Association between TSH-Receptor Autoimmunity, Hyperthyroidism, Goitre, and Orbitopathy in 208 Patients Included in the Remission Induction and Sustenance in Graves' Disease Study.

Peter Laurberg,Allan Carlé,Jesper Karmisholt,Anne Krejbjerg,Birte Nygaard,Stine Linding Andersen,Inge Bülow Pedersen,Stig Andersen

doi:10.1155/2014/165487

Peter Laurberg, Allan Carlé + Show 6 more

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https://doi.org/10.1155/2014/165487

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Abstract

Background. Graves' disease may have a number of clinical manifestations with varying degrees of activity that may not always run in parallel. Objectives. To study associations between serum levels of TSH-receptor autoantibodies and the three main manifestations of Graves' disease (hyperthyroidism, goiter, and presence of orbitopathy) at the time of diagnosis of hyperthyroidism. Methods. We describe a cohort of 208 patients with newly diagnosed Graves' hyperthyroidism. Patients were enrolled in a multiphase study of antithyroid drug therapy of Graves' hyperthyroidism, entitled “Remission Induction and Sustenance in Graves' Disease (RISG).” Patients were systematically tested for degree of biochemical hyperthyroidism, enlarged thyroid volume by ultrasonography, and the presence of orbitopathy. Results. Positive correlations were found between the levels of TSH-receptor autoantibodies in serum and the three manifestations of Graves' disease: severeness of hyperthyroidism, presence of enlarged thyroid, and presence of orbitopathy, as well as between the different types of manifestations. Only around half of patients had enlarged thyroid gland at the time of diagnosis of hyperthyroidism, whereas 25–30% had orbitopathy. Conclusions. A positive but rather weak correlation was found between TSH-receptor antibodies in serum and the major clinical manifestation of Graves' disease. Only half of the patients had an enlarged thyroid gland at the time of diagnosis.

Highlights

Graves’ disease (GD) is a common autoimmune disorder that may affect a number of organs and tissues
It is clear that the central element is autoimmunity directed against the TSH-receptor [2], and the vast majority of patients newly diagnosed with Graves’ disease have detectable TSHreceptor autoantibodies (TRAb) in serum [3, 4]
The most common manifestation of GD is hyperthyroidism caused by TRAb binding to and activating the TSHreceptor on the follicular cells of the thyroid

Summary

Introduction

Graves’ disease (GD) is a common autoimmune disorder that may affect a number of organs (thyroid, orbit, skin, fingers, and toes) and tissues (e.g., both fat and muscle cells in the orbit). It is clear that the central element is autoimmunity directed against the TSH-receptor [2], and the vast majority of patients newly diagnosed with Graves’ disease have detectable TSHreceptor autoantibodies (TRAb) in serum [3, 4]. To study associations between serum levels of TSH-receptor autoantibodies and the three main manifestations of Graves’ disease (hyperthyroidism, goiter, and presence of orbitopathy) at the time of diagnosis of hyperthyroidism. Positive correlations were found between the levels of TSH-receptor autoantibodies in serum and the three manifestations of Graves’ disease: severeness of hyperthyroidism, presence of enlarged thyroid, and presence of orbitopathy, as well as between the different types of manifestations. Around half of patients had enlarged thyroid gland at the time of diagnosis of hyperthyroidism, whereas 25–30% had orbitopathy. Half of the patients had an enlarged thyroid gland at the time of diagnosis

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Conclusion