Thyroid-Stimulating Antibody in a Patient with Euthyroid Graves' Disease.

Kubo, Toshio; Toki, Juri; Kado, Yuji; Kurihara, Makoto; Moriwake, Toshio; Susumu, Kanzaki; Seino, Yoshiki

doi:10.1507/endocrj.47.197

Cited by 5 publications

(2 citation statements)

References 15 publications

(14 reference statements)

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“…Though the pathogenesis of infiltrative ophthalmopathy is still unresolved, it has been suggested that autoantibodies to an antigen cross-reacting with the TSH receptor may be involved [18]. Watanabe et al reported the relationship between TSAb activity and severity of ophthalmopathy [19].…”

Section: Discussionmentioning

confidence: 99%

An Infant Case of Graves' Disease with Ophthalmopathy

et al. 2005

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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.

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Section: Discussionmentioning

confidence: 99%

An Infant Case of Graves' Disease with Ophthalmopathy

et al. 2005

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“…[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

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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.

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A case of thyrotropin-producing pituitary adenoma, accompanied by an increase in anti-thyrotropin receptor antibody after tumor resection

Kageyama

Ikeda

Sakihara

et al. 2007

J Endocrinol Invest

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We describe a rare, but interesting, case of TSH-producing adenoma (TSHoma), accompanied by increases in both anti-TSH receptor antibody (TRAb) and thyroid-stimulating antibody (TSAb) after tumor resection. A 21-yr-old woman was referred to our department for further evaluation of pituitary tumor. In a nearby hospital, she had been diagnosed as having pituitary tumor. Her serum free T4, free T3, and TSH levels were all elevated concomitantly. On the basis of a diagnosis of pituitary adenoma with TSH production, transsphenoidal resection of the pituitary adenoma was performed. Two weeks after the operation, the blood concentrations of TSH were undetectable, whereas both TRAb and TSAb levels were elevated. TSAb levels gradually increased further from 2 weeks to 3 months after the operation, accompanied by an increase in TSH and free T4 levels. TSH is an important hormone in maintaining physiology and regulating immunomodulators in thyrocytes, as it can influence a variety of immune-regulating cytokine-like activities and inhibit expressions of Fas antigen, intracellular adhesion molecule-1, and class II trans-activator. Changes in TSH would modulate the immune circumstances in the thyroid, and then induce TRAb and TSAb. Autoimmune parameters with thyroid function should be observed carefully when managing patients with TSHoma.

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Thyroid-Stimulating Antibody in a Patient with Euthyroid Graves' Disease.

Cited by 5 publications

References 15 publications

An Infant Case of Graves' Disease with Ophthalmopathy

An Infant Case of Graves' Disease with Ophthalmopathy

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

A case of thyrotropin-producing pituitary adenoma, accompanied by an increase in anti-thyrotropin receptor antibody after tumor resection

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