Evaluation of Impact of Graves Disease on some Selected Haematological Markers among Subjects.pdf (original) (raw)
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Clinical Endocrinology, 1987
This study represents an international double-blind collaborative study of abnormal immunoglobulin activity in untreated Graves' disease. Laboratories in two countries participated in a comparison of thyrotrophin binding inhibiting (TBII), thyroid stimulating (TSAb), and growth stimulating (TGI) immunoglobulins with clinical data, including ultrasonically measured thyroid size. The correlation between TGI and thyroid volume (n = 25, Rs = 0.54, P less than 0.05) and the fact that 9 of 10 patients with high range TGI values had large goitres establish the relationship between TGI and goitre, confirming that the in-vitro activity of these antibodies is related to an in-vivo action. In addition, both TBII and TSAb correlated with serum free T3 indices (TBII: n = 60, Rs = 0.46, P less than 0.001, and TSAb: n = 60, Rs = 0.64, P less than 0.001). Moreover, both TBII and TSAb correlated with thyroid volume (TBII: n = 60, Rs = 0.37, P less than 0.01, and TSAb: n = 60, Rs = 0.41, P less than 0.01) suggesting that these antibodies are also important in development of goitre in Graves' disease. Finally, some correlation between the antibodies was observed. TBII correlated with TSAb (n = 60, Rs = 0.47, P less than 0.001), and in the 16 patients with positive TGI results, this activity correlated with TBII (Rs = 0.54, P less than 0.05), but not with TSAb. Also some cases were found with corresponding high range TBII and TGI, while negative for TSAb, suggesting a close relationship between the in-vitro measurement of TSH binding and TGI.
1998
Graves' disease is an autoimmune disease wich etiology that is not completely understood. Numerous experimental investigations and clinical observations have primarily elucidated the role of the humoral stimulatory factors in the disease (LATS, TSI, etc). These autoantibodies (TRAb) react with TSH receptor and produce postreceptor stimulatory effects, that lead to hyperfunction of the thyroid. It is thus understandable why sensitive and specific techniques such as radioreceptor assays, cAMP generated in thyrocytes, etc. detect high levels of these autoantibodies in more than 85%, in patients with untreated Graves' disease 1-3 . The incidence and serum level of TRAb decrease during thyrosupressive therapy 4,5 , and are almost always negative in stable remission 6,7 . Transplacental passage of TRAb from mother to foetus, results in genesis of neonatal hyperthyroidism 8 . This model for the role of TRAb in autoimmune hyperthyroidism is partly complicated by the fact that not al...
The ophthalmopathy associated with Graves' hyperthyroidism is most likely a T-cell mediated disorder, although most investigators believe that autoantobodies directed against the TSH Receptor (TSH-R) expressed on the surface of the orbital fibroblasts and pre-adipocytes are the main driver of the orbital reactions. Cases of ophthalmopathy without TSH-R binding antibodies and not closely associated with Thyroid Stimulating Immunoglobulin's (TSI), challenge the notion that ophthalmopathy is perpetrated by TSI circulating in peripheral blood and TSI producing plasma cells resident in the orbital tissues. One way to address a possible role of TSH-R antibodies in the development of ophthalmopathy is to study patients with so-called "Euthyroid Graves' eye Disease (EGD)", who have a similar eye disorder but with normal thyroid function and no features of thyroid autoimmunity during long term follow up.
Endokrynologia Polska, 2021
Introduction: Although the TSH-receptor antibody (TRAb) plays a central role in the pathogenesis of Graves' disease (GD), the association between TRAb at first diagnosis and clinical and laboratory parameters is not well known. On the other hand, a minority of patients with GD may be TRAb negative, and there is a lack of adequate evidence to demonstrate the clinical and laboratory characteristics of these patients. Therefore, we aimed to investigate the association of TRAb at the initial diagnosis of GD with the clinical and laboratory parameters in a large number of patients with GD and to compare the clinical and laboratory parameters between patients with high TRAb levels and TRAb-negative patients. Material and methods: This study included 440 patients [326 (74%) female, 114 (26%) male]. All patients were classified according to gender, age, smoking habit, and TRAb levels. Results: TRAb levels were significantly higher in male compared to female patients and in smokers compared to non-smokers. Smoking male patients had the highest TRAb levels. In regression analysis, goiter size, male gender, cigarette smoking, Graves' orbitopathy, fT3, and anti-TPO antibody levels were independently associated with high TRAb levels, while age at diagnosis and fT4 levels were not independently associated with high TRAb levels. TRAb-negative GD was diagnosed in 80 (18%) patients. TRA-negative patients had markedly less severe clinical and laboratory hyperthyroidism compared to patients with high TRAb levels. Moreover, the smoking habit was significantly lower in patients with TRAb-negative GD. Conclusions: According to our study results, TRAb levels at the initial diagnosis of GD are differently associated with clinical and laboratory parameters. Male patients and smoking patients with GD tended to have markedly higher TRAb levels and more severe clinical hyperthyroidism. Therefore, besides other contributing factors, male gender and smoking may affect TRAb levels and consequently the severity of hyperthyroidism in patients with GD. Furthermore, male gender and smoking may have a synergistic effect on TRAb levels and consequently on the severity of hyperthyroidism in patients with GD.
The role of TSH receptor antibodies in the management of Graves' disease
European Journal of Internal Medicine, 2011
The central role of thyrotropin receptor antibodies (TRAbs) in the pathogenesis of Graves' disease has been recognised for several decades. However, the practical application of testing for TRAbs in clinical decision making remains the subject of controversy. The diagnosis of Graves' disease can be made in most cases simply based on a patient's clinical presentation. The TRAb test is therefore of most value in ambiguous clinical scenarios such as in the differential diagnosis of unilateral exophthalmos, euthyroid Graves' ophthalmopathy, subclinical hyperthyroidism, thyrotoxicosis associated with hyperemesis gravidarum, amiodarone-induced thyrotoxicosis and painless thyroiditis. It may also have a role in predicting the risk of a recurrence of Graves' disease following a course of antithyroid drug treatment. One further clinical utility of the TRAb test is in pregnancy where antibody titre measured during the third trimester is used to predict the risk of neonatal thyroid dysfunction. The TRAb titre not only aids in clinching a difficult diagnosis but can also help guide treatment in some patients. Although the TRAb assay has become more affordable in recent years, cost remains an important factor when considering its use routinely. Nonetheless, this is an underutilized blood test that could augment standard endocrine investigations in the differential diagnosis of hyperthyroidism.
Journal of Thyroid Research, 2014
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 enl...