THE ABILITY OF THE SERUM THYROTROPHIN RECEPTOR ANTIBODY (TRAb) INDEX AND HLA STATUS TO PREDICT LONG‐TERM REMISSION OF THYROTOXICOSIS FOLLOWING MEDICAL THERAPY FOR GRAVEs' DISEASE

Wilson, Rhoda; McKillop, James H.; Henderson, Nancy; Pearson, David; Thomson, John A.

doi:10.1111/j.1365-2265.1986.tb01676.x

Cited by 44 publications

(22 citation statements)

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“…However, preliminary reports (70) from a multicenter trial being carried out in Europe do not agree well with the data of Wilson et al (64,65). One of the reasons for the discrepancy between the two reports is probably related to the use of an assay system based on particulate thyroid membranes in the multicenter trial (70).…”

Section: A Trab Measurements and Relapse Or Remission After Antithyrmentioning

confidence: 44%

“…detergent-solubilized TSH receptors and receptor-purified 125 I-labeled TSH) will be considered in any detail here. The sensitivity of these assays is similar to that obtained by modern bioassays using isolated thyroid cells and the following are examples of percentage positive values obtained with the receptor assay by different laboratories in untreated hyperthyroid Graves' patients:-100% (9), 95% (19), 94% (64,65), 83% (66), 95% (44), 82% (67) and 88% (68).…”

Section: A Trab Measurements and Relapse Or Remission After Antithyrmentioning

confidence: 65%

“…One of the reasons for the discrepancy between the two reports is probably related to the use of an assay system based on particulate thyroid membranes in the multicenter trial (70). This is likely to give lower sensitivity and poorer specificity than the method used by Wilson et al (64,65). However, other factors relating to differences in patients' dietary iodine are also likely to be important.…”

Section: A Trab Measurements and Relapse Or Remission After Antithyrmentioning

confidence: 90%

“…Furthermore, only 1 of 20 (5%) patients who remained euthyroid 1 yr after stopping antithyroid drug treatment had detectable antibody levels at the time of drug withdrawal. In a more recent report, Wilson et al (65) conclude that in their patients TSH receptor antibody measurements made 12 months after the start of treatment could reliably predict the clinical course for the next 3 yr after the end of antithyroid drug treatment. In particular positive receptor antibody levels after 12 months' drug treatment predicted relapse in 10 of 11 patients at 1 yr and 3 yr after drug withdrawal.…”

Section: A Trab Measurements and Relapse Or Remission After Antithyrmentioning

confidence: 94%

“…At present, there are not many detailed published studies on the value of TRAb measured by modern methods other than those of Wilson et al (64,65) in predicting the course of Graves' disease after antithyroid drug therapy (but see section on juvenile Graves' disease). However, preliminary reports (70) from a multicenter trial being carried out in Europe do not agree well with the data of Wilson et al (64,65).…”

Section: A Trab Measurements and Relapse Or Remission After Antithyrmentioning

confidence: 97%

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Autoantibodies to the Thyrotropin Receptor

1988

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This review considers recent developments in our understanding of the properties of TRAb, particularly measurement of the antibodies and their sites of action and synthesis. Two new assay methods have allowed considerable improvements in the sensitivity, specificity, precision, and ease of measuring TRAb. In particular: 1) receptor assays based on inhibition of receptor-purified labeled TSH binding to detergent-solubilized TSH receptors and 2) bioassays based on stimulation of cAMP release from monolayer cultures of isolated thyroid cells. Detailed studies with the two assays indicate that TSH receptor antibodies nearly always act as TSH agonists in patients with a history of Graves' hyperthyroidism. Studies in areas of dietary iodine sufficiency suggest that measurement of the antibodies at various stages in the course of treating Graves' disease can be of value in predicting the outcome of therapy. However, in areas of iodine deficiency, difficulties in the ability of patients' thyroid tissue to recover from the effects of antithyroid drugs may prevent the receptor antibodies from causing a relapse of thyrotoxicosis. Consequently, the predictive value of receptor antibody measurements would be expected to be lower in these geographical areas. Although patients with a history of Graves' hyperthyroidism nearly always have TRAb which act as TSH agonists, about 20% of patients with frank hypothyroidism due to autoimmune destruction of the thyroid have TRAb which act as TSH antagonists (blocking antibodies). There is some evidence that these blocking antibodies can cause hypothyroidism particularly in the neonate. With regard to the site of synthesis of TRAb, there is now direct evidence that they are synthesized by thyroid lymphocytes, particularly the lymphocytes in close proximity to thyroid follicular cells. This is consistent with the well established effects of antithyroid treatment (drugs, radioiodine, or surgery) on TRAb levels in addition to their effects on thyroid hormone synthesis. Recent studies using affinity labeling with 125I-labeled TSH have enabled elucidation of the structure of the TSH receptor. TSH receptors in human, porcine, and guinea pig thyroid tissue have a two-chain structure in which the TSH binding site is formed on the outside surface of the cell membrane by a water-soluble A subunit (Mr approximately 50 K). The A subunit is linked by a disulfide bridge and weak noncovalent bonds to the amphiphilic B subunit (Mr approximately 30 K). This subunit, which penetrates the lipid bilayer, probably forms the site for interaction of the receptor with the regulatory subunits of adenylate cyclase.(ABSTRACT TRUNCATED AT 400 WORDS)

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Section: A Trab Measurements and Relapse Or Remission After Antithyrmentioning

confidence: 44%