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Horm Metab Res 2005; 37(12): 745-750
DOI: 10.1055/s-2005-921102
Original Clinical
© Georg Thieme Verlag KG Stuttgart · New York

Binding, Stimulating and Blocking TSH Receptor Antibodies to the Thyrotropin Receptor as Predictors of Relapse of Graves’ Disease after Withdrawal of Antithyroid Treatment

B.  Quadbeck1 , R.  Hoermann2 , S.  Hahn1 , U.  Roggenbuck3 , K.  Mann1 , O.  E.  Janssen1 for the Basedow Study Group1
  • 1Div. of Endocrinology, Dept. of Medicine University of Duisburg-Essen, Germany
  • 2Dept. of Medicine, Klinikum Luedenscheid, Germany
  • 3Institute for Medical Informatics, Biometry and Epidemiology, Essen, Germany
Further Information

Publication History

Received 4 April 2005

Accepted after revision 28 June 2005

Publication Date:
22 December 2005 (online)

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Abstract

TSH-receptor autoantibodies (TRAbs) are a valuable diagnostic tool for comfirming a diagnosis of Graves’ disease (GD). While there is evidence that high TRAb levels are associated with relapse of GD, whether a discrimination of TRAb into stimulating (TSAb) and blocking (TBAb) autoantibodies would benefit the clinician in terms of outcome prediction remains unclear. To address this issue, we have determined TRAb, TSAb and TBAb levels in serum samples of ninety-six euthyroid patients with GD taken four weeks after antithyroid drug withdrawal (ATDT). Forty-seven patients (49 %) underwent relapse of GD within two years. Amongst those, forty-one (87 %) had been positive for TRAb and thirty-five (74 %) for TSAb after treatment. All patients except one were negative for TBAb. The correlation between TRAb and TSAb in those treated GD patients was relatively weak (r = 0.268, p < 0.001). Based on a cut-off limit of 1.5 IU/l, the positive and negative predictive values with respect to prediction of relapse were too low for any clinical relevance (TRAb: 49 % and 54 %; TSAb: 51 % and 55 %). However, when a cut-off level above 10 IU/l was used, the positive and negative predictive values increased to 83 % and 62 %. The additional measurement of TSAb or TBAb in those samples after therapy did not add additional information, even at higher deciscion thresholds. In conclusion, differentiation of TRAb into TSAb and TBAb is of no help in the prediction of relapse of GD in euthyroid patients at the end of ATDT, and only high TRAb levels are associated with relapse.

Key words

Graves’ disease - TSH-receptor antibodies - thyroid stimulating antibodies - thyroid blocking antibodies - relapse

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