis associated with euthyroid ophthalmopathy

2003

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We report a 71-year-old woman with concomitant ocular myasthenia gravis and euthyroid Graves' ophthalmopathy. Unilateral ophthalmoplegia, including ptosis, initially was responsive to edrophonium and corticosteroids, except for diplopia on upward gaze, but refractory swelling of the inferior rectus muscle and proptosis followed. Autoantibodies to acetylcholine and thyrotropin receptors were detected. Her ophthalmopathy abated after orbital irradiation in combination with systemic steroids. There may be an immunological basis for the association of ocular myasthenia gravis with euthyroid Graves' ophthalmopathy.

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“…In some studies, these conditions have been re¬ ported to be a single and isolated autoimmune disease dif¬ ferent from Graves' disease because there was no evidence of thyroid abnormalities (4,17). However, more recent studies clarified that this was a subtype of Graves' disease, where thyrotoxicosis develops minimally in spite of the ex¬ istence of TSAb in almost all patients (5,8). We had pre¬ viously proposed that the thyroid gland might respond poorly to stimulating factors due to the complication of advanced autoimmune thyroiditis or to circulating in¬ hibitory factors (8).…”

Section: Discussionmentioning

confidence: 99%

“…In the studimmune reactions to orbital tissues have been considered ies we have reviewed, there have been no precise reports to be important (6,7). We previously reported that features on the responsiveness of the thyroid gland in this disease, of ophthalmopathy in euthyroid Graves' disease were al-Thus, we examined thyroid response to thyrotropinmost the same as that in untreated Graves' disease, and releasing hormone (TRH) in these patients, that thyroid-stimulating antibody (TSAb) was a good marker for the diagnosis of this disease (8), because almost all patients have circulating TSAb measured by sensitive . " _ « bioassay.…”

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confidence: 98%

Low Response of the Thyroid Gland to Endogenous Thyrotropin Increased by Thyrotropin-Releasing Hormone in Patients with Euthyroid Graves' Disease

Kashiwai

Tada²,

Watanabe³

et al. 1998

Thyroid

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Euthyroid Graves' disease is defined as Graves' ophthalmopathy without hyperthyroidism, and the thyroid-stimulating antibody (TSAb) has been known to be a good marker for diagnosis. However, the question of why TSAb does not cause hyperthyroidism arises. To settle this, we examined thyroid responsiveness to endogenous thyrotropin (TSH) increased by thyrotropin-releasing hormone (TRH) in 23 patients with euthyroid Graves' disease. Nineteen patients (83%) had positive TSAb and 21 (91%) had at least one of the autoantibodies to the thyroid gland. Only one patient (4%) had positive thyroid-stimulation blocking antibody (TSBAb). Basal levels of free thyroxine (FT4), free triiodothyronine (FT3), and thyrotropin (TSH) in patients were not different from those in age- and sex-matched normal controls (n = 25). Response of TSH to TRH was normal; however, an increase of FT3, either absolute or as a multiple of baseline, in the TRH test in these patients (0.46+/-0.23 pg/mL, P < 0.001; 1.14+/-0.09 fold, p < 0.001) was significantly lower than that in controls (0.86+/-0.19 pg/ml; 1.26+/-0.07 fold). There was no correlation between the deltaFT3/deltaTSH ratio and TSAb activity. It is concluded that thyroid responsiveness in euthyroid Graves' disease is lower than in normal controls and this explains the euthyroid function in the patients even in the presence of TSAb.

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Significance of Thyroid Stimulating Antibody and Long Term Follow Up in Patients with Euthyroid Graves' Disease.

Abstract: Abstract.We examined 13 patients with euthyroid Graves' disease suspected ophthalmologically, by comparing them with 20 patients with untreated Graves' disease and by following them up for

Cited by 17 publications

References 44 publications

A Rare Presentation of Euthyroid Orbitopathy in Papillary Thyroid Carcinoma

A Rare Presentation of Euthyroid Orbitopathy in Papillary Thyroid Carcinoma

Ocular myasthenia gravis associated with euthyroid ophthalmopathy

Low Response of the Thyroid Gland to Endogenous Thyrotropin Increased by Thyrotropin-Releasing Hormone in Patients with Euthyroid Graves' Disease

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