Subacute Thyroiditis with Highly Positive Thyrotropin Receptor Antibodies and High Thyroidal Radioactive Iodine Uptake

Fujii, Sumie; Miwa, Umeo; Seta, Takashi; Ohoka, Takio; Mizukami, Yuji

doi:10.2169/internalmedicine.42.704

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…There have been individual reports of a moderately high RAIU in SAT. Sumie et al report a patient with SAT and RAIU of 17% that they thought was transitory due to high Trab levels [5]. In their paper, they also mention that few other authors have reported high RAIU in SAT patients.…”

Section: Discussionmentioning

confidence: 91%

Painful Goiter: A Rare Presentation of Graves’ Disease

Kannan

2014

J Med Cases

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Here we report a rare case of Graves' disease presenting as subacute thyroiditis. In the literature, only two reports are available of such a presentation. Various authors have reported in total 33 patients with subacute thyroiditis who were subsequently, between 1 and 18 months later, diagnosed with Graves' disease. However, only two patients with both subacute thyroiditis and Graves' disease simultaneously have been reported. Subacute thyroiditis is an inflammatory disorder while Graves' disease has an autoimmune basis. Although the association of the two could be incidental, it could be postulated that thyroiditis exposes autoantigens, enhancing antibody formation in susceptible patients and thereby precipitating or unmasking Graves' disease. Hence, it is important to remember that though rare, Graves' disease can present with painful goiter due to concurrent thyroiditis, or rather is unmasked by the inflammation.

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Section: Discussionmentioning

confidence: 91%

Painful Goiter: A Rare Presentation of Graves’ Disease

Kannan

2014

J Med Cases

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“…We also found a cut-off (2 IU/L) that is slightly higher than the manufacturer-provided cut-off, though with high sensitivity (97.55) and specificity (100%) for diagnosing Graves’ disease. Several studies have demonstrated suboptimal diagnostic accuracy [ 19 - 21 ]. As 100% sensitivity was obtained at 1.4 IU/L, we suggest 99m-Tc thyroid scintigraphy for thyrotoxicosis patients with TSHrAb between 1.4 and 2.0 IU/L is prudent.…”

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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“…[ 3 18 ] Similarly, subjects with subacute thyroiditis are also known to have positive TRAb in studies. [ 20 21 22 ] In some of these cases, the presence of increased radioactive iodine uptake suggests the presence of concomitant GD. [ 22 ] TRAb was found to be positive in people with painless thyroiditis.…”

Section: Discussionmentioning

confidence: 99%

Utility of TSH Receptor Antibodies in the Differential Diagnosis of Hyperthyroidism in Clinical Practice

John

Jagesh

Unnikrishnan

et al. 2022

Indian Journal of Endocrinology and Metabolism

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Graves’ disease (GD) is the most common cause of hyperthyroidism in iodine-sufficient areas. It is important to distinguish GD from other causes of hyperthyroidism for optimal management. Thyroid stimulating hormone receptor antibody (TRAb) test is a commonly used test for this purpose. However, the sensitivity for this test in routine clinical practice may be affected by various factors leading to fallacies in diagnosis. Materials and Methods: A retrospective study was performed to assess the utility of an automated electrochemiluminescence TRAb immunoassay (Roche) in differentiating GD from non-Graves’ disease (NGD) in routine clinical practice. Results: In 227 subjects, 146 had GD and 81 had NGD. Total T3, Total T4, Free T4, and TRAb were significantly higher in people with GD in comparison to NGD. The area under the receiver operating characteristics (ROC) curve for the assay was 0.96 (95% CI: 0.926 to 0.984, P < 0.0001). The optimal threshold for the test derived from the ROC was 3.37 IU/L, which is more than the cut-off of 1.75 IU/L suggested by the manufacturer. The sensitivity/specificity of TRAb in the diagnosis of GD at presentation was 98.4%/62.9% at 1.75 IU/L and 91.2%/90.12% at 3.37 IU/L, respectively. Conclusion: The TRAb test is a sensitive test to differentiate between subjects with GD and NGD presenting with hyperthyroidism. However, the cutoff (1.75 IU/L) as per the kit manufacturer may lead to a lower specificity for diagnosis. A modified cut-off of 3.37 IU/L should be considered for optimizing the diagnostic efficacy of the test.

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Subacute Thyroiditis with Highly Positive Thyrotropin Receptor Antibodies and High Thyroidal Radioactive Iodine Uptake

Abstract: (Internal Medicine 42: [704][705][706][707][708][709] 2003)

Cited by 7 publications

References 17 publications

Painful Goiter: A Rare Presentation of Graves’ Disease

Painful Goiter: A Rare Presentation of Graves’ Disease

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

Utility of TSH Receptor Antibodies in the Differential Diagnosis of Hyperthyroidism in Clinical Practice

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