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This version published online on July 11, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-2813
A more recent version of this article appeared on September 1, 2006
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Submitted on December 23, 2005
Accepted on June 29, 2006

TSH-receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease*

Anja K. Eckstein*, Marco Plicht, Hildegard Lax, Markus Neuhäuser, Klaus Mann, Sebastian Lederbogen, Christian Heckmann, Joachim Esser, and Nils G. Morgenthaler

Department of Ophthalmology; Institute for Medical Informatics, Biometry and Epidemiology; Department of Medicine, Division of Endocrinology and, University of Essen, Germany; Private Praxis Endocrinology Essen and Wupperthal, Germany; Institut für Experimentelle Endokrinologie und Endokrinologisches Forschungszentrum EnForCé, Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany

* To whom correspondence should be addressed. E-mail: anja.eckstein{at}uni-essen.de.

Objective: To examine if TSH-receptor autoantibody (TBII) levels are associated to the severity of Graves’ ophthalmopathy (GO) over the entire course of the disease.

Methods and patients: 159 patients with GO were followed for 12-24 months. One year after first symptoms of GO, all patients were classified into mild or severe GO according to their clinical manifestations. TBII were measured every 3 months after onset of GO. ROC plot analysis was performed to assess the power to discriminate both patient groups by TBII (specificity > 90%).

Results: TBII levels and prevalence at each time point during follow up were significantly higher in patients with severe course of GO compared with patients with mild course of GO. Prognostic statements on the course of the disease were possible for about half of the GO patients at all time points (except first). If at first presentation and at consecutive time points TBII levels were <5.7, 2.6, 1.5, 1.5, 1.5 and 1.5 IU/L, the patients had a 2.3 to 15.6 fold higher chance of a mild course. If 5-8 months after GO onset and at consecutive time points TBII levels were above 8.8, 5.1, 4.8, 2.8, and 2.8 IU/L, the patients had a 8.7 to 31.1 fold higher risk of a severe course. This relationship of TBII to the severity was independent from age and smoking.

Conclusion: Follow up measurements of TBII allow in half of the patients assessment of the prognosis of GO and could be therefore of additional help for the disease management.
Key words: TSH-receptor-antibodies • Graves’ ophthalmopathy • prognosis




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