Positive Thyrotropin Receptor Antibodies in Patients with Transient Thyrotoxicosis

Angell, Trevor E.; Benschoten, Olivia Van; Cohen, David; Haas, A. R. C.; Alexander, Erik K.; Marqusee, Ellen

doi:10.4158/ep-2018-0059

Cited by 6 publications

(3 citation statements)

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“…Incident GD after percutaneous ethanol ablation has been described [ 9 ], suggesting that there may be a mechanistic connection between thyroid trauma, thyroid antigen release, and generation of TSI or thyrotropin-receptor antibodies (TRAb). Likewise, it has also been reported that patients with thyroiditis (both autoimmune and granulomatous) can have positive TRAb [ 10 ]. In the patients with thyroiditis, no induction of endogenous hyperthyroidism was noted [ 10 ], but this could be due to the diffuse damage inherent in thyroiditis as compared to the focal damage related to RFA in our case.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, it has also been reported that patients with thyroiditis (both autoimmune and granulomatous) can have positive TRAb [ 10 ]. In the patients with thyroiditis, no induction of endogenous hyperthyroidism was noted [ 10 ], but this could be due to the diffuse damage inherent in thyroiditis as compared to the focal damage related to RFA in our case.…”

Section: Discussionmentioning

confidence: 99%

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Hyperthyroidism Due to Graves Disease After Radiofrequency Ablation

et al. 2023

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Management options for benign, autonomously functioning, and malignant thyroid nodules were limited to surgery or targeting by radioactive iodine before the availability of radiofrequency ablation (RFA). Despite being a relatively new technique, RFA may be favored for patients of high surgical risk, and for those who wish to avoid hypothyroidism. Although insurance coverage for the procedure can be a significant barrier, several groups of investigators have shown improved quality of life for RFA compared to surgery, due to the less invasive nature and favorable risk profile. Hyperthyroidism due to transient thyroiditis is a known risk of RFA, secondary to direct trauma and subsequent thyroid hormone release. Here we present a case of an adult with large, symptomatic, multinodular goiter, with no prior history of thyroid autoimmunity, who underwent RFA with successful volume reduction of two nodules, but who developed acute hyperthyroidism due to Graves disease eight weeks after RFA. Larger studies evaluating the risks of RFA should evaluate for incident hyperthyroidism, specifically for Graves disease/thyroid autoimmunity, as this could represent an additional risk of the procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hyperthyroidism Due to Graves Disease After Radiofrequency Ablation

et al. 2023

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“…[ 22 ] TRAb was found to be positive in people with painless thyroiditis. [ 23 24 25 26 27 ] In a study from India on 67 subjects with hyperthyroidism, 22.3% of the subjects with painless thyroiditis were positive for TRAb. [ 27 ] The role of TRAb in these cases is not clear, although a possibility of mixed diseases (e.g., GD with multi-nodular goiter) is possible.…”

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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