PDF
ePub
Citation
Print
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).
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 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.
References
1. Feliciello A, Porcellini A, Ciullo I, et al. Expression of thyrotropinreceptor mRNA in healthy and Graves' disease retro-orbital tissue. Lancet. 1993. 342:337–338.
2. Heufelder AE, Dutton CM, Sarkar G, et al. Detection of TSH receptor RNA in cultured fibroblasts from patients with Graves' ophthalmopathy and pretibial dermopathy. Thyroid. 1993. 3:297–300.
3. Ludgate M, Crisp M, Lane C, et al. The thyrotropin receptor in thyroid eye disease. Thyroid. 1998. 8:411–413.
4. Marinò M, Lisi S, Pinchera A, et al. Identification of thyroglobulin in orbital tissues of patients with thyroid-associated ophthalmopathy. Thyroid. 2001. 11:177–185.
5. Lisi S, Marinò M, Pinchera A, et al. Thyroglobulin in orbital tissues from patients with thyroid-associated ophthalmopathy: predominant localization in fibroadipose tissue. Thyroid. 2002. 12:351–360.
6. Khoo DH, Ho SC, Seah LL, et al. The combination of absent thyroid peroxidase antibodies and high thyroid-stimulating immunoglobulin levels in Graves' disease identifies a Group at markedly increased risk of ophthalmopathy. Thyroid. 1999. 9:1175–1180.
7. Gerding MN, van der Meer JW, Broenink M, et al. Association of thyrotrophin receptor antibodies with the clinical features of Graves' ophthalmopathy. Clin Endocrinol. 2000. 52:267–271.
8. Konishi J, Herman MM, Kriss JP. Binding of thyroglobulin and thyroglobulin-antithyroglobulin immune complex to extraocular muscle membrane. Endocrinology. 1974. 95:434–446.
9. Rhim WI, Choi SS, Lew H, Yun YS. Correlation between the thyroid associated ophthalmopathy and thyroid function state. J Korean Ophthalmol Soc. 2002. 43:431–436.
10. Southgate K, Creagh F, Teece M, et al. A receptor assay for the measurement of TSH receptor antibodies in unextracted serum. Clin Endocrinol. 1984. 20:539–548.
11. Dolman PJ, Rootman J. VISA Classification for Graves orbitopathy. Ophthal Plast Reconstr Surg. 2006. 22:319–324.
12. Woo KI, Kim YD, Lee SY, et al. The Clinical Characteristics of Thyroid Orbitopathy in Thyroid Dysfunction Patients in Korea. J Korean Ophthalmol Soc. 2008. 49:1387–1396.
13. Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clin Endocrinol (Oxf). 1997. 47:9–14.
14. Park JM, Ahn HB, Lee JH. The clinical features and the change of extraocular muscle at the first visit in hyperthyroidism patients. J Korean Ophthalmol Soc. 2003. 44:2197–2203.
15. Rhee KC. The clinical study on Graves' ophthalmopathy. J Korean Ophthalmol Soc. 1996. 40:2923–2927.
16. Bartley GB, Fatourechi V, Kadrmas EF, et al. Clinical features of Graves' ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996. 121:284–290.
17. Gupta MK. Thyrotropin receptor antibodies: advances and importance of detection techniques in thyroid diseases. Clin Biochem. 1992. 25:193–199.
18. Orgiazzi J. Anti-TSH receptor antibodies in clinical practice. Endocrinol Metab Clin North Am. 2000. 29:339–355.
19. Lissak B, Tazartes M, Heron E, Feldman S. Thyroid orbital pathologies in ophthalmological settings. Presse Med. 2002. 31:64–68.
20. Goh SY, Ho SV, Seah LL, et al. Thyroid autoantibody profiles in ophthalmic dominant and thyroid dominant Graves' disease differ and suggest ophthalmopathy is a multiantigenic disease. Clin Endocrinol (Oxf). 2004. 60:600–607.
21. Eckstein AK, Plicht M, Lax H, et al. Clinical results of anti-inflammatory therapy in Graves' ophthalmopathy and association with thyroidal autoantibodies. Clin Endocrinol (Oxf). 2004. 61:612–618.
XML Download