THYROID STIMULATING ANTIBODIES ARE HIGHLY PREVALENT IN HASHIMOTO'S THYROIDITIS AND ASSOCIATED ORBITOPATHY.

THYROID STIMULATING ANTIBODIES ARE HIGHLY PREVALENT IN HASHIMOTO'S THYROIDITIS AND ASSOCIATED ORBITOPATHY.

J Clin Endocrinol Metab. 2016 Mar 10;:jc20161220

Authors: Kahaly GJ, Diana T, Glang J, Kanitz M, Pitz S, König J

Abstract
CONTEXT: Thyroid-associated orbitopathy (TAO) rarely occurs in patients with Hashimoto's thyroiditis (HT).
OBJECTIVE: There is evidence that TSH receptor (TSHR) stimulating antibodies (TSAb) play a role in the pathogenesis of TAO. In this report, the prevalence of TSAb in HT patients with and without TAO was studied.
DESIGN: Longitudinal observational study Setting: Academic joint thyroid-eye clinic Subjects: A total of 1055 subjects were included Methods: TSAb was measured with a FDA-cleared bioassay that utilizes CHO cells expressing a chimeric TSHR and a cAMP response element-dependent luciferase. Results of TSAb activity were reported as percentage of specimen-to-reference ratio (SRR%, cut-off >140%).
MAIN OUTCOME MEASURE: Association of TSAb with the risk of TAO in patients with HT.
RESULTS: Of 700 consecutive and unselected patients with HT, 44 (6%) had overt TAO. Patients with HT+TAO were older (p<0.001), heavy smoker (p=0.032), and clustered less with autoimmune diseases (p=0.005). All healthy controls were TSAb negative. In contrast, serum was TSAb positive in 30/44 (68.2%) and 36/656 (5.5%, p<0.001) patients with HT+TAO and HT, respectively. Compared to patients with HT only, serum TSAb levels were higher in HT+TAO (Median SRR%, 25% and 75% percentile): 45, 35-65 vs. 192.5, 115-455.3, p<0.001. Highest TSAb values were noted in patients with active and severe TAO versus those with mild and inactive TAO: 486, 392-592 versus 142, 73-192.5, p<0.001. The odds ratio (OR) of TSAb-positivity for the risk of TAO adjusted for gender and age was 55.9 (95% CI 24.6-127, p<0.0001), while the OR per ten-fold change in TSAb SRR% (quantitative TSAb) was 133 (95% CI 45-390, p<0.0001). The area under the ROC-curve for qualitative and quantitative TSAb was 87.2% (95% CI 80.6-93.8) and 89.4% (95% CI 84.1-94.7), respectively.
CONCLUSIONS: TSAb is strongly associated with TAO in HT and TSAb may contribute to the pathophysiology of TAO.

PMID: 26964732 [PubMed - as supplied by publisher]

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