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Comparative Study
. 2024 Nov 28:15:1487490.
doi: 10.3389/fendo.2024.1487490. eCollection 2024.

Comparison between thyroid stimulating immunoglobulin and TSH-receptor antibodies in the diagnosis and management of Graves' disease

Peiwei Yao  1 , Yunliang Xie  1 , Yunlin Wang  1 , Chunyan Liang  1 , Bingwen Huang  1
Affiliations
Comparative Study

Comparison between thyroid stimulating immunoglobulin and TSH-receptor antibodies in the diagnosis and management of Graves' disease

Peiwei Yao et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: TSH-receptor antibodies (TRAb) directed against the TSH receptor (TSH-R) induce hyperthyroidism in patients with Graves' disease (GD). TRAb detected by previous radioimmunoassay only reflects the presence of autoantibodies, but not the function of such antibodies. Thyroid stimulating immunoglobulins (TSI) is a relatively new method for assessing TSH-receptor antibodies function. The aim of this study was to investigate the role of TSI in the diagnosis and management of GD.

Methods: Patients with newly diagnosed GD (n=140, age 38.00 ± 11.99 years, 106 women) received pharmacological therapy (methimazole) up to 18 months in the outpatient or inpatient department of the Second People's Hospital of Foshan City from January 2013 to December 2018. GD was identified by clinical signs and symptoms and relevant laboratory tests. Blood samples for TSI and TRAb and other thyroidal biomarkers were obtained at baseline and at three times during the follow-up. All patients with GD were followed up for at least 5 years to see if the patient was cured or had relapsed.

Results: TSI and TRAb in GD patients were significantly higher than those in the normal control group (P<0.001), and there was a strong correlation between TSI and TRAb in GD patients (P<0.001). After treatment, TSI and TRAb significantly decreased (P<0.05), TSI and TRAb in patients with disease course more than 2 years were significantly higher than those in patients with disease course less than 2 years (P<0.05), There was no statistically significant difference in TSI and TRAb at initial diagnosis between patients with a disease duration of more than 2 years and less than 5 years and those with a disease duration of more than 5 years (P>0.05); if the patients were still positive for TSI or TRAb antibodies at 5 years of follow-up after treatment with anti-hyperthyroidism medication, the patients were at a higher risk of relapse (P<0.001).

Conclusion: The higher TSI at the initial diagnosis of GD, the longer duration of treatment with anti-hyperthyroid drugs and the higher risk of relapse. Compared with TRAb, serum TSI level is also important in the clinical diagnosis and prognosis of GD, but which one is superior to the other needs further study.

Keywords: Graves’ disease; TRAb thyroid antibodies; anti-hyperthyroidism drug therapy; duration of treatment; thyroid-stimulating immunoglobulin.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Correlation between TSI vs TRAb (A), TSI vs fT4 (B) and TRAb vs fT4 (C) at initial diagnosis. rs = Spearman’s Rho Coefficient.
See this image and copyright information in PMC

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