Thyrotropin Receptor Antibodies-An Overview

Ophthalmic Plastic and Reconstructive Surgery
Anupam Kotwal, Marius Stan

Abstract

Thyroid autoimmunity affects approximately 5% of the population, and its investigation relies heavily on the use of autoantibodies. Thyroid stimulating hormone receptor (TSHR) autoantibodies (TRAb) play a central role in the evaluation of Graves disease (GD), Graves ophthalmopathy (GO) and pretibial myxedema (PTM). However, there is still controversy regarding overall TRAb assay diagnostic accuracy and their prognostic utility. We reviewed and analyzed the literature reporting TRAb assays and their clinical utility. Current assays measure the overall TRAb titer in a competitive manner (TSH binding inhibiting immunoglobulin assay) or biologic activity of the stimulating TSHR autoantibodies (thyroid stimulating immunoglobulin assay). Both types of assays have improved over time with advances in sensitivity and specificity. TRAb are particularly relevant in hyperthyroidism cases where use of iodinated contrast is not an option (e.g., pregnancy or recent use of iodinated contrast) or in cases of euthyroid eye disease, suspicious for GO. Third generation TRAb assays are useful for therapy selection in GD, prognostic predictions in GO and risk prediction for fetal and neonatal thyrotoxicosis. Given the pathogenic role of TRAb, we exp...Continue Reading

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Citations

Apr 12, 2019·Thyroid : Official Journal of the American Thyroid Association·So Young HanJin Sook Yoon
Sep 13, 2019·Endocrine Reviews·Masaaki YamamotoYutaka Takahashi
Feb 13, 2019·The Journal of Clinical Endocrinology and Metabolism·George J KahalyTanja Diana
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Feb 29, 2020·Best Practice & Research. Clinical Endocrinology & Metabolism·Alessandro AntonelliPoupak Fallahi
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