Abstract
Previous studies indicate pre-existing subclinical Graves' disease in many patients
with the scintigraphic diagnosis of toxic multinodular goitre type A, equivalent to
the in Germany so-called disseminated thyroid autonomy. Furthermore, after radioiodine
treatment an increase or the induction of TSH-receptor antibodies (TRAb) in patients
with Graves' disease or toxic multinodular goitre has been repeatedly reported.
The distinction between both hyperthyroid conditions, Graves' disease and toxic multinodular
goitre type A, depends on the diagnostic power of the TSH-receptor antibody determination.
Bioassays using CHO cell lines expressing the hTSH-receptor or a new TBII assay based
on competitive binding to recombinant human TSH-receptor showed a higher sensitivity
for the detection of TSH-receptor antibodies in patients with Graves' disease than
previous assays using solubilized porcine epithelial cell membranes. In up to 50 %
of patients with toxic multinodular goitre A without antithyroid drug pretreatment
TSH-receptor antibodies were detectable with a high correlation between thyroid-stimulating
antibodies in the bioassay and the h-TBII assay. Moreover, in a recent study the development
of TSH-receptor antibodies after radioiodine treatment was detectable in 36 % of patients
with toxic multinodular goitre type A, whereas TSH-receptor antibodies were not detectable
in patients with toxic multinodular goitre type B or in patients with toxic adenoma.
In conclusion, thyroid-stimulating antibodies in a bioassay or TSH-receptor antibodies
detected with the h-TBII assay have the highest diagnostic power to differentiate
Graves' disease from toxic multinodular goitre. Because of its less cumbersome assay
technique the h-TBII should be performed in all patients with hyperthyroidism to differentiate
Graves' disease from non-autoimmune hyperthyroidism such as toxic multinodular goitre
to select the appropriate therapy for these patients.
Key words
TSH-receptor autoantibodies - Graves' disease - toxic multinodular goitre - hyperthyroidism
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Henri Wallaschofski
Medizinische Klinik I mit Poliklinik
Universitätsklinikum
Ulmenweg 18
91054 Erlangen
Germany
Phone: + 4991318535230
Fax: + 49 9 13 18 53 52 31
Email: Henri.Wallaschofski@med1.imed.uni-erlangen.de
