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ANTI–TSH RECEPTOR ANTIBODIES IN CLINICAL PRACTICE

2000; Elsevier BV; Volume: 29; Issue: 2 Linguagem: Inglês

10.1016/s0889-8529(05)70135-3

1558-4410

Jacques Orgiazzi,

Adrenal Hormones and Disorders

Autoimmune thyroid diseases are the more prevalent organ-specific autoimmune disorders in humans. They encompass a wide spectrum of clinical presentations, with hyperthyroid Graves' disease at one end and atrophic myxedema at the other. Whether Graves' disease and lymphocytic thyroiditis represent different aspects of the same disease or different diseases remains unclear. Autoimmune thyroid diseases share common immunologic markers—mononuclear cell infiltration of the thyroid—and circulating antithyroid antibodies, the specificities of which might, in part, account for the diversity of these diseases. Autoantibodies against the thyroid-stimulating hormone receptor (TSH receptor antibodies, [TSHR-Ab]) represent only one family of thyroid autoantibodies. Others include antithyroperoxidase (TPO-Ab), the former antithyroid microsomal antibodies, antithyroglobulin, and the recently identified anti–sodium/iodide symporter antibodies. Historically, TSHR-Ab have been associated with hyperthyroid Graves' disease.90 Indeed, contrary to the other antithyroid antibodies, TSHR-Ab are pathogenic, capable of activating or blocking TSH receptor functions, as demonstrated by the occurrence of transplacentally transmitted hyperthyroidism or hypothyroidism in the fetus of mothers with high enough levels of circulating stimulating or blocking TSHR-Ab.Pathogenic antibodies could be viewed as the ideal marker for the diagnosis and management of the corresponding autoimmune disease. The various conditions discussed in this article that could benefit from the assay of TSHR-Ab include the following: Graves' disease TSHR-Ab at diagnosis of hyperthyroid Graves' disease Diagnostic valueSeverity markerAn aid to the choice of treatmentTSHR-Ab and the management of antithyroid drug (ATD) treatmentTSHR-Ab and ablative treatments Radioiodine treatmentSurgical treatmentSpecial conditions Graves' disease and pregnancyGraves' disease in children and adolescentsExtrathyroidal manifestations of Graves' diseaseGraves' disease and thyroid carcinomaAutoimmune hypothyroidism Prevalence of TSHR-Ab in autoimmune thyroiditisClinical usefulness of TSHR-Ab assays Transient transplacental neonatal hypothyroidismSpontaneous remission from autoimmune hypothyroidismAtypical thyroid autoimmune patterns Fluctuating thyroid functionHypothyroid Graves' diseasePainless thyroiditisOther conditions Iatrogenic thyroid disordersSubacute thyroiditisThyroid irradiation for toxic or nontoxic nodular goiterDepending on the clinical setting, the determination of either stimulating or blocking TSHR-Ab is discussed. The presence of TSHR-Ab is the hallmark of Graves' disease. Nevertheless, TSHR-Ab may be detected in other conditions, indicating the possible association of Graves' disease with other thyroid diseases.