TSH receptor antibodies in Graves' disease
The role of TSH receptor antibodies (TRAbs) in the pathogenesis of
Graves' disease has been recognized for several decades. However, the
practical application of TRAbs in clinical settings is less clear. Whilst
the diagnosis of Graves' disease can be made with sufficient certainty
based on clinical features in most patients with the condition, the
TRAb test can be useful when pathognomonic features are lacking and in
ambiguous clinical scenarios such as euthyroid ophthalmopathy, unilateral
exophthalmos, painless thyroiditis, subclinical hyperthyroidism,
thyrotoxicosis associated with hyperemesis gravidarum and amiodarone-
induced thyrotoxicosis . TRAb titres can also help to distinguish
thyrotoxicosis due to Graves' disease from that caused by toxic
multinodular goitres in areas with high background prevalence of nodular
thyroid disease due to low iodine intake . They are of particular value
in assessing the risk of neonatal thyroid dysfunction from transplacental
migration of antibodies in pregnant women with a history of Graves'
disease . Cost effectiveness, reliability and availability have been
limiting factors in the uptake of the TRAb test in routine clinical
practice in previous years. With the development of automated third
generation assays with sensitivity of 99% and specificity of 99% , TRAb
tests are becoming more reliable, affordable and more widely available and
warrant more serious consideration in the management of patients with
David C. Matthews, medical student
Akheel A. Syed, consultant endocrinologist
The University of Manchester, Oxford Road, Manchester, M13 9PL,
Competing Interests: Nil
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Competing interests: No competing interests