Euthyroid Graves' disease showing no thyroid abnormalities except positive thyroid‐stimulating antibody (TSAb): two case reports

Watanabe, Mikio; Iwatanl, Yoshinori; Kashiwai, Taku; Iijima, Takashi; Fujikado, Takashi; Amino, Nobuyuki

doi:10.1111/j.1365-2796.1995.tb01214.x

Cited by 11 publications

(16 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Watanabe et al reported the relationship between TSAb activity and severity of ophthalmopathy [19]. In our case, the titers of both TSAb and TRAb decreased slightly and transiently during methylprednisolone therapy; these changes correlated with ocular manifestations.…”

Section: Discussionmentioning

confidence: 52%

An Infant Case of Graves' Disease with Ophthalmopathy

et al. 2005

View full text Add to dashboard Cite

Abstract. Graves' disease is a rare disorder in children, particularly in infants. Ocular manifestations of Graves' disease in children are even more rare and are mild compared to adults. We report a 3-year-old girl with Graves' ophthalmopathy who visited our clinic because of lacrimation. Her family had also noticed exophthalmos, goiter, irritability and increased appetite for more than 3 months. The ophthalmologist noted bilateral proptosis, eyelid erythema, lacrimation, entropion of the lower eyelid, and superficial keratitis. Her serum concentrations of free thyroxine and free triiodothyronine were high, and thyroid-stimulating hormone (TSH) was low. Serum samples were markedly positive for antibodies to TSH receptor (TRAb) and thyroid-stimulating antibody (TSAb). Although hyperthyroidism was controlled with propylthiouracil within 3 weeks, her eye signs did not improve. We administered methylprednisolone pulse therapy for ophthalmopathy, but the effect was limited and the lacrimation due to entropion and superficial keratitis persisted. Titers of both TRAb and TSAb decreased slightly and transiently with the pulse therapy. One year later, both titers remained high and eye signs did not improve any more though she was clinically euthyroid. This might indicate that both TRAb and TSAb levels correlate with the clinical course. Therefore, TRAb or TSAb might be good indicators of progress of Graves' ophthalmopathy. Ocular manifestations of Graves' disease should be followed closely with measurements of both TRAb and TSAb even in infant cases.

show abstract

Section: Discussionmentioning

confidence: 52%

An Infant Case of Graves' Disease with Ophthalmopathy

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Thyroid-stimulating immunoglobulin (TSI) measurement has been reported to be a useful and possibly more sensitive marker of euthyroid GO than TBII measurement in Asians 2 21 22. This is also the case for primarily hyperthyroid patients 23.…”

Section: Discussionmentioning

confidence: 99%

Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetrical Graves ophthalmopathy

Eckstein

Lösch

Glowacka³

et al. 2009

British Journal of Ophthalmology

121

View full text Add to dashboard Cite

Background and aims: Retrospective, observational study to compare clinical symptoms and TSH-receptor antibodies (TRAb) in Graves ophthalmopathy (GO) in euthyroid and primarily hypothyroid patients to those in hyperthyroid patients. Methods: Clinical symptoms (NOSPECS (severity) and CAS (activity) score), prevalence and levels of thyroid specific antibodies and the course of the disease were evaluated in 143 primarily hyperthyroid, 28 primarily euthyroid and 11 primarily hypothyroid patients with GO. Results: Patients with euthyroid/hypothyroid GO developed significantly less severe GO symptoms (NOSPECS score 4.4 vs 5.7; p = 0.03), less active GO (CAS score 3.9 vs 5.2; p = 0.002) and more asymmetrical disease (proptosis side difference: 1.9 mm vs 1.0 mm (p = 0.01); side difference of >3 mm: 23% vs 4.8%) than hyperthyroid patients. TRAb levels 6 months after GO onset were significantly lower (2.2 IU/l, p = 0.02) in euthyroid/hypothyroid than in hyperthyroid patients (8.6 IU/l), as was the prevalence of both TRAb and thyroid peroxidase antibodies (75% vs 94.6%, p = 0.0008). Conclusions:The knowledge about the phenotype of GO in primarily euthyroid and hypothyroid patients is helpful for differential diagnosis and patient consultation. TRAb titres are very low in these patients, and the availability of a sensitive assay technique is therefore an important diagnostic tool in euthyroid and hypothyroid patients.

show abstract

“…[7][8][9] Because most cases involving euthyroid TAO showed no thyroid abnormalities except testing positive for thyroidstimulating hormone receptor antibodies (TRAbs), 7,9 the clinical significance of TRAb as a criterion in the diagnosis of euthyroid TAO has been suggested. 3,6 Recently, Eckstein et al 10 reported that the TRAb titer was low in euthryoid and hypothyroid patients, suggesting that a more sensitive assay technique was necessary to utilize the TRAb assay for diagnosis of euthyroid/hypothyroid TAO.…”

Section: Introductionmentioning

confidence: 99%

Clinical features of thyroid-associated ophthalmopathy in clinically euthyroid Korean patients

Jang

Lee

et al. 2012

Eye

View full text Add to dashboard Cite

Aim To compare clinical characteristics and thyroid-stimulating hormone receptor antibodies (TRAbs) in thyroid-associated ophthalmopathy (TAO) in euthyroid Korean patients with those in hyperthyroid patients. Methods Clinical activity scores (CASs), modified NOSPECS scores, exophthalmometry values, prevalence of optic neuropathy, restrictive myopathy and lid retraction, and the positivity and levels of TRAb (thyrotropin-binding inhibitor immunoglobulin (TBII) and thyroidstimulating immunoglobulin (TSI)) were compared in 24 euthyroid (group A) and 139 clinical/subclinical hyperthyroid TAO patients (group B). Results Group A presented more clinically unilateral involvement than group B (79.2% vs 27.3%, Po0.001), less active (CAS 1.50 vs 2.26, P ¼ 0.014) and less severe clinical course (NOSPECS 3.38 vs 4.13, P ¼ 0.037). Lid retraction was more prevalent in group A than group B (91.7% vs 66.2%, P ¼ 0.014). Prevalence of optic neuropathy and restrictive myopathy, and the mean value of exophthalmometry were not different. Mean TBII levels were lower (7.20 IU/l) in group A than in group B (44.58 IU/l, Po0.001). A similar difference was found in the TSI bioassay (201.40% vs 425.19%, P ¼ 0.001). The positive rate of TBII in group A (34.8%) was significantly lower than in group B (90.8%, Po0.001). The positive rate of TSI was high in both group A (83.3%) and B (91.7%), with no significant difference (P ¼ 0.337).Conclusions Patients with euthyroid TAO showed a less active and severe clinical course, more unilateral involvement, and lower levels of TRAb than those in patients with hyperthyroid TAO. These distinct clinical and biochemical characteristics might be useful in assessment of euthyroid TAO, and the TSI might be more sensitive for diagnosing these patients.

show abstract

Euthyroid Graves' disease showing no thyroid abnormalities except positive thyroid‐stimulating antibody (TSAb): two case reports

Cited by 11 publications

References 13 publications

An Infant Case of Graves' Disease with Ophthalmopathy

An Infant Case of Graves' Disease with Ophthalmopathy

Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetrical Graves ophthalmopathy

Clinical features of thyroid-associated ophthalmopathy in clinically euthyroid Korean patients

Contact Info

Product

Resources

About