Heterogeneity of TSH Receptor-binding Antibodies in Hashimoto’s Thyroiditis and Graves’ Disease

Bruin, T.W.A. de; Braverman, Lewis E.; Brown, Rosalind S.

doi:10.1097/00000441-199005000-00001

Cited by 13 publications

(4 citation statements)

References 30 publications

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“…Evidence and TSH binding-inhibitory activities (22)(23)(24), but none of these antibodies have been proven to be against the TSH receptor. The reported ability of IgG from patients with autoimmune thyroid disease to immunoprecipitate TSH -TSH receptor complexes (25)(26)(27)(28) would also support the existence of separate binding sites for TSH receptor antibodies and TSH. However, these findings have been disputed (1).…”

Section: Discussionmentioning

confidence: 88%

Binding domains of stimulatory and inhibitory thyrotropin (TSH) receptor autoantibodies determined with chimeric TSH-lutropin/chorionic gonadotropin receptors.

Nagayama

Wadsworth²,

Russo³

et al. 1991

J. Clin. Invest.

152

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Section: Discussionmentioning

confidence: 88%

Binding domains of stimulatory and inhibitory thyrotropin (TSH) receptor autoantibodies determined with chimeric TSH-lutropin/chorionic gonadotropin receptors.

Nagayama

Wadsworth²,

Russo³

et al. 1991

J. Clin. Invest.

152

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“…Diese TSH-Rezeptorantikörpern können funktionsblockierende und seltener auch funktionsstimulierende Eigenschaften aufweisen (4). Man hat geschätzt, daß (blockierende) Antikörper bei bis zu 5 bis 10% der Erkrankten an der Entwicklung einer Hypothyreose beteiligt sind (3).…”

Section: Patienten Und Methodenunclassified

Clinical Implications of a New TSH-receptor-antibody-assay (DYNOtest® TRAKhuman) in Autoimmune Thyroid Diseases

Meller

Schreivogel²,

Bergmann³

et al. 2000

Nuklearmedizin

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Summary Aim: Conventional radioreceptor-antibody-assays (RAAs) fail in the detection of TSH-receptor antibodies (TRAKs) in 10–30% of patients with Graves’ disease (GD). The aim of this study was the evaluation of the diagnostic and clinical impact of a new RRA (DYNOtest® TRAKhuman) which uses the human recombinant TSH-Receptor in the diagnosis of autoimmune thyroid disease. Methods: Sera from 142 consecutive patients (GD: n=50, autoimmune thyroiditis/AIT: n=92) and from 55 controls (31 patients without any thyroid disease and 14 with euthyroid goiter) were evaluated both with the DYNOtest® TRAKhuman-assay and a conventional RRA (TRAK-Assay®). Thyroid in vitro parameters and thyroid sonography were performed in all patients. Results: The DYNOtest® TRAK-assay was significantly superior to the conventional RRA in the diagnosis of GD (p < 0,00012), especially in those who were treated by thionamides (p < 0,003) and in the diagnosis of TRAK-positive patients with AIT(p < 0,003). The majority of TRAK-positive AIT-patients suffered from hypothyroidism. One false positive result in patients with euthyroid goiter was found in the TRAK-Assay® as well as in the DYNOtest® TRAKhuman-Assay. Therefore the specifity of the DYNOtest® TRAKhuman was not inferior compared with the conventional assay. Conclusion: The DYNOtest® TRAK-assay is superior in the diagnostic work up of Graves’ disease compared with a conventional TRAK-assay and offeres an equal specifity.

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“…Suppressed TSH concentrations, together with elevated thyroid hormones, are usually the most sensitive parameters. [6,7] If discrimination is not possible, the coexistence of ophthalmopathy, which should be carefully evaluated in all patients, or the clinical course, may eventually verify the diagnosis. In a recent retrospective evaluation, antibodies against the TSH receptor (TSI), thyroid peroxidase (TPO), and thyroglobulin were determined in 80-90% of pediatric patients with hyperthyroidism.…”

Section: Laboratory Diagnosis Of Hyperthyroidism In Childhood and Adomentioning

confidence: 99%

Graves Disease in Childhood

2003

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While diagnosing Graves disease in childhood and adolescence does not usually present specific problems, the treatment of hyperthyroidism is still controversial. In particular, with regard to the use of radioiodine therapy, strategies vary between many European and North American pediatric endocrinology centers. After the diagnosis is made, antithyroid drug treatment with methimazole (thiamazole), carbimazole, or propylthiouracil should be performed with caution, in particular, because of severe adverse effects, such as agranulocytosis or hepatitis, that are found in up to 1% of patients. Antithyroid drug treatment should not be continued long-term, particularly since definitive remission cannot be expected in more than 30-40% of patients. In contrast, the risk of severe adverse effects is still present, and the risk of thyroid carcinoma increases with time and appears to be considerably higher than after radioiodine treatment. To a great extent, the success of surgery depends on the skills of a trained surgeon. The question of whether to perform total or subtotal thyroidectomy is yet to be resolved. Surgery should be considered in patients with a large thyroid gland (>80g), severe ophthalmopathy, and a lack of remission on antithyroid drug treatment. Success rates have increased to up to 97%, while severe adverse effects (laryngeal nerve palsy, hypoparathyroidism) occur in approximately 4% of patients. Mortality is below 0.1%. Radioiodine treatment in children >5 years of age does not appear to be associated with an increased risk of thyroid carcinoma; however, long-term data are lacking. Compared with the surgical approach, success rates are lower, particularly if low doses of radioiodine are used. In general, adverse effects are less prevalent than in patients who have undergone surgery.

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Heterogeneity of TSH Receptor-binding Antibodies in Hashimoto’s Thyroiditis and Graves’ Disease

Cited by 13 publications

References 30 publications

Binding domains of stimulatory and inhibitory thyrotropin (TSH) receptor autoantibodies determined with chimeric TSH-lutropin/chorionic gonadotropin receptors.

Binding domains of stimulatory and inhibitory thyrotropin (TSH) receptor autoantibodies determined with chimeric TSH-lutropin/chorionic gonadotropin receptors.

Clinical Implications of a New TSH-receptor-antibody-assay (DYNOtest® TRAKhuman) in Autoimmune Thyroid Diseases

Graves Disease in Childhood

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