Significance of Thyroid Stimulating Immunoglobulin and Thyrotropin Receptor Antibody in Graves' Disease

Rongguang Peng; Pu Xie; Zhou Jin; Wenzhong Zhou; Yanqiu Wang; Xinxin Chen; Qinglei Yin; Liyun Shen; Lingyang Meng; Lei Ye; Yulin Zhou; Shu Wang

doi:10.1210/clinem/dgae892

Significance of Thyroid Stimulating Immunoglobulin and Thyrotropin Receptor Antibody in Graves' Disease

J Clin Endocrinol Metab. 2024 Dec 23:dgae892. doi: 10.1210/clinem/dgae892. Online ahead of print.

Authors

Rongguang Peng^{1

2}, Pu Xie^{1

2}, Zhou Jin^{1

2}, Wenzhong Zhou^{1

2}, Yanqiu Wang^{1

2}, Xinxin Chen^{1

2}, Qinglei Yin^{1

2}, Liyun Shen^{1

2}, Lingyang Meng^{1

2}, Lei Ye^{1

2}, Yulin Zhou^{1

2}, Shu Wang^{1

2}

Affiliations

¹ Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

PMID: 39715350
DOI: 10.1210/clinem/dgae892

Abstract

Context: Thyroid stimulating immunoglobulin (TSI) and thyrotropin receptor antibody (TRAb) are specific biomarkers for Graves' disease (GD), but their clinical characteristics are not fully understood.

Objectives: To clarify the clinical features and prognostic significance of TSI and TRAb in patients with GD.

Design: A retrospective data analysis and a follow-up study.

Methods: Medical records of patients newly diagnosed with GD were examined. TSI and TRAb correlations were assessed using Passing-Bablok regression and Bland-Altman plot. Patients were categorized into unresolved (Group A) and resolved (Group B) hyperthyroidism based on thyroid function after one month of therapy. The relationship between thyroid function and changes in TRAb and TSI was analyzed. Logistic regression identified relapse risk factors, including TSI levels at antithyroid drugs (ATDs) withdrawal in the follow-up study.

Results: Data from 957 patients (762 female and 195 male) revealed a strong correlation between TRAb and TSI (r=0.873, p < 0.001). Compared to group B, group A showed minimal antibody decline [100% (interquartile range (IQR) 87.91%-115.1%) and 100% (IQR 85.03%-118.3%), respectively]. Among 206 patients followed for over 12 months after ATD discontinuation, the relapse rate was 41.26%. Relapse was more frequent in patients with positive TSI (54.84% vs. 35.42%, p < 0.05). Positive TSI levels at withdrawal, past history of GD, age and mild thyroid-associated ophthalmopathy were independent relapse predictors.

Conclusions: TSI and TRAb are strongly correlated in GD, with slow antibody decline linked to unresolved hyperthyroidism. Discontinuing ATDs may be considered when both TSI and TRAb are negative.

Keywords: Graves’ disease; Prognosis; Thyroid stimulating immunoglobulin (TSI); Thyrotoxicosis; Thyrotropin receptor antibody (TRAb).

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