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Horm Metab Res 2021; 53(07): 435-443
DOI: 10.1055/a-1525-2070
Endocrine Care

Predicting the Course of Graves’ Orbitopathy Using Serially Measured TSH-Receptor Autoantibodies by Automated Binding Immunoassays and the Functional Bioassay

Mareile Stöhr
1   Department of Ophthalmology, University Hospital Essen, Essen, Germany
,
Michael Oeverhaus
1   Department of Ophthalmology, University Hospital Essen, Essen, Germany
,
Simon D. Lytton
2   SeraDiaLogistics, Munich, Germany
,
Mareike Horstmann
1   Department of Ophthalmology, University Hospital Essen, Essen, Germany
,
Denise Zwanziger
3   Department of Endocrinology, Diabetes and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
,
Lars Möller
3   Department of Endocrinology, Diabetes and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
,
Achim Stark
4   Practice for General Medicine, Essen, Germany
,
Dagmar Führer-Sakel
3   Department of Endocrinology, Diabetes and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
,
Nikolaos Bechrakis
1   Department of Ophthalmology, University Hospital Essen, Essen, Germany
,
Utta Berchner-Pfannschmidt
3   Department of Endocrinology, Diabetes and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
,
J. Paul Banga
5   Emeritus, King’s College London, London, UK
,
Svenja Philipp‡
3   Department of Endocrinology, Diabetes and Metabolism, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany
,
Anja Eckstein‡
1   Department of Ophthalmology, University Hospital Essen, Essen, Germany
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Abstract

The aim of the study was to investigate the use of serial measurements of TSH-receptor autoantibodies (TRAb) with the newest available assay technology to predict the course of Graves’ Orbitopathy (GO) during the first 24 months from disease onset. Serial serum samples from patients with GO (103 mild/135 severe) were collected between 2007 and 2017 and retrospectively analyzed. The course of GO were classified into mild/severe 12 months after manifestation (severe: NOSPECS≥5; mild<5). TRAb were measured with automated binding immunoassays (IU/l): TRAb Elecsys (Cobas, Roche), TRAb bridge assay (IMMULITE, Siemens), and a cell-based bioassay (percent of specimen to reference ratio - SRR%) (Thyretain, Quidel). Variable cut off levels of measured TRAb were calculated at specificity of 90% from receiver operator curve (ROC) analysis for several timepoints during the course of GO. To select one: 5–8 months after first GO symptoms, which is the timepoint for usual referals for treatment mild course could be predicted at cut offs of 1.5 IU/l (Elecsys), 0.8 IU/l (Immulite) and 402% SRR (Thyretain) and the risc of severe course has to be anticipated if TRAb are above 11.6 IU/l (Elecsys), 6.5 IU/l (Thyretain), and 714% SRR (Thyretain). The Thyretain bioassay showed the highest diagnostic sensitivity (using the commercial cut off’s) over the entire follow up period. TRAb measurements during the 24-month follow up of GO provide added value to the GO clinical activity and severity scores and should be used especially in the event of an unclear decision-taking situation with regard to therapy.

Key words

Graves’ orbitopathy - TSH-receptor antibodies - functional antibodies - binding assays - bioassays


Publication History

Received: 12 April 2021

Accepted after revision: 01 June 2021

Article published online:
19 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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