Association Between Thyroid Associated Ophthalmopath and Thyroid Autoantibody

Duck Jin Hwang; Yun Jeong Kim

doi:10.3341/jkos.2010.51.9.1167

Journal List > J Korean Ophthalmol Soc > v.51(9) > 1008631

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Hwang and Kim: Association Between Thyroid Associated Ophthalmopath and Thyroid Autoantibody

Original Article

Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2010; 51(9): 1167-1173.

Published online: 30 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.9.1167

Association Between Thyroid Associated Ophthalmopath and Thyroid Autoantibody

Duck Jin Hwang, MD, Yun Jeong Kim, MD

Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea.

Address reprint requests to Yun Jeong Kim, MD. Department of Ophthalmology, Hallym University Sacred Heart Hospital, #896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, Korea. Tel: 82-31-380-3835, Fax: 82-31-380-3837, bonamd@paran.com

Received 16 February 2010 Accepted 7 July 2010

Abstract

Purpose

The same autoimmune process is thought to cause thyroid associated ophthalmopathy (TAO) and Graves' disease. The aim of this study is to determine hether thyroid autoantibody is related to the development of thyroid associated ophthalmopathy.

Methods

A retrospective chart analysis was performed on patients with a newly diagnosed Graves' disease, who presented to our ophthalmology clinic between January 2006 and December 2009. Thyroid autoantibody titers were obtained at the time of diagnosis and were used to determine the presence or absence of TAO. In addition, any correlations between thyroid autoantibodies were analyzed in patients with TAO.

Results

Thyroid autoantibody levels correlated with the development of TAO. Fifty-eight (69%) out of 84 patients with positive thyroid-stimulating hormone receptor antibody (TRAB) levels at the time of diagnosis had TAO. Only 50 (51%) of the 99 patients with negative TRAB levels had TAO. This difference between the two groups was statistically significant (odds ratio, OR=2.2, p=0.013). A statistically significant correlation with the development of TAO was also found in thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb), respectively (OR=0.5, p=0.317; OR=0.3, p=<0.001). In patients with TAO, the correlation between TPOAb and TgAb levels was very high (r=0.64, p=<0.001).

Conclusions

A significant association was determined to exist between the development of TAO and thyroid autoantibody level. This result demonstrates the clinical utility of thyroid autoantibody for the diagnosis of TAO in patients with newly diagnosed Graves' disease.

Keywords: Anti-thyroglobulin antibody, Thyroid associated ophthalmopathy, Thyroid peroxidase antibody, Thyroid stimulating hormone receptor antibody

Figures and Tables

Figure 1

Number of patients with positive TRAB, TPOAb, and TgAb levels according to increasing CAS. TRAB= thyroid stimulating hormone receptor antibody; TPOAb= thyroid peroxidase antibody; TgAb=anti-thyroglobulin antibody.

Figure 2

Association between the CAS and the prevalence of TRAB, TPOAb and TgAb. The prevalence of TRAB increased with increasing CAS. However, the difference of the prevalence of TRAB was statistically insignificant. The prevalence of TPOAb and TgAb were not different among two groups. TRAB=thyroid stimulating hormone receptor antibody; TPOAb=thyroid peroxidase antibody; TgAb=anti-thyroglobulin antibody.

Figure 3

The prevalnce of immunological parameters in 184 patients with newly diagnosed, untreated thyroid disease. Fifty-eight (53%) of 108 patients with TAO had positive TRAB levels. Only 26 (35%) of the 75 non-TAO patients had positive TRAB levels. The chi-square tests for trend were statistically significant for all antibodies, respectively (P=0.013, 0.032 and <0.001). TAO=thyroid associated ophthalmopathy; TRAB=thyroid stimulating hormone receptor antibody; TPOAb=thyroid peroxidase antibody; TgAb=anti-thyroglobulin antibody.

Table 1

Manifestation of thyroid associated ophthalmopathy (N=108)

Table 2

Distribution of Clinical Activity Score among thyroid associated ophthalmopathy patients

^*CAS=Clinical activity score.

Table 3

Association between immunological parameters and TAO

^*Multivariate logistic regression analysis with TAO as the dependent variable and each antibody as the independent variable; ^†Adjusted for age and sex. TAO=thyroid associated ophthalmopathy; TRAB=thyroid stimulating hormone receptor antibody; TPOAb=thyroid peroxidase antibody; TgAb=anti-thyroglobulin antibody; OR=odds ratio; CI=confidence interval.

Table 4

Prevalence of TAO in patient subgroups based on TRAB, TPOAb and TgAb status

^*The odds ratio of TAO was significantly higher in Group 1 but not the other groups when compared with Group 8; ^†Adjusted for age and sex. TAO=thyroid associated ophthalmopathy; TRAB=thyroid stimulating hormone receptor antibody; TPOAb= thyroid peroxidase antibody; TgAb=anti-thyroglobulin antibody; OR=odds ratio; CI=confidence interval.

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