Clinical Relevance of Thyroid-Stimulating Immunoglobulins in Graves' Ophthalmopathy

• Published in: Ophthalmology (Rochester, Minn.) Vol. 118; no. 11; pp. 2279 - 2285
• Main Authors: Ponto, Katharina A., MD, Kanitz, Michael, Olivo, Paul D., MD, PhD, Pitz, Susanne, MD, PhD, Pfeiffer, Norbert, MD, PhD, Kahaly, George J., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2011; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biological Assay; Biomarkers - blood; Cross-Sectional Studies; Diplopia - blood; Diplopia - physiopathology; Endocrinopathies; Female; Graves Ophthalmopathy - immunology; Graves Ophthalmopathy - physiopathology; Humans; Immunoglobulins, Thyroid-Stimulating - blood; Male; Medical sciences; Middle Aged; Miscellaneous; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Ophthalmology; Prevalence; Sensitivity and Specificity; Severity of Illness Index; Thyroid. Thyroid axis (diseases); Young Adult; Endocrinopathy; Relevance; Immunopathology; Immunoglobulins; Hyperthyroidism; Thyroid diseases; Graves disease; Autoimmune disease; Thyroid gland; Ophthalmology
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2011.03.030

Purpose Thyroid-stimulating immunoglobulins (TSIs) likely mediate Graves' ophthalmopathy (GO). The clinical relevance of these functional autoantibodies was assessed in GO. Design Cross-sectional trial. Participants A total of 108 untreated patients with GO. Methods Thyroid-stimulating immunoglobulins, assessed with a novel bioassay, bind to the thyrotropin receptor (TSHR) and transmit signals for cyclic adenosine monophosphate (cAMP)-dependent activation of luciferase gene expression. The cAMP/cAMP response element-binding protein/cAMP-regulatory element complex induces luciferase that is quantified after cell lysis. The TSI levels were correlated with activity and severity of GO and compared with a TSHR binding inhibitory immunoglobulin (TBII) assay. Main Outcome Measures Thyroid-stimulating immunoglobulins, activity and severity of GO, diplopia, and TBII. Results Thyroid-stimulating immunoglobulins were detected in 106 of 108 patients (98%) with GO. All 53 hyperthyroid patients were TSI positive versus 47 patients (89%) who were TBII positive. All 69 patients with active GO were TSI positive, whereas only 58 of 69 patients (84%) were TBII positive. Thyroid-stimulating immunoglobulins correlated with the activity ( r =0.83, P < 0.001) and severity ( r =0.81, P < 0.001) of GO. All 59 patients with GO with diplopia were TSI positive, and 50 of 59 patients (85%) were TBII positive. Among patients with moderate-to-severe and mild GO, 75 of 75 (100%) and 31 of 33 (94%) were TSI positive compared with TBII positivity in 63 of 75 (84%) and 24 of 33 (73%), respectively. The TSI levels were higher in moderate-to-severe versus mild GO (489%±137% vs. 251%±100%, P < 0.001). Chemosis and GO activity predicted TSI levels alone ( P < 0.001, multivariable analysis). The TSI levels were higher in patients with chemosis (527%±131%) than in patients without chemosis (313%±127%, P < 0.001). Conclusions Thyroid-stimulating immunoglobulins show more significant association with clinical features of GO than TBII and may be regarded as functional biomarkers for GO. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.