POSITIVE THYROTROPIN RECEPTOR ANTIBODIES IN PATIENTS WITH TRANSIENT THYROTOXICOSIS.

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  • Author(s): Angell TE; Van Benschoten O; Cohen DA; Haas AV; Alexander EK; Marqusee E
  • Source:
    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists [Endocr Pract] 2018 Jun; Vol. 24 (6), pp. 512-516. Date of Electronic Publication: 2018 Apr 06.
  • Publication Type:
    Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Elsevier Inc Country of Publication: United States NLM ID: 9607439 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1530-891X (Print) Linking ISSN: 1530891X NLM ISO Abbreviation: Endocr Pract Subsets: MEDLINE
    • Publication Information:
      Publication: 2021- : [New York] : Elsevier Inc.
      Original Publication: Jacksonville, Fla. : The College and the Association,
    • Subject Terms:
      Autoantibodies/*blood ; Graves Disease/*diagnosis ; Receptors, Thyrotropin/*immunology ; Thyrotoxicosis/*immunology; Adult ; Female ; Humans ; Immunoglobulins, Thyroid-Stimulating/blood ; Male ; Middle Aged
    • Abstract:
      Objective: Thyrotropin (TSH) receptor antibody (TRAb) testing is considered accurate for the diagnosis of Graves disease (GD) and has been identified rarely in thyrotoxic patients without GD. We describe 4 patients with transient thyrotoxicosis and positive TRAb to highlight this clinical possibility.
      Methods: Patient demographics, symptoms, laboratory findings, and time to resolution of thyrotoxicosis are summarized. TRAb testing was performed by either a third-generation thyrotropin-binding inhibitory immunoglobulin (TBII) competitive-binding assay or a thyroid-stimulating immunoglobulin (TSI) bioassay from either Mayo Clinic Laboratory or Quest Diagnostics.
      Results: Four patients with transient thyrotoxicosis and positive TRAb testing were identified. Of these, three were female, and the median age was 44 years (range, 25 to 49 years). Median symptom duration at evaluation was 6.5 weeks (range, 3 to 12 weeks). No patient had any clinical manifestations unique to GD or exposure to biotin, thyroid hormone, supplements, iodine, or relevant medications. The TSH was <0.1 mIU/L in all patients. Three patients had a positive TSI, which was elevated less than twice the upper limit of the reference range in all cases, and 1 patient had a strongly positive TBII. None of the patients were treated with thionamides or radioactive iodine. Spontaneous resolution occurred in all patients at a median of 5.5 weeks (range, 2 to 14.4 weeks).
      Conclusion: These cases demonstrate that TSI or TBII may be present in thyrotoxic patients with transient thyrotoxicosis. For clinically stable patients presenting without pathognomonic evidence of GD, mildly elevated TRAb results may require cautious interpretation, and alterative diagnostic testing or close monitoring should be considered.
      Abbreviations: cAMP = cyclic adenosine monophosphate; FT4 = free thyroxine; GD = Graves disease; TBII = thyrotropin-binding inhibitory immunoglobulin (also known as TBI); TRAb = thyrotropin receptor antibody; TSH = thyrotropin; TSHR = thyrotropin receptor; TSI = thyroid-stimulating immunoglobulin; TT3 = total triiodothyronine; TT4 = total thyroxine.
    • Accession Number:
      0 (Autoantibodies)
      0 (Immunoglobulins, Thyroid-Stimulating)
      0 (Receptors, Thyrotropin)
      0 (thyrotropin-binding inhibitory immunoglobulin)
    • Publication Date:
      Date Created: 20180407 Date Completed: 20180823 Latest Revision: 20210204
    • Publication Date:
      20250114
    • Accession Number:
      10.4158/EP-2018-0059
    • Accession Number:
      29624097