Thyroid autoantibody profiles in ophthalmic dominant and thyroid dominant Graves’ disease differ and suggest ophthalmopathy is a multiantigenic disease

Abstract

The study demonstrates markedly different thyroid autoantibody profiles in newly diagnosed GD patients with ophthalmic dominant as opposed to thyroid dominant features. It suggests differing antibody patterns are associated with predisposition to hyperthyroidism and orbitopathy. In addition, an association between smoking and low TPOAb levels was noted.

Relevance of TSH-receptor antibody levels in predicting disease course in Graves’ orbitopathy: comparison of the third-generation TBII assay and Mc4-TSI bioassay

“…17,18 A previous report conducted in Singapore 31 showed that TSI was Abbreviations: CAS, clinical activity score; CI, confidence interval; GD, Graves' disease; M, anti-thyroid drug; OR, odds ratio; R, radioiodine treatment; S, thyroidectomy; TBII, thyrotropin-binding inhibitory immunoglobulin; TSI, thyroid-stimulating immunoglobulin. TBII and TSI assays were entered into the models I and II, respectively.…”

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

“…Diagnosis of TAO was based on clinical ophthalmic examination. All patients had clinical features of the disease including at least one of the following in one eye (unilateral involvement) or both eyes (bilateral involvement): lid retraction (upper eyelid margin at or above the superior corneoscleral limbus in primary gaze or 2 mm of difference on lid aperture in primary gaze), 3,11 soft tissue involvement, exophthalmos (Hertel measurement Z17 mm and/or 2 mm of difference between the eyes), 3 restrictive myopathy (limitation of eye movement in the Hess chart and/or diplopia assessed by binocular single-vision test and/or objective evidence of enlarged muscles assessed by computed tomography (CT)), and optic neuropathy (abnormal visual acuity, relative afferent pupillary defect, decreased color perception, and visual field by perimetry).…”

Thyroid Peroxidase and Thyroglobulin Antibodies and Ophthalmopathy in Patients with Graves’ Disease, Hashimoto Thyroiditis and Transient Thyroiditis

“…Indeed, we have recently shown that high serum levels of TPO antibodies were protective against the development of UER but not ophthalmopathy [21]. Earlier, Khoo et al, [22,23] proposed that the combination of negative anti-TPO antibody tests or low titres of TPO antibodies, positive TSHR antibodies and smoking, indicates high risk for ophthalmopathy. However, others [24,25] have failed to confirm these findings and a relationship between thyroid antibodies and the eye disorder is not proven.…”

“…While TG antibodies are less often positive, or positive but in low titres, than TPO antibodies, in all 3 disorders, they are also markers of the thyroid autoimmune process, but probably not directly pathogenetic. Khoo et al, [22,23] reported that TPO antibodies were negatively related to ophthalmopathy namely, that low titres, or undetectable antibodies, were risk factors for the development of ophthalmopathy, particularly in patients with TSHR antibodies who smoked. These workers postulated that TPO antibodies were somehow protected against ophthalmopathy.…”

“…Smoking is a definite risk factor for ophthalmopathy [27,28], and we report here for the first time a modest relationship between smoking and chronic UER as a dominant feature of ophthalmopathy. It is likely that the association reported by Khoo et al, [22,23] reflects this, rather than a role of TPO antibodies per se. In conclusion, our study did not confirm a significant relationship between ophthalmopathy and thyroid antibodies in patients with GD, Hashimoto thyroiditis or transient (sub acute, silent, post partum) thyroiditis.…”