Abstract
The presence of TSH-receptor antibodies (TRAb) in serum is a key abnormality in Graves' disease (GD). The latest generation of assays detects TRAb in around 95% of unselected patients with newly diagnosed GD. TRAb negative patients have a mild disease and respond well to antithyroid drug therapy. In a low iodine intake area, around 15% of patients diagnosed to have multinodular goitre are TRAb positive patients are more hyperthyroid and have more complications to radioiodine therapy, and they may suffer from GD on top of a multinodular goitre. Around 10% of patients with spontaneous (autoimmune) hypothyroidism are TRAb positive. It is uncommon to find TRAb in serum from healthy individuals. TRAb measurement is useful for diagnosing GD in hyperthyroid patients, and for diagnosing remission during anti-thyroid drug therapy. TRAb status can be used to evaluate risk of relapse after withdrawal of anti-thyroid drug therapy, risk of fetal hyperthyroidism after previous radioiodine or surgical therapy of the mother and risk of neonatal hyperthyroidism when the pregnant woman receives anti-thyroid drugs for GD. It is important to recognize differences in quality between TRAb assays.
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