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Measurements of serum thyrotropin-receptor antibodies may predict the severity of Graves’ eye disease
The background of the study. Many patients with Graves’ eye disease have high serum concentrations of antibodies that stimulate the thyroid gland (thyrotropin [TSH]-receptor antibodies, TSHR-Ab), but little is known about the relationship between these antibodies and the severity and course of the eye disease. In this study, the severity of eye disease was assessed and serum TSHR-Abs were measured repeatedly in patients with Graves’ eye disease.
How the study was done. The study subjects were 159 patients with Graves’ eye disease. Approximately half of them had the onset of eye disease before or coincident with the onset of hyperthyroidism and half had the onset after the onset of hyperthyroidism. Patients with hyperthyroidism were treated with an antithyroid drug, radioiodine, or surgery.
The patients were evaluated at regular intervals for up to 24 months after the onset of eye disease. The evaluations consisted of determination of the Clinical Activity Score (CAS) and a symptom-severity score (SSS), tests which assess changes in eye appearance and symptoms, and measurement of serum TSHR-Abs. At 11 to 14 months of follow-up, the patients were subdivided into two groups, based on assessment of their course: mild course, low CAS and SSS scores; and severe course, high CAS and SSS scores.
The results of the study. The course was mild in 47 percent of patients and severe in 53 percent. The median duration of hyperthyroidism at the time of onset of ophthalmopathy was 0 months in the mild-course group and 2 months in the severe-course group. The median serum TRHR-Ab values were higher (P<0.01) at all times during follow-up in the severe-course group than in the mild-course group.
The conclusions of the study. In patients with Graves’ eye disease serum TSHR-Ab concentrations are higher at base line and remain higher during follow-up in patients with more severe eye disease.
The original article. Eckstein AK, Plicht M, Lax H, Neuhauser M, Mann K, Lederbogen S, Heckmann C, Esser J, Morgenthaler N. Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease. J Clin Endocrinol Metab 2006;91:3464-70.
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| Thyroid Digest Index | | | November 2006 Thyroid Digest |
