Horm Metab Res 2006; 38(1): 53-56
DOI: 10.1055/s-2006-924979
Original Clinical
© Georg Thieme Verlag KG Stuttgart · New York

Does Autoantibody-negative Graves’ Disease Exist? A Second Evaluation of the Clinical Diagnosis

J.  Paunkovic1 , N.  Paunkovic1
  • 1 Medical Center, Department of Nuclear Medicine, Zajecar, Serbia
Further Information

Publication History

Received 3 May 2005

Accepted after revision 11 August 2005

Publication Date:
13 February 2006 (online)

Abstract

Advanced technical methods are essential for accurate diagnosis of Graves’ or Basedow’s disease (GD). Inadequate methods may lead to a false diagnostic conclusion. We have analyzed the clinical features and methodology aspects of cases diagnosed as GD with negative findings for TSH receptor autoantibodies. The initial diagnosis was based on clinical findings (patient record, hypermetabolic state, goiter palpation) and laboratory testing (fT4 and TSH). From a total of 255 newly registered patients with GD, fifty-one (20 %) were negative in a conventional porcine TBII assay. All fifty-one patients were retested with 131I or 99 mTc uptake tests, thyroid scintigraphy, and a second-generation TBII assay. Results disclosed twenty-one cases (8.3 %) with diagnosis other than GD: ten cases of autonomous hyperthyroidism (Plummer’s disease), seven cases of painless thyroiditis and four cases of euthyroid endocrine ophthalmopathy. All twenty-one patients remained negative in the second-generation TBII assay. Measurement by second-generation TBII assay was performed on the remaining thirty patients initially found negative for TBII. As a result of this reevaluation, only 234 of the original 255 patients had GD. Of those, 231 (204 according to porcine plus 27 according to human TRAb assay) had detectable TBII (98.7 %). This investigation stresses the problem of correct diagnosis and the methodological limitations in the assessment of laboratory parameter validity in GD. Based on this work, TSH receptor autoantibody-negative GD is extremely rare.

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Jane Paunkovic

Department of Nuclear Medicine · Medical Center · Zajecar

Rasadnicka b.b. · 19000 Zajecar · Serbia and Montenegro

Phone: +381 (19) 443 521

Fax: +381 (19) 420 672

Email: janep@sezampro.yu